American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Integrated Network Cancer Program Requirements and Guidelines

What Is an INCP?

The Integrated Network Cancer Program (INCP) category is defined as "an organization that owns, operates, leases, or is part of a joint venture with multiple facilities providing integrated cancer care and comprehensive services." At least one facility in the category is a hospital and all facilities that are part of the Network are CoC-accredited cancer programs. Generally, Integrated Network Cancer Programs are characterized by a unified cancer committee, standardized registry operations with a uniform data repository, and coordinated service locations and practitioners. Each entity of the INCP meets performance expectations for the quality measures under the umbrella of the integrated program. The INCP participates in cancer-related clinical research either by enrolling patients in cancer-related clinical trials or by referring patients for enrollment at another facility or through a physician’s office. Participation in the training of resident physicians is optional, and there is no minimum caseload requirement for this category.

Necessary Steps to Become an INCP

Each program seeking to be part of an Integrated Network Cancer Program is required to:

  • Be CoC accredited and in good standing, which is defined as:
  • Name an INCP Cancer Program Administrator
  • Name an INCP Cancer Liaison Physician
  • Sign a Business Associate Agreement (BAA) with the American College of Surgeons
  • Maintain compliance with INCP-specific requirements as outlined in the current edition of the Cancer Program Standards from the time of the category change through survey
  • Be surveyed as part of the network within 14 months of category change confirmation

If your program meets the above requirements and is interested in changing your category to an Integrated Network Cancer Program, please review and complete the Network Application Form and submit to Karen Stachon. Questions regarding the Guidelines for Integrated Network Cancer Programs may also be directed to Karen Stachon at kstachon@facs.org.

Network Checklist

The following checklist is provided to ensure successful network formation and a smooth transition between your facility and the CoC.

  • Download, complete, and submit the Network Application Form.
  • Coordinate cancer registry data collection and reporting in preparation for network registry operations.
  • Review and sign HIPAA Business Associate Agreement for network.
  • Pay $1,000 application fee.
  • Receive e-mail confirmation from CoC with new INCP facility identification number (FIN) and category.
  • Complete INCP Survey Application Record (SAR) in preparation for survey.
  • Schedule an INCP survey within 14 months of application submission.

Cancer Program Identification

Programs meeting the requirements for the formation of an INCP are assigned a Network FIN. An automated letter will be sent to the CEO, Network Cancer Program Administrator, Cancer Committee Chair, Cancer Liaison Physician, and cancer registrars confirming the following:

  • Category change
  • Network FIN
  • Participating individual cancer programs and their FINs
  • Reference date
  • Preliminary survey date

Programs should continue to make submissions to the NCDB as required by the Call for Data schedule. Additionally, the INCP will maintain compliance with INCP-specific requirements as outlined in the most current edition of the Cancer Program Standards.

Cancer Liaison Physician

A single cancer liaison physician (CLP) should be appointed to serve the network facility. In most cases, a cancer liaison physician currently in place at one of the campuses will be selected to fill this role; however, new networks may optionally select an entirely new cancer liaison physician. If a new liaison is selected, complete the Cancer Liaison Physician Appointment Application or contact cjones@facs.org.

If the network facility believes that it is necessary to appoint more than one cancer liaison physician, please contact Carolyn Jones. The network facility must submit its rationale in writing in order to receive permission to maintain more than one cancer liaison physician.

Reference Date

Reference date of INCP will be the earliest reference date of the individual programs in the network.

Cancer Registry Operations and Database Management

The network is required to coordinate the existing data sets from each individual facility and maintain follow-up activities for all cases within 12 months of the formal network formation.

Each individual facility in the network must store its facility-specific FIN for NCDB submissions. The facility-specific FIN must be reported in both the Reporting Facility [#540] and Archive FIN [#3100] items when submitting data to NCDB in order to demonstrate compliance with Standard 4.4. The Network FIN should not be recorded in submitted records. The NCDB will combine cases from facilities and provide aggregate reports for the network. Any registrar or co-registrar so identified in CoC records representing any facility in the network, or a software provider specified by that person, may submit NCDB data for any facility in the network.

