The ACCC 47th Annual Meeting & Cancer Center Business Summit (AMCCBS), which took place online March 1-5, addressed health care policy, the use and reimbursement of telehealth during and post-pandemic, keys to optimizing revenues and outcomes, gaps in oncology care among different racial and ethnic groups, and staff stress and burnout during COVID-19. Within all of the topics addressed, the expansion of telehealth played an outsized role, with presenters and attendees sharing how they expect the boom in virtual care caused by the pandemic to play out post-pandemic.
Kavita Patel, MD, MS, FACP, a fellow at the Center for Health Policy at the Brookings Institution, launched the meeting by recognizing the immense impact COVID-19 has had on health care delivery across the country during the past year.
"No one could have predicted at the end of 2019 that a new disease would kill more than 500,000 Americans within a year and bring the world to its knees," said Patel. "COVID-19 is the start, middle, and end of what will define health care practice and policy in 2021 and beyond."
Following Patel's keynote address, a panel of physician and nurse leaders from cancer programs and practices across the country shared their experiences at the intersection of cancer care and the ongoing pandemic. A point everyone quickly agreed upon was the likely lasting impact of the rapid transition to telemedicine. Although several people said the provision of telehealth has slowed some since many programs are now open to in-person visits, panelists agreed there is no going back to pre-pandemic levels of virtual office visits.
"Telehealth is here to stay," said Luis Isola, MD, Director of Cancer Clinical Programs at Mount Sinai Health System & Tisch Cancer Institute. "It has become part of the fabric of the care we provide."
Feyi Olopade Ayodele, MBA, CEO of CancerIQ, Inc., emphasized that by understanding telehealth as simply providing the same in-office services virtually, providers do not consider its unique capabilities, and thus sell it short. "Telehealth is not just a new way of conducting typical office visits," said Ayodele. "It can be transformative in the way it provides patient care."
Unequal Access
On the flip side of telehealth's positive impact of being able to provide quality at-home care is the fact that many patients simply do not have the means to access telehealth services. Sibel Blau, MD, Medical Director at Northwest Medical Specialties and President and CEO of the Quality Cancer Care Alliance Network, said that, in response to the pandemic, her practice hired technology coordinators to visit nursing homes and give patients access to the technology they needed to receive remote care.
"We need to give access to care to all patients, regardless of how remote they are," said Blau. Other panelists said they had patients whose socioeconomic status made telehealth impossible. "It's essential to keep in mind social determinants of health," said Adam Riker, MD, FACS, Chair of Oncology at Anne Arundel Medical Center DeCesaris Cancer Institute. "We could not do telehealth with many of our patients because they do not have access to tools like Zoom or MyChart."
In a session on removing transportation barriers for rural and underserved cancer patients, Johanna Garzon, MHA, HBAT, Director at Central Care Cancer Center, said, "Since the ultimate goal of telehealth is to increase access to care, it is a big topic of conversation in rural regions." She found significant disparities in access to virtual care when implementing a telehealth program in Kansas and Missouri during the pandemic. Twenty percent of the patients that Central Care Cancer Center serves have a landline phone or non-smart cell phone, said Garzon, precluding them from participating in video-based telehealth visits. Even more surprising to her was the discovery that some patients-and some providers-are unaware of the existence of telehealth. "Eliminating these barriers is key to implementing and effectively using telehealth in rural settings," Garzon noted.
Reimbursing What Works
In the end, though, the future of telehealth is tied to reimbursement. Prior to COVID-19, adequate reimbursement for remote care was rare. Providers fear that, as the pandemic recedes, so too will coverage for telehealth.
"We need an impartial assessment of when and where telehealth is comparable to in-person care," said Frank Micciche, Vice President Of Public Policy and Communications at the National Committee for Quality Assurance. "It's not easy; it will require us to create processes that everyone can agree to."
Ayodele added that, like telehealth itself, reimbursement for telehealth should not take a one-size-fits-all approach. Having a regulatory body or process to impartially identify when telehealth services are superior to or comparable with in-person care would go a long way toward developing appropriate reimbursement guidelines.
"If advocacy for telehealth comes from both patients and providers attesting to its value, and showing data proving its value, that is huge," Micciche said. "Show that your costs did not spiral out of control, show that deferred care is more costly. Document it, get patients to advocate for it, and show that to the decision-makers."
Assessing the changed landscape of a health care system still in the throes of a global pandemic, David Dougherty, MD, MBA, Medical Director of the Dana-Farber Cancer Institute Network, said it's important to consider how COVID-19 has been and can be a source of disruptive innovation-for good.
"COVID-19 has not ignited new problems," he noted. "It has exacerbated the issues already there. We need to think about how we can apply the innovations wrought of necessity into long-term solutions."
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AMCCBS Virtual Now On-Demand!
Sessions at the ACCC 47th Annual Meeting & Cancer Center Business Summit (AMCCBS) are now available on-demand. Learn from real-world case studies from organizations that used the opportunity created by the COVID-19 crisis to forge a new path forward. Learn how to lead your cancer program or practice through change by accelerating digital health capabilities, transforming business operations and care processes, and enhancing the patient and provider experience. Register today at https://courses.accc-cancer.org/AMCCBS2021.
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