Sunday, November 13, 2016

Reducing Cancer Care Costs and Hospital Stays

There are two really irritating things about cancer care for me. (Well there are really lots of things that irritate me about cancer care. I could make a giant list of them if anyone really cared but today I am going to focus on two things.

Cancer care is ridiculously expensive. You can take a drug for $100,000 that might increase your lifespan for a couple of months. A single chemo infusion can cost upwards of $20,000.

And at the least sign of germs or low blood counts, you are sent to the emergency room where they admit you. That is a really stupid part. You feel like crap on a Friday night, you call your oncologist and they send you to the emergency room for blood tests and then they admit you after you sit in a room full of car accident victims and finally end up in a really uncomfortable bed with IV antibiotics. Really not a good idea.

The second annoying issue is how quickly doctors throw more drugs at cancer patients. Here, take this too and this and this and this. Let's get you some skilled nurses at home to help you with some fancy new equipment. Each one adds another triple zero item to your bills.

(I could rant on about the annoying part of going to daily radiation for weeks and weeks.)

But finally there are two new ideas that are focused on reducing cancer care costs and hospital stays. (Its about time.) Anyway here are the two new ideas:

Oncologist Dr Barbara McAneny in Albuquerque, NM looked at how her cancer patients dealt with hospital stays and ER visits due to low blood counts and other chemo side effects. She convinced the rest of her practice to provide weekend and evening availability for shots. Then they added other 'off hour' services such as nighttime appointments and same day availability. This resulted in major cost savings and reduced hospital stays. This practice is now being expanded to other clinics across country.

Next, this program above has been expanded even more after July 1 of this year:

"The Centers for Medicare and Medicaid Services has long talked about alternative payment models (APM), and now they are a reality: as of July 1, CMS launched its first APM, for one of the priciest specialties in healthcare, oncology.

The so-called Oncology Care Model (OCM) is now in play in 195 practices across the country, and will last 5 years. Late last June, just before the OCM went live, CMS Acting Administrator Andy Slavitt tweeted: "Big news fr @CMSGov this morning. 3,200 oncologists (double the target) signed up 4 new payment model -- 25% of all cancer care smarter way."

In a nutshell, in addition to traditional E&M codes, the CMS is paying oncologists $160 a month per patient undergoing chemotherapy for 6 months, starting with the patient's first dose. Oncologists are supposed to use that money to set up programs that effectively manage patients' chemotherapy complications "and heighten the focus on furnishing services that specifically improve the patient experience or health outcomes," the agency said.

A key element is that practices must provide "patient access 24 hours a day, 7 days a week to an appropriate clinician who has real-time access to practice's medical records." This and some other aspects of the OCM were drawn from the "Come Home" program pioneered in Albuquerque, N.M., by oncologist Barbara McAneny, MD.

Okay, who wnts 24 hour access, 7 days a week during cancer treatment? Me! Look at smart business practices being applied to cancer patients, reducing care costs and hospital stays.

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