Social distancing, stay-at-home orders, and “the new normal.” We are all adapting to the changes brought about by COVID-19, but what does it mean for cancer care? At the virtual 2020 Community Oncology Alliance (COA) Community Oncology Conference, Bo Gamble, Director, Strategic Practice Initiatives, COA, asked a panel of experts to predict how the current climate will shape challenges for community oncologists in the future.
“We could be here all day discussing our current challenges, whether that’s constantly updating the COVID policies we all developed in the middle of the night, securing personal protective equipment for our facilities, or adjusting to the reality that all of us now have ‘Zoom’ as our middle name,” said Kathy Oubre, MS, Chief Operating Officer, Pontchartrain Cancer Center, Covington, LA.
According to Ms Oubre, the top 3 challenges for community oncologists going forward are telehealth, home infusions, and a surge of new patients.
Telehealth was a “Godsend” at the beginning of the COVID-19 pandemic, Ms Oubre said, as it allowed patients and providers to maintain some sense of normalcy in patient care. “I think we all recognize that telehealth cannot stay in its current form after this public health emergency is over,” she noted. “[The Centers for Medicare & Medicaid Services] is already evaluating what that’s going to look like. COA needs to have a seat at the table, and they plan to do so.”
Ms Oubre explained that her organization is working with the Centers for Medicare & Medicaid Services to develop appropriate patient criteria for telehealth, and to shape policy going forward. Considering the current pandemic, she added, most stakeholders agree that telehealth is here to stay.
Regarding home infusions, Ms Oubre asserted that the oncology community is entering dangerous territory when patients start receiving infusions of biologics at home by nurses not trained in oncology. “We’re already starting to see payer policies come out that move these infusions to the home setting after the first dose, but we know that patients can have reactions well into the third or fourth dose and beyond,” she said. “In my nonclinical opinion, this is bad medicine and it puts the patient at risk.”
A Surge of New Patients
Ms Oubre pointed out that the upcoming and potentially huge surge of patients who have not yet been to cancer clinics may present a significant challenge. “I think it’s fair to say that there’s a whole population of symptomatic patients who are waiting longer to seek initial care as a result of this COVID crisis,” she said. “By the time they see an oncologist, they’re going to have more advanced disease.”
Although this potential surge will be challenging, it can also serve as an invaluable learning opportunity. Ms Oubre said that her organization is working with COA to develop a COVID-related patient-reported outcomes data project, and more details are forthcoming.
According to Robert Braun, Vice President, Operations and Integration, Regional Cancer Care Associates, Hackensack, NJ, one of the biggest challenges facing community oncologists is those practices that operate with a financial risk model. “We’re definitely in uncharted territory, and I think we’re going to need organizations like COA, local representatives, and people on the federal level to help us navigate these waters,” he said. “We can hopefully come to a happy medium where our practices are stable and able to provide services to our patients, but are also ready to move forward once this challenge is done with us.”
He agreed with Ms Oubre’s prediction about an upcoming surge of patients, but added that this surge is “a good thing in terms of getting our patients in, treating them, and getting them healthy again.”
Mr Braun expressed a cautious optimism about the magnitude of a potential resurgence of COVID-19, and the effect it may have on the financial stability of practices in terms of patient numbers, staffing, and the supply chain of drugs and personal protective equipment (PPE).
“The most important thing is the care of our patients, but I think we also need to look at potentially remodeling our financials in terms of what it may look like if we have another surge of patients,” he said.
Adjusting to the New Normal
Mr Braun also pointed out some of the challenges involved in adjusting to the “new normal.” He noted that most practices will probably see more changes regarding standard operating procedures, the use of telemedicine, cleaning and disinfecting protocols, and the use of PPE.
Mr Braun suggested that practices may be more prepared for these changes than they give themselves credit for, given the expediency with which they were forced to adjust to the challenges over the past few months. “Particularly in regard to telehealth, are we more change-ready?” he asked.
According to Barry Russo, MBA, Chief Executive Officer, The Center for Cancer & Blood Disorders, Dallas, TX, oncology practices did adapt rapidly to the influx of telemedicine visits and schedule changes, but perhaps not quite as quickly as patients did.
“We’re excited about how quickly our physicians adopted the telehealth approach, but what’s been really interesting to me is how quickly the patients adapted, and the expectations that they have now,” he said. “I think going forward, a challenge for us is not just more telehealth visits, but the fact that our communication with patients in a broader sense will need to be more technology-focused.”
He also pointed out the challenges of working within a value-based care model—particularly regarding spending more time with patients—in a new age of social distancing.
“So, how do we communicate with patients more frequently while seeing them less often?” Mr Russo asked. “What we’re going to have to, and what the patients themselves are doing, is adapt much more quickly to the tools we can use to communicate with patients electronically.”