Main Line Health is a multi-hospital health system serving patients in Philadelphia, PA, and its western suburbs. The system has been recognized as among the best in the region by U.S. News & World Report. In 2017, it was named Workplace of the Year by the Advisory Board. In addition, it has earned System Magnet designation from the American Nurses Credential Center, along with other recognition from groups such as The Joint Commission and Nurses Improving Care for Health System Elders.
Rita Edwards, RRT, RPFT, joined Main Line Health as a respiratory therapist back in 1988 and has worked there her entire career. But what started as a job in critical care has morphed into a passion for pulmonary diagnostics and wellness.
When the system decided to offer lung cancer screening, it seemed like the perfect fit for her, and she jumped on board.
“After several years of doing PFTs, I was invited to attend monthly lung tumor board meetings to be part of a panel discussing lung cancer cases,” Edwards said. ”About a year later, our new thoracic surgeon wanted to begin a lung cancer screening program, and my manager and I became part of the original task force for it.”
The team launched a pilot program at their location. They then rolled it out to the other three acute care hospitals in the Main Line System, initially training oncology nurse navigators to do the lung cancer screening. That added hours to their current role, however, and it eventually became clear that it would be best to have a single individual coordinate the program system-wide to grow the program.
“Since I was part of the springboard and development and involved in the Epic transition, I took ownership,” Edwards said.
That didn’t mean she was a shoo-in for the new position, though. She still had to apply, and she wasn’t the only applicant.
“I had to earn the position with diligent preparation for the interviews and the conveyance of current understanding and involvement, along with a plan to grow the program and address potential challenges,” she said.
Once all was said and done, she got the job, and she hasn’t looked back.
“As an enthusiastic respiratory therapist being part of the diagnosis and treatment for tobacco-related diseases for so many years, it was an easy decision,” she said.
Her background with the program has paid off. For example, she brought knowledge of the program guidelines and insurance requirements, and requirements set forth for data submission by the American College of Radiology. Yet, Edwards emphasizes other factors gave her an advantage in her new role as well.
That’s particularly true for her background in pulmonary rehabilitation, where a good understanding of ICD-10 codes and the ability to deal with insurance guidelines is crucial.
“Although the lung screening is a totally different program, just knowing where to find resources is a great help,” she said.
Being able to connect with people who are struggling to cope with the fact that their smoking caused their lung diagnosis or possible diagnosis has been priceless too.
“I speak to people with dignity and respect, and once they hear that I’m not going to condemn or preach to them, they generally open up and become engaged in the conversation, especially with the initial screening appointment,” she said.
Solid organizational skills are paramount as well.
“In my case, orders come in many different ways — phone, fax, Epic — and attention to the details is very important,” Edwards siad. She is also thankful for the great team of lung oncology nurse navigators she works with to get patients with lung cancer on the way to the care they will need to treat the disease.
Challenges and rewards
Edwards says the most significant challenge she faces as the system lung coordinator at Main Line Health deals with insurance companies and pre-authorizations. Problems are particularly troublesome in disparity groups, many of which have a higher risk of lung cancer.
“It’s vital that they understand that if they’re qualified for the screening per insurance guidelines, they will not pay a dime for the screening,” she said.
Unfortunately, that fact is often not well defined within the insurance companies, and patients can end up with a bill for a co-pay or deductible. She works the problem from the hospital side, doing what she can to ensure patients are relieved of these payments.
“The other challenge is making sure the orders have the right CPT code and ICD-10 codes,” she said. ”Medicare is the most particular, and besides only accepting certain codes, they require an attestation from the physician that there was a shared medical decision-making conversation.”
The rewards of the job come when patients find out they have lung cancer early enough in the course of the disease to cure it.
“I like to say that I help prevent patients who smoke from getting metastatic lung cancer,” she said.
Being part of a multidisciplinary team that includes surgeons, oncology nurses, medical and radiology oncologists, pathologist radiologists, and geneticists is highly rewarding.
“I have learned so much from this team, and it has been an incredible journey since 2013,” Edwards said.
Rita Edwards believes any RT who is good at navigating patients could make the transition to a position like hers.
“Lung screening navigation is making sure the qualified patients get their annual screening or diagnostic follow-ups according to radiology recommendations from the National Comprehensive Cancer Network,” she said. ”There’s no doubt that my experience as a respiratory therapist made the transition quite easy.