eP612 - Financial Sustainability of a Hereditary Colorectal Cancer Registry

ePoster Presenter(s)

• 

  Joseph Lin, MD

  Fellow
  Cleveland Clinic Foundation, OH
  Cleveland Clinic
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• LL

  Lisa A. Laguardia, RN, BSN

  Clinical Research Nurse Coordinator
  Cleveland Clinic Cleveland, Oh
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• MO

  Margaret O'Malley, BS

  Research Coordinator
  Cleveland Clinic - Cleveland, OH
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• DB

  David Braunstein, MPHTM

  Clinical Research Coordinator
  Cleveland Clinic Foundation
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• AV

  Ana Vazquez Villasenor, MS, BS

  Clinical Research Coordinator
  Cleveland Clinic Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• SM

  Sarah McGee, MS, CGC

  Genetic Counselor
  Cleveland Clinic Foundation
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• CM

  Carole Macaron, MD

  Staff gastroenterologist
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• CB

  Carol A. Burke, MD

  Gastroenterologist
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Scott Steele, MD MBA

  President, Chairman, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• AB

  Amit Bhatt, M.D

  advanced endoscopist
  Cleveland Clinic
  Pepper Pike, Ohio, United States

  Disclosure information not submitted.
• EG

  Emre Gorgun, MD, MBA

  Vice Chair, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• JS

  Joshua Sommovilla, MD

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  David Liska, MD

  Associate Professor of Surgery, Chair
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic, Cleveland, Ohio
  Cleveland, OH, United States

  Disclosure information not submitted.

Purpose/Background: Caring for patients and families with a hereditary colorectal cancer syndrome (HCCS) is a complex, multidisciplinary, and intensive endeavor. Clinical hereditary colorectal cancer registries (HCRs) that utilize clinical coordinators have been shown to improve outcomes by increasing adherence. Establishing and maintaining an HCR requires significant financial support and staffing. We hypothesized that a clinical coordinator-based HCR is financially sustainable, with productivity offsetting the costs of a coordinator.Methods/Interventions: We queried a single institution, prospective database of all newly enrolled patients enrolled in our HCR in 2015 with a confirmed germline pathogenic variant or who met clinical criteria for HCCS. We abstracted all billable encounters and associated charges over the subsequent 5 years. To maintain institutional compliance, billing charges are reported as multiples of the full-time equivalent (FTE) of salary and benefits for one nurse coordinator employed by the HCR.Results/Outcomes: 87 patients were included; 55 with a polyposis syndrome (47 with familial adenomatous polyposis) and 32 with Lynch syndrome. Twenty patients (23%) were lost to follow up, including 3 deaths. 2,431 billable encounters were completed, including 1,091 office visits, 425 endoscopic procedures, 127 surgeries, and 412 imaging studies. During the study period, total HCR charges were equivalent to 226.33 FTE, ranging from 22.30-57.13 FTE per year. Charges per enrolled patient averaged 2.60 for the study period, ranging from 0.26-0.66 FTE per year. Charges for digestive disease services (including colorectal/gastrointestinal surgery and gastroenterology) peaked in the first year of enrollment, generating a total of 35.61 FTE in 2015, tapering off to 7.75 by 2020 (Figure 1). However, charges for all other subspecialty services (oncology, endocrinology, dermatology, obstetrics/gynecology, and others) had a later peak of 36.55 in 2017 and a sustained level of 14.55 by 2020 (Figure 1).Conclusion/

Discussion: Patients enrolled in an HCR require intense treatment and surveillance, including many diagnostic and therapeutic interventions. Clinical productivity associated with an HCR can offset the costs of staffing the HCR with clinical coordinators. An important factor contributing to financial sustainability is diversification of care by providing comprehensive services. Demonstrating financial sustainability may make the HCR model more generalizable, although this study is limited by reporting billed charges instead of actual revenue and not including an analysis of overall costs incurred by the HCR over the study period.Figure 1: Annual charges for a cohort of hereditary colorectal cancer patients FTE, full time equivalent, equal to salary plus benefits of one clinical coordinator