Goshen Center for Cancer Care in Goshen, Ind. is a leading community-based oncology center. As the integrated cancer program for the Goshen Health System, Goshen Center has received numerous awards including Hematology & Oncology News’ HOPE award for the best example of integration of care at a medium-sized oncology practice and the Commission on Cancer of the American College of Surgeons' Outstanding Achievement Award, which is awarded to less than 7 percent of cancer hospitals in the United States. The cancer program also consistently receives high patient satisfaction scores, with scores above the 95th percentile from Press Ganey, and has superior clinical outcomes as judged by state and national clinical outcomes databases.
Goshen Center employs a multidisciplinary integrated model of care and focuses on not only meeting the physical needs of patients, but also their emotional and spiritual needs, says Doug Schwartzentruber, MD, medical director of Goshen Center. Here are five of the primary reasons why Goshen Center has found so much success.
1. All services under one roof
Goshen Center began just 10 years ago as a result of community need for quality care close to home. Hospital leaders determined that an integrated model would provide patients with the best care and that a holistic approach would be favored by community members. In 2001, Goshen Center moved into a new, dedicated facility adjacent to the hospital. The new location provided space for all outpatient cancer services to be located under one roof, while remaining close to the hospital.
Within the single, comprehensive facility, radiation oncologists, medical oncologists, urologic oncologists and surgical oncologists all see and treat patients. Additionally, the organization is home to a number of naturopathic oncologists, dieticians and counselors dedicated to treating cancer patients.
According to Dr. Schwartzentruber, these integrated services help Goshen Center to meet the needs of its patients. Patients who come to the organization for their medical services receive access to its integrated care programs, including appointments with naturopathic oncologists, dieticians and counselors, free of charge.
"Our focus in not only on curing or treating cancer but on healing the whole person. We offer healing to patients, and these integrated services are critical to that healing," he says.
These integrated services are also a necessary part of complete cancer care, according to naturopathic oncologist, Marcia Prenguber, ND, director of integrated care at Goshen Center. "It is critically important that patients have access to these [integrated] types of services," she says. "If we don't address these areas, we're just dealing with a disease, not a patient's health. Healthcare, as the term implies, must address the patient's overall health."
2. Multidisciplinary care
The cornerstone of the cancer center's integrated approach is its multidisciplinary approach to care, which is apparent beginning from the patient's first visit.
"When patients have their first appointment, they are set up to see the appropriate medical provider for them at that time, perhaps a surgeon or a radiation oncologist, and this initial meeting initiates a chain of events," says Dr. Prenguber. "After the medical provider determines what the treatment is going to be, patients meet with a number of other providers, including a naturopathic oncologist, dietician and counselor. Their work is then partially based on the patient's medical treatment."
These providers help to improve the patient's overall health. Naturopathic oncologists and dieticians work to ensure that the patient is adequately nourished and not taking any supplements that might inhibit treatment, while counselors treat the patient's emotional needs.
"It's very clear that patients want and need these types of services. Surveys have shown that 80 percent of cancer patients are taking supplements, but less than 40 percent tell their doctor," says Dr. Prenguber. "This isn't safe for the patient. Access to a provider that is well-educated in pharmacology and natural therapeutics and can educate the patient about which supplements to take is appreciated by the patient, enhances patient participation in their own care and improves patient outcomes."
Naturopathic physicians can also recommend supplements to reduce symptoms of other conditions, which cannot be treated with traditional medicine, such as hot flashes, when a patient is undergoing cancer treatment, according to Dr. Prenguber.
To promote multidisciplinary care after a patient's initial appointments, the center holds a number of weekly meetings among providers of all disciplines to discuss patient treatment. The meetings are organized according to cancer type, so that separate meetings occur for all patients with breast cancer, lung cancer, liver cancer, colon cancer and hematologic malignancies. The providers also hold an additional general meeting for patients with cancers that do not fall into these categories.
Each of the meetings is attended by Goshen Center's physicians and representatives from each of the integrated services as well as nurses, rehabilitation specialists and researchers. Each patient undergoing treatment at the organization is discussed in at least one meeting, and all new outpatients as well as all current inpatients are discussed on a weekly basis. The meetings ensure multiple perspectives from a variety of providers as well as ongoing monitoring, improvement and continuity of care between all the services that interface with any particular patient, says Dr. Schwartzentruber.
3. Salaried physicians
Goshen Center employs all of its cancer physicians, making the organization unique in this respect as most community cancer programs do not have all physicians salaried on staff, according to Dr. Schwartzentruber.
"Most other community programs feature physicians that are in private practice. They have busy offices to return to, and they depend upon seeing many patients for their livelihood," says Dr. Schwartzentruber. "A salaried model decreases that need to have a high output, and you're not rewarded for high output but rather for your participation in the overall integrated program."
The salaried model also fosters Goshen Center's multidisciplinary approach to cancer care. Private practice physicians generally have a financial disincentive to participate in meetings or events that are not compensated, such as the facilty's weekly multidisciplinary meetings, says Dr. Schwartzentruber. Salaried physicians have no financial loss while attending and are more fully available to participate in this type of program.
