Community-Based Oncology Practices Adapt to Uncertainty of Pandemic

Financial challenges are nothing new to community-based oncology practices. In recent years, practices have faced increasing pressure from a variety of external factors, including declining reimbursements, increasing direct and indirect renumeration fees, and rising drug costs. However, in early spring 2020, as coronavirus disease 2019 (COVID-19) spread throughout the country, the financial challenges intensified.

During the first few months of the pandemic, new oncology patient visits dropped sharply,¹ and most oncology practices experienced a reduction in new patient volume of more than 50%, according to a survey conducted by Flatiron.² Although new patient visits have rebounded somewhat, industry data indicate that they are still down from their more typical levels in early February 2020.³

The impact of COVID-19 has been felt deeply by community-based oncologists. According to an August 2020 Cardinal Health survey of more than 70 oncologists and urologists, more than 60% said the pandemic had an either “severe” or “moderate” negative effect on their professional life, and more than half said it had a moderate or severe negative impact on their income. The negative effect on income was largely attributed to cancellation of elective services and procedures and the shift from office-based visits to tele-medicine appointments (Table). Some practices adapted remark-ably well in the first few months, but sustained flexibility and focus will be needed as the virus continues to affect health care.

Table. Impact of COVID-19 On US-Based Oncologists

Optimizing Telemedicine Services

The use of telemedicine visits skyrocketed in April and peaked in May. An IQVIA survey of oncologists and other specialists showed that just 9% of patient visits were conducted via telemedicine before the pandemic, but telemedicine visits rose to 51% during the pandemic period and are expected to remain at 21% after the pandemic ends, according to a US Department of Health and Human services report.⁴

Looking toward the future, leading practices are viewing telemedicine as a tool to complement and augment other types of patient interactions.

Follow-ups, appointments to address questions, and palliative care check-ins can be managed effectively through telemedicine on an ongoing basis. Some practice leaders have said they also see telemedicine as a tool to support value-based care. For example, a patient who is experiencing an adverse event could connect with their provider via tele-medicine for guidance before going to the emergency department or hospital, which might help oncologists to reduce unnecessary high-cost interventions.

Other practice leaders see an opportunity to use telemedicine more broadly with advanced practice providers to provide patient services such as chemotherapy education, which may also contribute to lower practice costs.

Managing Claims Submissions In A Timely Manner

One of the best ways for practices to “future-proof” their financial operations is to avoid billing backlogs and reimbursement denials by ensuring that claims submission processes are consistently followed. The reality is that submitting “unclean” claims— those that lack information or National Drug Code numbers, have incorrect coding, or are for services that weren’t preauthorized—can dramatically slow down the reimbursement process or lead to denials.

Although unclean claims have long been the leading reason for claims denials, the submission of unclean claims by oncology practices rose in early spring 2020, when many practices began advising staff to work remotely or come into the office just a few days a week.

In addition, timeliness of claims submissions took a hit. According to Karen Kellogg, PharmD, director of practice consulting at VitalSource GPO, the average amount of time to submit Medicare B claims for some oncology practices jumped from 15 days before the onset of COVID-19 to more than 60 days at the height of the pandemic.

“Although submission times have returned to more normal levels, these trends still serve as a cautionary tale for practices. Even when working in normal practice environments with well-articulated claims submission processes, it can be easy for interruptions and increased workloads to get in the way of accurate claims submission. When clinicians and staff are working outside of their normal environments, with more distractions, it gets even easier to make mistakes and to fall behind,” Kellogg said.

Understanding these challenges, savvy practices are continually evaluating their claims submission processes, making sure staff receive adequate training to understand those processes, and tasking specific team members with double-checking all claims to ensure they are submitted without error—especially when staff are transitioning between working in the office and at home. Best practice processes include the following:

• Have staff members document patient visits in real time, as soon as a visit is completed or a medication is administered.
• Assign specific team members to serve as “scribes” whose sole purpose is to document this information during the visit.
• Ensure that nurses document medication start and stop time, total number of units administered, and total amount of unit waste so that the practice doesn’t leave any reimbursement dollars on the table.
• Overtly task at least 1 specific team member—whether it’s a nurse manager, a reimbursement director, a lead biller or coder, or even a physician—with overarching responsibility for making sure that clean claims submission processes are followed.

Monitoring and analyzing reimbursement trends can also drive increased value for practices. At Southern Oncology Specialists, a group of North Carolina–based oncology practices, administrators found that data analytics tools are critical in helping to manage finances during the pandemic.

“For us, the challenge has been ensuring our operations stay consistent and predictable in a time of great change. Data is king; we can’t run our business without it. Every day, we look at our practice analytics tool for billing reconciliation so we can understand what is still outstanding and what actions we may need to take. If we didn’t have this mind-set and tools to support it, it would be very difficult to have visibility into the whole picture,” said Sarah Cowart, practice manager at Southern Oncology Specialists.

Maximizing The Bottom Line By Controlling Inventory

Another key strategy for improving a practice’s financial health during times of uncertainty: Optimize medication inventory and reduce waste by improving charge capture, clinical workflows, and day-to-day inventory levels.

By using a web-based inventory management platforms for a “just in time” drug inventory—keeping on hand only the medications needed for patients on a given day—practices can help prevent cash flow from being tied up with unused medications sitting on a shelf.

During the current pandemic, when patient volumes are more unpredictable than normal, this may be particularly helpful. Inventory management systems help reduce costs by notifying a practice when the least costly version of a medication wasn’t purchased and by providing alerts of opportunities to take advantage of drug rebates. They also help practices significantly improve charge capture for billable waste. This documentation helps the practice avoid bearing the financial burden of the unused portion of that medication.

During the current pandemic, when patient volumes are more unpredictable than normal, this may be particularly helpful. Inventory management systems help reduce costs by notifying a practice when the least costly version of a medication wasn’t purchased and by providing alerts of opportunities to take advantage of drug rebates. They also help practices significantly improve charge capture for billable waste. This documentation helps the practice avoid bearing the financial burden of the unused portion of that medication.

References

1. London JW, Fazio-Eynullayeva E, Palchuk MB, Sankey P, McNair C. Effects of the COVID-19 pandemic on cancer-related patient encounters. JCO Clin Cancer Inform. 2020(4):657-665. doi:10.1200/CCI.20.000
2. Green B. An emerging story: what data tell us about the impact of COVID-19 in community oncology. Flatiron blog. April 14, 2020. Accessed September 23, 2020. https://flatiron.com/blog/impact-covid-community/​
3. Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. The impact of the COVID-19 pandemic on outpatient visits: a rebound emerges. The Commonwealth Fund. May 19, 2020. Accessed September 23, 2020. https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits​
4. HHS issues new report highlighting dramatic trends in Medicare beneficiary telehealth utilization amid COVID-19. US Department of Health and Human Services. News release. July 28, 2020. Accessed September 20, 2020. https://www.hhs.gov/about/news/2020/07/28/hhs-issues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary-telehealth-utilization-amid-covid-19.html​