Carol Murtaugh, RN, OCN: Managing a Community Oncology Practice
The Group Room sits down with Carol Murtaugh, RN, OCN at the 2012 Community Oncology Alliance (COA) Annual Meeting. Carol is an oncology nurse, turned practice administrator. She gives us a look into the reality of running a community oncology practice in today’s health care environment, and the realities patients and caregivers should be aware of as they embark on their cancer care journey.
The Group Room interviews at the Community Oncology Alliance (COA) 2012 annual meeting in Las Vegas was made possible by the generous support of our members.
VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International
This is Selma Schimmel for The Group Room in Las Vegas at the Community Oncology Alliance meeting. Joined now by Carol Murtaugh, who is an Oncology Nurse Administrator at the Hematology and Oncology Consultant Practice in Omaha, Nebraska. Hello, Carol.
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
Hi, how are you?
Selma Schimmel, Founder & CEO, Vital Options International
How are you?
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
Good.
Selma Schimmel, Founder & CEO, Vital Options International
We’re going to talk about some of the challenges in administering the community oncology practice. And you have a very interesting role, because you understand the dynamics both as an oncology nurse, also as an administrator. So you have to have your eye on two balls. So, talk to us really about what an oncology nurse administrator does.
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
I’ve been with the practice for quite a long time and I came up from the nursing side, so working with patients, administering chemo and doing phone triage and working with the physicians, and had a large interest in the business side of the practice and started learning more and more about the reimbursement side from a patient perspective and working with patients for patient assistance.
So, about three years ago our practice administrator decided to make a change in her role and the doctors asked me to take over the practice manager role. So, now I manage the practice, but in addition to that, continue to manage the clinical side of the practice as well- so, the nurses, the lab, and the clinical function also, in addition to the reimbursement piece.
Selma Schimmel, Founder & CEO, Vital Options International
As an oncology nurse that originally focused really just on the clinical side and solely to the patient, what was it like to now understand the dynamics of a practice also from the administrative side?
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
It was a gradual adjustment for me because I had started working more in a patient advocacy role when I was still doing clinical nursing, so it was a gradual adjustment. As I learned more and more about the changes in oncology reimbursement and some of the challenges that we’ve seen in the practice with more prior authorizations from insurance companies, less payment from Medicare, some of those types of things, I took a real interest in making sure that we could maintain a viable practice so we could continue to treat patients in the practice, from a reimbursement perspective.
Selma Schimmel, Founder & CEO, Vital Options International
One of the things that became so clearly understood with my discussion with your colleagues that were interviewed here today is that the public may not readily understand how much risk the physicians take since they have to advance all the costs for these therapies, which is not what you think about when you go in for treatment – you’re thinking, ‘will my insurance ultimately pay for it?’ – and it’s so easy to lose sight that the only way you can get your therapy is if someone advances the medication to give it to you.
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
For example, it’s interesting you would bring that up because I had one of my nurses come to me yesterday, as a matter of fact, as I was in my office. She wanted to let me know that one of our physicians has decided to start a patient on a new therapy, a drug that has recently been approved by the FDA and that when she called to order that drug the bill was going to be $18,000. And so, she felt that that was strong enough that she would come and let me know that because she knew that that was a significant amount of money, obviously, to the practice.
So, part of our challenge, I guess, as a practice administrator, is to make sure that we’re taking as good care of the patients as we can but obviously still keeping the practice viable and making sure that the patients get all the benefits they can from either their insurers, or co-pay assistance foundations, or those type of organizations.
Selma Schimmel, Founder & CEO, Vital Options International
What does a practice do if the acquisition of one compound is $18,000?
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
You know, it’s definitely a challenge. The first thing that we do in our practice for every new treatment or every change in treatment for a patient is, we make sure that we check with that patient’s insurance company to make sure that the patient will have coverage for that drug. If there isn’t coverage or the patient doesn’t have insurance then we go to the drug companies, there are co-pay foundations, and try to exhaust all the resources we can to make sure that that drug will be covered.
Selma Schimmel, Founder & CEO, Vital Options International
You see, that is the other thing I think is so important for other people to understand is how much behind the scenes work goes on to obtain drugs, to approvals to, approvals for imaging, all of that, and it is not only a challenge but it is very time consuming for the doctor’s office.
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
Yes, and in fact we just got a new list today from one of our payers with, effective April 1st, they’ll be requiring more prior authorizations on many more drugs that we administer and more imaging tests as well. And in our practice it’s not just a clerical person or a billing person that gets involved, because in many cases, they want clinical information; so that has to involve a nurse’s time, and in some cases, even a doctor’s time to help make sure that those treatments are covered. And it just changes the whole function of the staff and a practice with that additional time commitment.