Salaried physicians also have less financial incentives or competition that might influence treatment plans. In a traditional cancer program model, treatment plans are often linked to where the point of care begins, according to Dr. Schwartzentruber. For example, a patient with prostate cancer may be more likely to pursue radiation over surgery if he presents first to a radiation oncologist, even if they could have been treated equally-well with either option.
"Discussing treatment in a multidisciplinary meeting among a number of physicians with no financial incentives is one of the biggest benefits of an integrated, salaried program," says Dr. Schwartzentruber. "Physicians in these meetings are prepared to justify their opinions while undergoing peer review. It helps us to determine which treatment options may be best for a particular patient, even though different approaches might be expected to have similar outcomes."
4. Commitment to research
Another focus of Goshen Center is research. The organization has an active clinical trial program. Recently it served as the coordinating organization for a multi-institutional clinical trial on the effects of a vaccine for treating patients with metastatic melanoma. The study produced positive results, with the vaccine more than doubling the response rate for tumor shrinkage in patients with metastatic melanoma. In addition to clinical trials, Goshen Center also participates in pre-clinical trial research though partnerships with Purdue University and the University of Notre Dame.
Of the nearly 90 employees employed by Goshen Center, five are dedicated to cancer research. Such a large commitment to research is unique for a community-based cancer program, says Dr. Schwartzentruber.
"Maintaining a research program, in addition to the other services we provide, takes a lot of effort and resources that are not normally reimbursed," says Dr. Schwartzentruber.
However, he says this commitment to research has brought ample recognition and continued success to the Center. "Patients are looking for information on which programs are innovative. We publish our available clinical trials online and maintain a very up-to-date Web site with these opportunities," he says.
5. Focus on transparency and outcomes tracking
A final area where Goshen Center separates itself from other community cancer programs is its commitment to transparency and outcomes tracking.
The organization participates in cancer registries through the Commission on Cancer and the American Society of Clinical Oncology, which allows the program to compare its clinical performance against other programs in the state and nation. Participation in these registries also allows providers to track the outcomes of various treatments for different cancers over time, which could improve future cancer care options.
Additionally, Goshen Center monitors its adherence to the National Comprehensive Cancer Network's guidelines, which adds another level of compliance to the organization's quality of care, according to Dr. Schwartzentruber.
Goshen Center publishes all of its quality measures and benchmarking data to its Web site and hopes that other cancer programs will eventually do the same.
"It is very difficult to find these measures for many other programs at this time, because the registries are fairly young," says Dr. Schwartzentruber. Having access to this quality and outcomes information is becoming more important to patients, he says.
Learn more about Goshen Center for Cancer Care.
Goshen Center employs a multidisciplinary integrated model of care and focuses on not only meeting the physical needs of patients, but also their emotional and spiritual needs, says Doug Schwartzentruber, MD, medical director of Goshen Center. Here are five of the primary reasons why Goshen Center has found so much success.
1. All services under one roof
Goshen Center began just 10 years ago as a result of community need for quality care close to home. Hospital leaders determined that an integrated model would provide patients with the best care and that a holistic approach would be favored by community members. In 2001, Goshen Center moved into a new, dedicated facility adjacent to the hospital. The new location provided space for all outpatient cancer services to be located under one roof, while remaining close to the hospital.
Within the single, comprehensive facility, radiation oncologists, medical oncologists, urologic oncologists and surgical oncologists all see and treat patients. Additionally, the organization is home to a number of naturopathic oncologists, dieticians and counselors dedicated to treating cancer patients.
According to Dr. Schwartzentruber, these integrated services help Goshen Center to meet the needs of its patients. Patients who come to the organization for their medical services receive access to its integrated care programs, including appointments with naturopathic oncologists, dieticians and counselors, free of charge.
"Our focus in not only on curing or treating cancer but on healing the whole person. We offer healing to patients, and these integrated services are critical to that healing," he says.
These integrated services are also a necessary part of complete cancer care, according to naturopathic oncologist, Marcia Prenguber, ND, director of integrated care at Goshen Center. "It is critically important that patients have access to these [integrated] types of services," she says. "If we don't address these areas, we're just dealing with a disease, not a patient's health. Healthcare, as the term implies, must address the patient's overall health."
2. Multidisciplinary care
The cornerstone of the cancer center's integrated approach is its multidisciplinary approach to care, which is apparent beginning from the patient's first visit.
"When patients have their first appointment, they are set up to see the appropriate medical provider for them at that time, perhaps a surgeon or a radiation oncologist, and this initial meeting initiates a chain of events," says Dr. Prenguber. "After the medical provider determines what the treatment is going to be, patients meet with a number of other providers, including a naturopathic oncologist, dietician and counselor. Their work is then partially based on the patient's medical treatment."
