April 2021 Edition Vol.13, Issue 4

Oncologists Balance Practice Efficiency with Improving the Patient Experience

By Aaron Tallent

With the growing number of people living with cancer, increasing regulatory demands, and advances in understanding and treating the disease, it is critical that oncology practices strive for efficiency for both their patients and staff. At the Community Oncology Alliance (COA) annual conference held virtually in early April, oncology stakeholders discussed challenges and clinical-support tools that help improve practice efficiency, with the goal of improving quality of life for both patients and staff.

Efficiency in Oncology

At first glance, the notion of being efficient may seem counterintuitive to treating people with cancer. For patients with cancer, their diagnosis and treatment are often the greatest challenge they will face in their lives and the expert panel agreed that oncology professionals must be sympathetic to that struggle even as they try to improve operations within their practice.

“It’s difficult to be efficient in an oncologist’s world,” said Marcus Neubauer, MD, Chief Medical Officer of The US Oncology Network. “The patients are sick. They’re dealing with serious diagnosis. They often have other issues such as financial and social concerns.”

Efficiency and improving patients’ quality of life are crucial to the overall experience of the patient. However, Dr Neubauer pointed out that physician burnout is a real concern, with more than 30% of the US Oncology Network of physicians reporting that they have experienced burnout on a recent survey. US Oncology Network is exploring ways to help practices in their network overcome burnout so it can continue to focus on efficiency.

Inefficiency may result in a practice losing patients, especially in competitive markets. New York Cancer & Blood Specialists has more than 25 locations in the New York metropolitan area, which has numerous oncology practices and 6 National Cancer Institute Designated Cancer Centers. To get a better sense of how it compares with other practices, the Center measured the number of patients who come in through referrals.

“It’s probably in the neighborhood of 15% to 20%, [probably] because there are waits of 2 to 4 weeks with larger institutions,” said Todd O’Connell, Chief Operating Officer and Chief Financial Officer of New York Cancer & Blood Specialists.

Ways to Improve Practice Efficiency

According to Bo Gamble, COA’s Director of Strategic Practice Initiatives, there are simple ways to simultaneously improve the overall experience for patients at all stages of care and increase practice efficiency at the same time. He cited an example of a physician who would record the initial visit of a newly diagnosed patient, since many are in a state of shock when they receive the news and do not take in all the information that is being shared. He would then hand over the recording to the patient’s family so they could replay the conversation at home and be able to re-listen to what was actually being said during the visit. “They could hand that audio recording to the family and say, ‘Here we go’” said Gamble.

Another way to improve efficiency is to allow patients to fill out questionnaires at home prior to their visit. At New York Cancer & Blood Specialists, a link is sent to patients either on their cellphone or on a tablet prior to their visit. Patients have the option of answering questions beforehand on signs or symptoms they may be experiencing. The information is recorded into the patient’s chart on the practice’s electronic medical record (EMR) and the physician can review it with the patient, thereby saving time during the visit.

O’Connell said that an internal study of medical notes found that, because the physician and patient did not have to complete the review of systems during the visit, “There was about a 43% reduction in the amount of time that the doctor had to spend inside that note.”

Although EMRs continue to show value over paper records, they have yet to achieve their full promise in revolutionizing practice efficiency. The inability to share records across different platforms, poorly designed interfaces with some platforms, and numerous fields to input have cut into the time clinicians are spending on patient care and contribute not only to practice inefficiency but also with burnout.

“When you are a provider trying to get through the day and trying to provide good care to your patients, the tool has to be an assist. It can’t get in the way,” said Dr Neubauer.

Even with EMR struggles, technology remains a significant innovator in practice efficiency. The US Oncology Network uses the Clear Value Plus℠ platform, which is a decision-support tool that helps mitigate the challenge of keeping abreast of the volume of scientific literature being published. The tool updates treatment options in the workflow, so physicians have them available at the point of care. Dr Neubauer said, “It helps [doctors] stay abreast without having to read up on every patient they see.”

Clear Value Plus also helps manage prior authorization requirements by offering access to clinical summaries that office staff can include in an insurer’s prior authorization request.

Alti Rahman, Practice Administrator, Oncology Consultants, considers how practices can reduce costs & maximize savings:

 

Oncology Consultants, which has more than 10 sites in the Houston area, addressed delay to treatment due to prior authorization approvals through variance analysis of all insurance companies. They found that some insurers were taking 2 days, while others were taking 10 days to process requests. The analysis helped them understand where the issues were and prompted the staff to handle certain types of prior authorization differently based on timing.

“From January to March, there was at least a 35% to 40% reduction in variance,” said Alti Rahman, MHA, MBA, CSSBB, Practice Administrator for Oncology Consultants. “That meant a lot more patients were getting a much more controlled outcome in terms of when they could start therapy.”

Rahman also discussed a tool that Oncology Consultants uses that screens patient records and flags those who have not been completed within a certain threshold. The tool informs the physicians, so the staff does not have to spend manpower screening the charts. With the tool, Rahman sees a significant improvement in meeting those thresholds.

“Physicians are driven by numbers and competition, so when you’re able to demonstrate who’s not doing the best, who’s doing well, who’s not doing well, it strives them to move toward that quality metric,” he said.

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