Selma Schimmel, Founder & CEO, Vital Options International
What are some of your goals and your own vision with some of the changes that are now coming rather rapidly to the situation that practices, not only yours but others, are going to be facing?
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
From our perspective, the area that I’m in, we have many roll-locations and we need to watch those locations very closely because they have a high Medicare population. So we want to make sure that we’re able to keep those practices open because we know many of those patients wouldn’t be able to drive the distance to our primary site. In some cases, we’d ask patients to drive two hours for care if we weren’t able to maintain that location. So, from a practice perspective, we want to make sure that we’re doing everything we can with some of our organizations.
You know, one of the reasons I got involved with COA was because I wanted to make sure that we’re trying to keep community oncology a good, viable option for treatment, because that’s where patients get the best care in the country.
Selma Schimmel, Founder & CEO, Vital Options International
And you’ve also helped to clarify something because perhaps it’s very easy for people to think, when of doctors closing their practices, that it’s a ‘greed’ thing, you know. They’re not making enough money and whatever, that he closed his practice or she closed her practice; but in reality, it’s not that at all. And the reimbursement thing- it’s so easy for people to perceive reimbursement as the doctors getting wealthy without that very important distinction that no, it’s the cost of running a practice and an oncology practice is really expensive to run.
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
Especially when I look at my list of drugs that I purchase for patients and for the Medicare reimbursement, at the level that it is now, I have almost 40% of the drugs I buy that I don’t get reimbursed that amount from Medicare. So that’s why I say it’s so important for me to track what our Medicare population is and what location and how those clinics are doing because we have to be able to keep our doors open.
Selma Schimmel, Founder & CEO, Vital Options International
Not to… about what your practice costs, but would you, for the sake of our viewers, give a range of what could it on average cost, let’s say a 3-6-doctor practice to operate in this climate?
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
Just drug costs alone, for a probably 4-6 physician practice would be anywhere between probably a million to a little over that a month and that’s only drug costs. So then the staff, remember, in those offices are highly trained RNs, many practices employ pharmacists, there are lab personnel, there are physicians and in addition to that, usually nurse practitioners or physician’s assistants. So, when you add on top of that all the staff costs and overhead it’s multimillion dollars a month.
Selma Schimmel, Founder & CEO, Vital Options International
What are your final thoughts to your oncology nurse friends and colleagues as well as other interested parties in oncology? What do you want them to know as someone who is an administrator of an oncology practice?
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
I think, something that changed for me coming from the clinical side is, when I tried very hard as a nurse to just take care of my patients and shelter them from all the other financial pieces and all of those things initially – and I think that was very common for practices 5-6 years ago, and there are some practices that still find it very difficult to have those conversations with patients – but even though my allegiance is to my patients first and foremost I think we don’t do patients a service by not talking to them about the financial piece.
Because, even though you are a patient and you’ve been diagnosed with a disease and that is very difficult to take and you’re dealing with all those pieces, it’s not fair to a patient to then have that patient all of the sudden be either sent a bill for a huge amount of money they weren’t expecting or find out that their insurance isn’t covering their care that they thought they would, and those are conversations I think everyone needs to have with their patients now and I help patients understand this is a crisis. This is an issue where there are patients that can’t be taken care of in their private practice setting any longer because of the financial reimbursement and the burden that it’s placed on practices.
So, while it’s so important for the patient to get all the clinical pieces that they need for their care, it’s important that they understand the financial piece now too.
Selma Schimmel, Founder & CEO, Vital Options International
I agree with you, and I think that it is the one way that we will begin to foster that sense of ‘what can I do, and how do I raise my voice, and how can I be more involved in the issues of patient advocacy?’ Because the partnership between patients and doctors, oncology nurses, and the entire oncology professional team really needs to be cohesive now.
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
We have to all come together as a team now, you know. We have to all start the dialogue and make sure that everybody is on the same page so we can continue to deliver the high quality care that we have in the past.
Selma Schimmel, Founder & CEO, Vital Options International
Thank you, Carol. Carol Murtaugh- Oncology Nurse and Administrator of Hematology and Oncology Consultants in Omaha, Nebraska. Very interesting dual situation that you work in. Thank you for sharing your insight and experience with us.
Carol Murtaugh, RN, OCN, Practice Administrator, Hem-Onc. Consultants, Omaha, Nebraska
Thank you.
END OF VIDEO