Program access to CoC Datalinks for the individual facilities and for the network will be accomplished through the new network FIN, once the network has been accredited. Prior to accreditation of the network, access will be available only through the legacy facility-specific FINs.

Previously CoC accredited programs are required to submit NCDB data from the time of the network reference date, in accord with the Calls for Data. Facilities (or campuses) that were not previously accredited are required to submit NCDB data from the date of network accreditation forward, but earlier cases may be submitted at the program’s discretion.

All the information for submitting data can be found on the NCDB web page. Facility staff should contact Anna Delev via e-mail at adelev@facs.org if clarification of submission guidelines is necessary.

A network may request CoC Datalinks access for additional members of the cancer program and/or medical staff. These additional users must complete the Request for an Additional User Form. It is at the discretion of the network to designate the additional users and to notify the CoC of these users.

Health Insurance Portability and Accountability Act (HIPAA)

Under the HIPAA regulations, the American College of Surgeons (ACoS) serves as a Business Associate to assist you with quality improvement efforts for your cancer program. To accomplish these tasks, the ACoS must enter into Business Associate Agreements (BAA) with all CoC accredited cancer programs. Before any cancer program can schedule a survey and before data can be accepted by the NCDB, a signed BAA must be in place. The network program accesses the BAA for electronic signature through the Activity Menu of the password-protected CoC Datalinks portal. Information describing the BAA is accessible through the HIPAA link.

The BAA specifically addresses the following issues:

  • Data confidentiality
  • Systems in place to safeguard protected health information within the CoC's NCDB
  • The survey process and surveyors associated with the Program

A BAA has been individually signed by each CoC-accredited facility involved in the network. Once a program category has been changed to INCP the network program will be prompted to electronically sign the BAA in Datalinks. The BAA currently in effect prior to the network will remain in effect until a BAA for the network facility is signed.

CoC Hospital Locator 
(Effective July 1, 2012)

The CoC Hospital Locator, accessible by the public via the CoC website, lists all CoC-accredited cancer programs including the resources and services they provide as reported to the CoC using the Survey Application Record (SAR). The data fields in the SAR that require program completion for display in the CoC Hospital Locator are clearly identified. In addition to resource and service information, CoC-accredited cancer programs can voluntarily choose to release annual cancer caseload data, provided by the National Cancer Data Base (NCDB), for display in the CoC Hospital Locator.

Prior to becoming a network, the resource and service information for individual facilities accredited by the CoC are listed separately in the CoC Hospital Locator. Upon network designation, a new SAR will become available, and all data fields that contain resource and service information identified for display in the CoC Hospital Locator must be completed within 90 days. Records for the individual facilities will be removed from the CoC Hospital Locator, and a new record will appear reflecting the resources and services of the newly designated network.

Also upon network designation, one data table showing the annual cancer caseload of the network will be posted to the network’s Activity Menu in CoC Datalinks. This data table will reflect the combined caseload for all facilities in the network. The cancer registrar for the network will receive an e-mail notification once this data table is posted, and the network cancer committee must determine whether to authorize release of the annual cancer caseload data for display on the CoC Hospital Locator within 90 days.

If you have any questions about this process, or the CoC Hospital Locator, please contact CoC@facs.org.

NCDB Statistical Tools

Once the new network has been accredited, it will have access to the NCDB Hospital Comparison Reports and the NCDB Survival Reports. However, the Cancer Program Practice Profile Reports (CP3R) are updated annually and will be re-calibrated to show measure performance rates for the new network at that time. Extensive documentation for these reporting tools is available online, providing an overview of the NCDB statistical tools.

Survey Application Record (SAR)

Cancer programs participating in CoC accreditation are required to complete the Survey Application Record (SAR) in preparation for survey. After your application has been accepted, your program will be given access to a single SAR for the network. The SAR details the cancer program’s activity as it relates to compliance with the most current CoC Cancer Program Standards.

For questions regarding the SAR and SAR Annual Update, e-mail SAR@facs.org.