PET Steering Committee Meeting Minutes. Wednesday, January 21, 2015 Time: 2:00 4:00 pm

Transcription

1 PET Steering Committee Meeting Minutes Wednesday, January 21, 2015 Time: 2:00 4:00 pm Committee Members Present: U. Metser (Chair), C. Caldwell, J. Dobranowski, K. Kingsbury, Y. Ung Other Attendees: B. Monaghan, A.M. Kooiman, K. Tracey, M. McCarthy, E. Bienenstock, S. Melamed, D. Langer, C. Bedford, P. MacCrostie, R. Poon, J. Wang, M. Wang Maric Regrets: R. Beanlands, R. DeKemp, S. Houle, R.M. Iwanochko, W. Pavlosky, A. Singnurkar Business 1. Opening Remarks 1.1. The Agenda was approved as circulated The November minutes were approved as circulated. In relation to an item in the November minutes, it was noted that the use of FDG in pediatrics is part of regular practice in other Canadian jurisdictions Updates from the chair In recent months the PET Steering Committee (The Committee) has received several requests regarding equity of PET scan funding between the current Ministry approved PET Centres within the province. Differences in funding streams are being cited as an issue for access to PET Scans for patients, increasing wait times. As assessed by wait times, there are no barriers to access for patients in the GTA (where there is a perceived access issue); wait times are 9, 6, and 1 business days for the three hospital-based adult oncology centres, which are within the 10 business day bench mark. As a Committee, recommendations are made on a regional level with a focus on provincial, high quality, evidence-based access to PET scanning; specific funding allocations are the role of the Ministry and out of scope for Committee discussions. The Committee and CCO has been working collaboratively with the Ministry to manage inquiries, ensuring they are directed to the appropriate individuals. Regular information sharing regarding wait times and means of access was recommended to prospectively address regional concerns Review of Follow-up Items from Prior Meetings

2 2. Insured/Uninsured Program Updates 2.1. Insured Program No insured program updates 2.2. Uninsured Program 3. Mobile PET Discussion In continuation of discussions/presentations regarding a proposed Mobile PET/CT pilot program, representatives/co-owners of the current mobile PET IHF presented their business plan for a Mobile PET/CT Pilot program. The Mobile PET/CT Pilot program is a detailed dissertation for what they can do to improve access to PET scans in a way that is cost-effective for smaller communities throughout the province. Providing better access closer to home. The overall model outlines a partnership between a mobile Independent Health Facility (IHF) and a hospital. They cited past examples where this has worked and showed that service could be delivered on a rotational basis, but with the quality of fixed site units. They were mobilized to Mississauga to assist another IHF on a rotating basis over a six-month period during upgrades from a PET to a PET/CT. They have also filled in at a hospital-based PET Centre during down time to their service. They also mentioned diagnostic CT services could also be provided with the Mobile PET/CT, as well as Cardiac PET/CT scans. There will be a central administrative hub (located in Windsor for now). Each site would maintain their own Standard Operation Procedures (SOPs). The presenters suggested the following benefits of this model: Economic The mobility of this model allows for economic viability in small and remote communities. The costs are significantly reduced compared to a fixed site model (i.e., staffing can be supplied; service costs are shared amongst several sites). More efficient use of financial and human capital. Sharing the costs among 3-4 sites makes it affordable where it is not possible individually. No need for travel allowances when patients are serviced in their own areas. Negotiate economies of scale for FDG. Can mentor/overread scans in order to bring centres up-to-speed. Using a Mobile PET/CT can allow a site to build volumes until it is mature and then transition to a permanent site. Preliminary models (CCO) suggest a site needs approximately scans/year to be economically viable.

3 Access Allows patients to access care closer to home. (i.e., when the unit in Windsor is down some patients refuse to travel to London for a scan). The presenters suggested that, due to travel barriers, there is unmet need in remote locations, and not all qualified patients are receiving the PET scan they need. Route flexibility means more Ontarians are served with one machine. Wait times are comparable to fixed sites. Can meet increased demand without capital funding. Quality Can provide both PET/CT or CT services for a hospital in the event the hospital experiences loss of CT service. Offers training opportunities for hospital staff in rural and remote communities that they might other not have access to To be sustainable two pilot routes (401 corridor including Newmarket and Kitchener; Northeast including Kingston, Barrie, Sudbury and Durham Regional Cancer Centre) are being proposed as the best solution for mobile PET/CT services while taking into account the patient population, geography, FDG supply and economies of scale. Durham region is the largest LHIN without PET services and Barrie could be serviced through either route. The 401 route is thought to be the best (logistically) to test the Pilot program. This route is needed to make the pilot sustainable to support the Northeast route. The presenters suggested that the Mobile PET/CT Pilot program would grow gradually, and would not pose a significant impact to existing PET centres viability. Financial assumptions include an FDG cost of $400 per patient as well as shipping costs, which is currently higher than the average cost across current PET Centres. They will look into these costs further (i.e., FDG cost per patient + shipping costs for each site on the proposed routes). The assumption is that the FDG costs will be lower as negotiations with FDG vendors have not yet commenced. They have unique experience in Mobile PET/CT. They are the owner of the sole existing IHF license with a Mobile PET/CT, and have been in operation since SOPs are already established and proven. They have existing relationships with suppliers which will result in cost savings. There is flexibility in routes and they are willing to work with the PET Steering Committee to ensure the pilot is viable. The presenters also addressed additional questions that were posed previously regarding ultimate responsibility over the patient during a mobile scan, site set-up costs, confirmation the

