March 2020 Edition Vol.11, Issue 3

"No Pillow, No Paper": Oncology Practices Act Fast Against COVID-19

By Christina Bennett, MS

In light of the novel coronavirus, COVID-19, community oncology practices have started rapidly implementing changes in hope of mitigating the spread of the virus among their already vulnerable patient population.

“Patients ask if this [COVID-19 crisis] is real and serious,” said Lucio Gordan, MD, Managing Physician and President of Florida Cancer Specialists & Research Institute (FCS). “I explain it is very real and potentially catastrophic for people at higher risk.”

However, Dr. Gordan explained, there isn’t a lot of data on which cancer patients are at the highest risk of having worse complications from COVID-19 or whether certain cancer drugs increase a patient’s risk for complications. In general, patients with advanced hematological malignancies may fare worse, he said.

According to the Centers for Disease Control and Prevention (CDC), individuals with cardiovascular disease, diabetes, chronic respiratory disease, hypertension, and cancer have a higher mortality rate from COVID-19 than individuals without comorbidities.1

What is clear is that oncology practices are making changes to reduce the likelihood their patients contract—or spread—the virus. For example, pillows and sheets have been removed from exam rooms, as have magazines and newspapers from waiting rooms.

“We tried to eliminate as much paper as possible, even at the check-in area,” said Todd Schonherz, Chief Operating Officer of FCS.

At OneOncology practices, chairs in the waiting room as well as in the treatment room have been moved farther apart in an effort to practice social distancing, said Jeff Patton, MD, Acting Chief Executive Officer and President of Physician Services of OneOncology. The practices have limited visitors who can enter their offices and rescheduled patient visits that are not urgent.

“It really is all about reducing traffic flow through the clinic as well as trying to follow the social distancing rules,” said Kathleen L. Murphy, MSN, AOCN, RN, Executive Director of Nursing Services at OneOncology.

In accordance with CDC recommendations, practices are actively screening patients and visitors that come into the clinic.

“We’ve actually tried to do some of the screening now outside of the clinic itself,” said Mr. Schonherz. For example, patients have been screened out in hallways or under covered entryways outside of FCS. Screenings over the phone are also being done.

Certain cancer patients may be seeing changes to their treatment schedules to avoid any unnecessary risk. Dr. Gordan explained that patients who are undergoing curative therapy are being kept on their treatment schedule, but given that certain treatments may increase a patient’s risk for infection, patients receiving treatment in the palliative setting may receive a short treatment holiday if they desire after thorough discussion related to risks, benefits, and alternatives.

“This is unprecedented,” said William Harwin, MD, about the many changes at FCS. He founded FCS and stepped down as managing physician and president of FCS in 2018.

Practices are also trying to offer COVID-19 testing on-site, though neither FCS nor OneOncology have secured this capability as of yet.

“We don’t want to become a testing center,” Dr. Patton cautioned. “We’re willing to test folks who we should be seeing, but we don’t want to be any more general than we need to be because we have a very vulnerable population.”

Both FCS and OneOncology are rolling out telehealth services. On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) announced they will be temporarily reimbursing for telehealth services provided on March 6 or later for all Medicare beneficiaries without requiring them to visit a medical facility.

Previously, reimbursement for telehealth services was limited to certain scenarios, such as the patient living in a rural area, and typically patients had to go to a medical facility.2

Dean Gesme, MD, past president of Minnesota Oncology and now an independent consultant, said oncology practices should also consider cross-training their staff, including lab personnel, schedulers, and financial counselors, so that if one gets sick that particular skill is not lost.

In addition to concern for patients, practices are also concerned about staff members getting sick. If physicians, nurses, and other staff members are out sick or in self isolation, patients will not be able to receive the care they need.

FCS has not made changes to their staffing but recognize that they may need to stagger shifts in the future to prevent all staff members at a single location from becoming infected.

“It’s preferable to have our clinics going even at a slower pace than zero function,” said Dr. Gordan.

At this time, the supply chain for oncology drugs does not appear to be disrupted, but the same cannot be said about the supply of personal protection equipment.

“On the personal protective equipment, we have some concerns,” said Dr. Patton. “We’ve got two weeks’ supply and everything’s on manufacturer backorder.”

On March 18, 2020, CMS released recommendations to delay elective surgeries and non-essential medical, surgical, and dental procedures to conserve personal protective equipment as well as beds and ventilators.3

OneOncology is currently participating in the two-sided risk Oncology Care Model, in which practices are financially responsible for a patient’s total cost of care, and Dr. Patton said whether costs associated with COVID-19 care—which are out of their control—will contribute to total cost of care is a concern.

At the time of this writing, CMS has not announced any changes to two-sided risk OCM.


References

  1. Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. Accessed March 18, 2020.
  2. President Trump expands telehealth benefits for Medicare beneficiaries during COVID-19 outbreak [press release]. https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak. March 17, 2020. Accessed March 18, 2020.
  3. CMS releases recommendations on adult elective surgeries, non-essential medical, surgical, and dental procedures during COVID-19 response [press release]. https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental. March 18, 2020. Accessed March 18, 2020.

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