Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center in Zion, IL, recently announced the addition of the TomoTherapy HI-ART System to their radiation department. TomoTherapy is the most advanced radiation delivery system available, providing precise delivery to tumor sites while minimizing damage to healthy tissue. Unlike current radiation therapies, the integrated system does not require patient transfer, containing all patient information in a central unit to minimize errors.

Before each treatment, the system takes Verification/Registration Computed Tomography (VRCT) images of the tumor site to verify its exact size, shape and location. During treatment, the radiation beam rotates 360° while the patient enters the system in a reclined position. The rotating beam allows for accurately shaped radiation as prescribed by the physician, successfully treating both large tumors and multiple sites simultaneously. Traditional therapies projected radiation onto the tumor from a few different directions.

"This is an exciting new advancement in radiation therapy that will reduce exposure of healthy tissue to unnecessary radiation, allowing us to improve treatment for all of our patients," says Bernard Eden, M.D., Medical Director of Radiation Oncology at CTCA. "Patients who would otherwise be untreatable because they have reached their maximum tolerance dose with traditional radiation or have tumors in sensitive areas may be able to receive additional radiation treatments. Additionally, all patients may experience reduced treatment side effects."

Construction is currently underway on a radiation vault for the TomoTherapy System.

Susan W’s mom was being discharged from the hospital on Tuesday. A loving daughter but also a busy executive, Susan knew mom shouldn’t be left alone at home – but Susan’s schedule meant she couldn’t be there with mom. Desperate, Susan asked her mom’s doctor for a referral. He directed Susan to the hospital discharge planning department where they gave her "the list" – a long list in neat alphabetical order. "Which one do you think I should call"?", asked Susan. "Oh we can’t tell you that." , the discharge planner informed her. "You’ll have to make your own decisions."

Feeling somewhat as if her car mechanic had left the choice of timing gears up to her, Susan began wading through "the list" the discharge planner had given her. What questions should she ask these companies? What were the right answers? How would she be able to tell a good agency from a bad one? What about all those horror stories she’d read involving caregivers taking advantage of their elderly clients?

Susan’s anxiety heightened. She was a bright, successful professional – but in the marketing field! What did she know about home care? How could she possibly make an informed decision?

How many Susans do we encounter in our professional lives? Why do we feel perfectly justified in hiding behind "the list"? Although the selection of a home care company will ultimately be the client’s choice, we have a clear responsibility to ensure our clients and their families are making informed decisions. By simply handing out a list to our patients, we are ignoring our professional responsibility.

The 2 Biggest Excuses
1. "…but we have to give out everyone’s name by law. It’s our policy."
This is a gross misinterpretation of the Medicare ruling that requires professionals to make unbiased referrals. Fist of all, this ruling applies only to Medicare certified providers. (Does your list specify which agencies are Medicare certified?) Secondly, even for Medicare providers, the intent was to prevent self referral and/or inappropriate financial gain. It was not intended to leave consumers floundering while seeing information. This ubiquitous excuse has become the lazy man’s way of avoiding any work involved in compiling the list. Skilled agencies are haphazardly mixed with registries, nurse agencies, employment agencies, DME companies and anyone else who has found their way onto that "list".

2. "…but we don’t have time to research each company."
It’s true we don’t. But thank heaven we don’t have to. We can certainly indicate which companies are accredited. We can place companies on the list into appropriate categories with an explanation about what each category means. We can indicate the differences between a registry and a home care company. We can explain what ‘licensed and bonded’ actually means. In fact, are we as professionals even clear on the differences? We can and should educate ourselves first!

What Are the Differences?
Briefly, the basic differences are as follows:

Medicare Agencies: These agencies provide 2 or more skilled services on an intermittent basis as ordered by a physician. Services must meet the definition of "medically necessary" in order to be covered by medicare or by insurance companies.

Licensed Private Duty: These type of agencies provide skilled nursing services but are not covered by Medicare. Most of the requirements that apply to Medicare agencies in IL also apply to Licensed Private Duty companies.

Personal Care and Support: The vast majority of home care companies are either personal care and support companies or registries. (See next category.) Personal care companies provide a broad range of custodial services such as personal care, medication reminders, housekeeping, meal preparation and other such services most often described as "activities of daily living". There is no license available or required. A reputable Personal Care and Support Services company will be accredited by an accrediting body such as the Joint Commission.

Registries: These agencies are licensed as employment agencies. They are not home care companies and do not employ their own caregivers. The client – not the agency – is the employer. All liability rests with the client. The term "licensed and bonded" refers only to the agency, not the caregiver.

What Should A List Include?
Briefly, home care companies should be listed by category with appropriately accredited companies leading the list. Accreditation agencies like the Joint Commission are there to perform the quality checks for consumers. Agencies who have undergone and achieved such a "quality standard" should be so indicated on any professional list. Alphabetical order of the non-accredited companies should follow in each category. An explanation of the categories should be included. If possible, a checklist indicating which type of service is most appropriate for specific patients can also be included.

Summary
As patient advocates and professional resources, by distributing the ubiquitous "list", we may be exposing our patients to major risks and liabilities. As professionals, we have a clear obligation to assist our clients in ensuring their health and safety by guiding them through the confusing maze that is home care.

Conclusion
Let’s take another look at Susan – this time the discharge planner hands Susan a list with home care resources listed by category and accredited companies clearly marked. Explanations of each category and appropriate questions to ask are included. As Susan scans the list she sees that a registry may be more affordable for mom but she feels mom’s safety and security are a bigger concern. For this she needs a home care company that screens and supervises their staff. Moving to that category, Susan notes that 2 accredited agencies are at the top of the list. She calls each company following the guide questions provided. When Susan makes her selection she feels comfortable and secure that she’s made the right decision and sends a silent thank you to the discharge planner who gave her this list!

Tim Ostrowski has been appointed as Vice President, Corporate Services and Resource Utilization for Alexian Brothers Medical Center and Alexian Brothers Hospital Network.

Ostrowski has a wealth of experience in strategic planning, organizational efficiency, supply chain management, information systems and financial analysis. His most recent position was as Chief Financial Officer for Verizon Public Communications Group, Silver Spring, MD. He has also held key executive financial planning and strategic and operational roles at Verizon and Zenith. He has also served for more than 10 years in various roles on the ABMC Board, including as chairperson of the Board of Trustees and as a member of the ABHS Finance Committee.

Ostrowski earned a bachelor of science in Finance and his master's of business administration with an emphasis in Marketing, both from Northern Illinois University, DeKalb.