These providers help to improve the patient's overall health. Naturopathic oncologists and dieticians work to ensure that the patient is adequately nourished and not taking any supplements that might inhibit treatment, while counselors treat the patient's emotional needs.
"It's very clear that patients want and need these types of services. Surveys have shown that 80 percent of cancer patients are taking supplements, but less than 40 percent tell their doctor," says Dr. Prenguber. "This isn't safe for the patient. Access to a provider that is well-educated in pharmacology and natural therapeutics and can educate the patient about which supplements to take is appreciated by the patient, enhances patient participation in their own care and improves patient outcomes."
Naturopathic physicians can also recommend supplements to reduce symptoms of other conditions, which cannot be treated with traditional medicine, such as hot flashes, when a patient is undergoing cancer treatment, according to Dr. Prenguber.
To promote multidisciplinary care after a patient's initial appointments, the center holds a number of weekly meetings among providers of all disciplines to discuss patient treatment. The meetings are organized according to cancer type, so that separate meetings occur for all patients with breast cancer, lung cancer, liver cancer, colon cancer and hematologic malignancies. The providers also hold an additional general meeting for patients with cancers that do not fall into these categories.
Each of the meetings is attended by Goshen Center's physicians and representatives from each of the integrated services as well as nurses, rehabilitation specialists and researchers. Each patient undergoing treatment at the organization is discussed in at least one meeting, and all new outpatients as well as all current inpatients are discussed on a weekly basis. The meetings ensure multiple perspectives from a variety of providers as well as ongoing monitoring, improvement and continuity of care between all the services that interface with any particular patient, says Dr. Schwartzentruber.
3. Salaried physicians
Goshen Center employs all of its cancer physicians, making the organization unique in this respect as most community cancer programs do not have all physicians salaried on staff, according to Dr. Schwartzentruber.
"Most other community programs feature physicians that are in private practice. They have busy offices to return to, and they depend upon seeing many patients for their livelihood," says Dr. Schwartzentruber. "A salaried model decreases that need to have a high output, and you're not rewarded for high output but rather for your participation in the overall integrated program."
The salaried model also fosters Goshen Center's multidisciplinary approach to cancer care. Private practice physicians generally have a financial disincentive to participate in meetings or events that are not compensated, such as the facilty's weekly multidisciplinary meetings, says Dr. Schwartzentruber. Salaried physicians have no financial loss while attending and are more fully available to participate in this type of program.
Salaried physicians also have less financial incentives or competition that might influence treatment plans. In a traditional cancer program model, treatment plans are often linked to where the point of care begins, according to Dr. Schwartzentruber. For example, a patient with prostate cancer may be more likely to pursue radiation over surgery if he presents first to a radiation oncologist, even if they could have been treated equally-well with either option.
"Discussing treatment in a multidisciplinary meeting among a number of physicians with no financial incentives is one of the biggest benefits of an integrated, salaried program," says Dr. Schwartzentruber. "Physicians in these meetings are prepared to justify their opinions while undergoing peer review. It helps us to determine which treatment options may be best for a particular patient, even though different approaches might be expected to have similar outcomes."
4. Commitment to research
Another focus of Goshen Center is research. The organization has an active clinical trial program. Recently it served as the coordinating organization for a multi-institutional clinical trial on the effects of a vaccine for treating patients with metastatic melanoma. The study produced positive results, with the vaccine more than doubling the response rate for tumor shrinkage in patients with metastatic melanoma. In addition to clinical trials, Goshen Center also participates in pre-clinical trial research though partnerships with Purdue University and the University of Notre Dame.
Of the nearly 90 employees employed by Goshen Center, five are dedicated to cancer research. Such a large commitment to research is unique for a community-based cancer program, says Dr. Schwartzentruber.
"Maintaining a research program, in addition to the other services we provide, takes a lot of effort and resources that are not normally reimbursed," says Dr. Schwartzentruber.
However, he says this commitment to research has brought ample recognition and continued success to the Center. "Patients are looking for information on which programs are innovative. We publish our available clinical trials online and maintain a very up-to-date Web site with these opportunities," he says.
5. Focus on transparency and outcomes tracking
A final area where Goshen Center separates itself from other community cancer programs is its commitment to transparency and outcomes tracking.
The organization participates in cancer registries through the Commission on Cancer and the American Society of Clinical Oncology, which allows the program to compare its clinical performance against other programs in the state and nation. Participation in these registries also allows providers to track the outcomes of various treatments for different cancers over time, which could improve future cancer care options.
Additionally, Goshen Center monitors its adherence to the National Comprehensive Cancer Network's guidelines, which adds another level of compliance to the organization's quality of care, according to Dr. Schwartzentruber.
Goshen Center publishes all of its quality measures and benchmarking data to its Web site and hopes that other cancer programs will eventually do the same.
"It is very difficult to find these measures for many other programs at this time, because the registries are fairly young," says Dr. Schwartzentruber. Having access to this quality and outcomes information is becoming more important to patients, he says.
Learn more about Goshen Center for Cancer Care.