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Answers straight from the experts on the latest news and topics in oncology

Wednesday, March 20, 2019

3 Questions on...Triaging Patients' Symptoms to Improve Quality of Care, Reduce Costs

With Ronald R. Barkley, MS, JD, President of the Cancer Center Business Development Group

By Sarah DiGiulio

Few disagree that high health care costs are a growing problem and solutions need to be developed. One solution is a system management and triage pathway protocol. The goal of these protocols is to reduce costs and deliver high-value care by better managing patient symptoms and side effects of treatment to reduce unwarranted emergency room visits.

A recent study examined the cost-savings potential of using such a strategy. Researchers identified likely emergency room visits that were avoided (as documented in the triage program) at two practices participating in the Center for Medicare & Medicaid Innovation's (CCMI) Oncology Care Model program over a 6-month period. They calculated an estimated cost savings based on the average emergency room and hospitalization costs for such events (J Oncol Pract2019;15(2):e91-e97).

The results revealed 222 emergency room visits were avoided—an annual cost savings of $3.85 million between the two practices.

"In addition to improved patient care and satisfaction, [this data provides] further evidence that cancer care costs can be reduced through a routine system of symptoms management and nurse triage of symptoms," noted study co-author Ronald R. Barkley, MS, JD, President of the Cancer Center Business Development Group, a company that advises oncology practices in transitioning to and implementing value-based care systems.

The researchers noted the study's limitations. For instance, it is impossible to know with certainty—based on the predictive design of the study—whether or not the emergency room non-events identified as being avoided because of the symptom triage program would have actually turned into emergency room visits or hospitalizations without the program.

The study authors also noted the time period used to look at such events was limited to 6 months, and the figures they reached do not include operating expenses incurred by the practices to provide the symptom management and triage program services, nor did the study attempt to identify any amounts of alternate payment model reimbursements earned by the practices associated with the cost savings achieved for payers. Follow-up research will analyze data from a larger number of practices and factor in operating cost data, Barkley said.

Here's what else he said about the significance of these findings and the potential of such symptom triage pathways.

1. What is a symptom management and triage pathways program and how do they help save money?

"A software service documents incoming patient calls and diverts high-acuity calls to a nurse call center for intervention. The system allows providers to manage a high volume of patient inquiries. Without it, a high volume of patient calls can slip through the cracks."

2. Why is value-based care and implementing strategies that save important in cancer care?

"There is heightened public awareness and government scrutiny with regard to the high costs of health care. It is well-known and documented that health care services are provided that are unwarranted, unnecessary, and could be avoided. This is true in oncology care.

"So, if we can avoid unnecessary services through care management and cost consciousness, why shouldn't we do so?

"Reduced units of service equal reduced costs (claims) to the system. Why is reducing emergency room events and associated hospitalizations an important part of overall cost-saving strategies (in addition to looking at other factors, like drug costs, etc.)? One of the three primary sources of reduced services and costs in oncology is in precluding unwarranted emergency room trips and subsequent emergency room-related hospitalizations.

"Cancer patients undergoing active treatment (chemo in particular) experience dizziness, nausea, vomiting, and dehydration. When a patient is at home and experiences these side effects, the natural tendency is to call 9-1-1 or run to the ER. However, if the patient and/or caregiver had an alternative, such as a nurse call service to walk them through their symptoms and see them at home, or an in-office physician instead, most of the emergency room trips could be precluded.

"Avoid an emergency room trip and emergency room-related hospitalization and you just precluded generating the associated costs.

"Note that chemo patient emergency room visits result in hospitalization a high percent of the time (50-75% in some instances). Emergency room staff are trained in trauma, not cancer care, so the tendency is to get the cancer patient out of the emergency room and into a bed to free up space for the trauma cases."

3. What is the key takeaway message from this research?

"Reduce costs to health care systems and payers through symptom management. However, there are operating costs to the provider associated with providing such enhanced care. Absent an innovative or alternative payment model to incentivize and compensate for the increased operating costs to providers and costs reduced (savings achieved for the payer), the only winner is the bottom line of the payer.

"Examples of [alternative payment models] in oncology that financially reward a provider for the extra effort are the CMMI Oncology Care Model program, Anthem Cancer Care Quality Program, and Aetna oncology medical home—all with economic features built in to incentivize providers to preclude unwarranted services and costs."