4 patient meets OHIP eligibility requirements, division of the technical fees, and reading physician and technologists meeting QA requirements. Upon completion of the presentation the floor was opened for further discussion. The current Mobile PET/CT scanner does not have time of flight capabilities, and must be replaced; it is not ready for the pilot at this time. The next level of analysis will include a comparison between the costs of a scan in the GTA and the costs of a scan in the North (i.e., Sudbury). The difference between the costs of a travel grant and the shipping costs for FDG as well as the need for a companion to take a day to travel with a patient long distance because most patients are too ill to make the trip themselves. What is the actual cost of a PET scan for a patient from the NE LHIN in the GTA versus a PET scan in their own LHIN. Recent dialogue with the Minister of Health and the NDP Health Critic has acknowledged the current volumes in Sudbury are not at a level to support a fixed PET/CT site but it is felt that using a mobile PET/CT will help build the data and volumes to prove a fixed site will be sustainable soon. Past use in Mississauga and the hospital based PET centre have shown the viability of using a mobile PET/CT in this type of situation. The patient advocacy group in the Sudbury area also shows how patients feel about accessing care close to home. There was discussion surrounding how to assess the effectiveness of this pilot program. It was stressed by the Committee that pre-defined metrics are needed, in order to objectively assess the success/performance of the pilot program. Some initial suggestions were measuring the quality of the services, wait times, patient satisfaction, LHIN penetration (i.e., 175 Windsor patients received PET/CT scans the year before the Windsor PET Centre opened, and the volume doubled to 350 scans the year the PET Centre opened in Windsor). The volume of PET scans is increasing by approximately 5% per year in the province and the funding envelope has remained stable. There is a concern that the funding envelope is the same no matter what, and dividing it up amongst even more centres could cause costs to increase at other centres. Further assessment is needed on the impact of quality. The PET Steering Committee needs to take the following items into further consideration before providing an assessment of the Mobile PET/CT Pilot program to the Ministry. Where is there a problem/need for the provision of PET services? How do we address this? What are the possible solutions? (mobile PET/opening a new centre) Is it better to provide additional access through 20 different sites or to maintain a higher level of expertise by centralizing larger volumes into fewer centres (like other smaller medical services in the province)? Need a clear evaluation plan to determine if the Pilot is working (because once a service has been provided it is hard to remove it if it is not working).

5 4. PET Siting Model Update and Recommendations Report Discussion The PET Siting Model considers regional PET demand and access patterns and facilitates modeling of future demand for PET services, how the addition of new centres addresses current and/or future demand, and the impact to the provincial infrastructure for different scenarios. This is one tool used to support the PET Steering Committee s mandate to assist the Ministry in making decisions regarding the provision of PET services in the province. Potential sites should provide timely, evidence-based care administered as close to home as possible while ensuring quality standards are met and that services are economically viable. The model has been updated to include FY13/14 data and includes case studies based on regions that have expressed interest in having local access to PET scanning. Next steps were discussed, including how best to communicate the results of the model to a wider audience. It is anticipated that the model could be leveraged to assist in the forthcoming siting considerations Recommendations Report to the Ministry, and may also be useful as part of business planning at the LHIN level. The report will also be made publicly available. The initial draft(s) will be completed shortly, and timely review by the Committee is requested. The ability of the current model to include mobile PET was discussed; although the model doesn t currently have that capability, it could be incorporated to have that flexibility. Given the interplay between different aspects of final siting decisions (e.g., access, demand, quality, costing, etc), it was agreed that the Recommendation Report should contain aspects for consideration as the decision is made. Action Item: The draft recommendation report will be circulated once complete. Detailed, timely feedback is requested. 5. Emerging Areas Meeting adjourned at 4:07pm