ARLINGTON, Va.—A major congressional disappointment sharpened the focus of the Association of Community Cancer Centers (ACCC) Annual National Meeting. But speakers and ACCC members vowed to provide more of the supportive services cancer patients want and need through multidisciplinary teams, despite a frustrating, complex, and financially unpredictable practice environment.
ACCC members had visited with Congressional staffers to request a permanent solution to the flawed sustainable growth rate (SGR) formula that sets Medicare physician payments; legislation before both houses of Congress would have repealed the SGR. But instead, Congress enacted yet another temporary short-term SGR “patch” (the 17th) rather than a permanent solution, and SGR repeal will have to be revisited in 2015.
“We would have liked a longer SGR fix,” ACCC Executive Director Christian Downs, JD, MHA, told OT, calling congressional inaction “disappointing.” One of the speakers at the meeting, Wendy Andrews, Practice Manager for Hematology/Oncology at the University of Arizona Cancer Center, said, “We need a final fix on this; we went [to Congress] with that message.”
Like the ACCC, the American Society of Clinical Oncology also released a statement of disappointment, with ASCO President Clifford A. Hudis, MD, calling the short-term SGR fix “a threat to physician practices and the access of Medicare beneficiaries to high-quality, affordable cancer care.”
Ardis Dee Hoven, MD, President of the American Medical Association, used the words “deeply disappointed” in a statement, noting that the lack of a permanent SGR fix “perpetuates an environment of uncertainty for physicians, making it harder for them to implement new innovative systems to better coordinate care and improve quality of care for patients.”
In an increasingly challenging practice environment, data show that community oncologists are offering not only direct medical care but also many more supportive services. “The community drove the establishment of multidisciplinary care,” care, which provides services such as financial counseling, survivorship programs, and genetic counseling, noted Mark Soberman, MD, MBA, Medical Director of the Oncology Service Line at Frederick Regional Health System in Maryland.
In offering supportive new services, “sometimes as providers we just have to make the leap—it's the right thing to do for patients.”
In ACCC's 2013 “Trends in Community Cancer Centers” survey, 88 percent of respondents reported providing financial counseling; 78 percent reported providing survivorship services; 96 percent reported providing nutritional services; and 92 percent reported having social work services.
In addition, 77 percent of survey respondents said they had nurse navigators; 45 percent reported providing services by non-nurse patient navigators; 75 percent said they have genetic counseling; 69 percent reported providing psychological counseling; and 67 percent reported having cancer rehabilitation services. Close to half of respondents reported that their programs offer advanced diagnostic testing and molecular testing.
“Patients are telling us what they need,” said Marie Garcia, RN, OCN, Director of Clinical Services at Virginia Cancer Specialists, PC, in Fairfax, Va.
Soberman, whose practice uses social workers and patient navigators, noted that many of the services that patients perceive as adding the most value to their care are delivered by non-physician providers. That is all to the good, said Linda Ferris, PhD, Vice President of the Oncology System Service Line at Centura Health in Englewood, Colo. With the anticipated shortage of physicians, “We have to seriously think about how we're going to re-engineer our delivery system,” she said.
The ACCC offers a detailed financial assistance toolkit for oncology practices, which was free to all meeting attendees. Providing financial counseling services to patients can actually save money for oncology practices as well as for patients, noted Chad Knight, FACHE, Administrator of Oncology Services at New Hanover Regional Medical Center, Zimmer Cancer Center in Wilmington, N.C.
He said that in 2012 financial assistance programs were able to save his cancer program $1.44 million in drug costs; in 2013 savings were similar: $1.43 million. Because his center is a safety-net regional hospital and the state has not expanded Medicaid coverage, these savings were vitally important, he said.
“Our payer mix is horrible in cancer, frankly. Cancer patients are poor vs. penniless. These financial assistance programs really do make a difference in these patients' lives.”
Tara Lock, MHA, Director of Oncology Operations for Southcoast Centers for Cancer Care in Fairhaven, Mass., said that patients are increasingly expecting help from financial counselors in cancer programs in dealing with their medical bills. In the ACCC survey, 88 percent of respondents said that within the past 12 months their program had seen more patients needing help with prescription drug expenses, while 87 percent reported they had seen more patients needing help with co-pays and coinsurance.
“It sounds fluffy, but this is how we're evolving,” Lock said. “These are the things patients care about.”
Agreeing with Lock was Catherine Credeur, LMSW, OSW-C, Social Worker with the University of Texas Southwestern Medical Center Harold C. Simmons Comprehensive Cancer Center. Financial counselors/advocates' success on behalf of patients pays off physically as well as psychologically in improved medication compliance and fewer treatment disruptions, she said.
Financial counselors/advocates secured $2.9 million in patient assistance for oncology drugs at her institution last year, said Ariel Foster, Patient Financial Advocate at St. Luke's Mountain States Tumor Institute in Fruitland, Idaho. It is important for oncology practices to track their time and resources spent on patient financial assistance, she said, noting that her institution has developed an assessment in the patient's chart to track the time financial counselors spend on patient assistance, drug assistance, co-pay assistance, and disability paperwork.
The tracking system at her cancer institute includes the following specifics:
- Patient-assistance applications: Time spent on internal patient assistance applications (if applicable); time spent on filling out applications or gathering necessary materials from the patient; the amount of potential write-off and the outcome of the patient assistance application.
- Chemotherapy assistance: This assessment includes co-pay assistance for IV and oral drugs; drug company assistance program; the amount of assistance the patient received for the current month/date of assistance expiration; and the time the financial counselor spent obtaining assistance as well as time spent with the patient.
- Disability policies and Family and Medical Leave Act (FMLA) paperwork: Time spent on patient cancer insurance policies (tracking the company the policy is through), including time spent filling out paperwork and gathering materials for patients; time spent on FMLA paperwork and the amount of time the patient or patient's family member is requesting; time spent with the patient and time spent filling out paperwork for short- or long-term disability.
- Health care exchanges, Affordable Care Act (ACA): Time spent with a cancer patient, and finding out whether the patient applied for insurance with an Idaho exchange, which Foster noted involves an “immense amount of information.”
While speakers at the meeting stressed that today's practice environment is extremely challenging, they emphasized that a multidisciplinary approach to cancer care that includes the supportive services patients want can help meet those challenges: “There is more and more pressure for publicly reported [patient] outcomes,” Ferris emphasized. “You're only going to get there through multidisciplinary teams.”