By: Eric Hoffman

Caring for vulnerable cancer patients in the COVID-19 era is catalyzing change in community oncology. The expansion of tele-medicine services, and the value these in-home virtual visits provide patients, is a trend that is likely to continue in the future.

On March 17, the Centers for Medicare and Medicaid Services (CMS) loosened its regulations to allow providers to be reimbursed for tele-health visits. Equally important, the temporary action also allowed researchers to keep some clinical trials open by evaluating and enrolling out-of-state patients.

OneOncology partner practices utilized tele-medicine services prior to the pandemic, but each practice has significantly stepped up remote patient engagement during this crisis. The goal is to keep patients who aren’t on treatment at home and away from the clinic and also to reduce the number of times patients on active treatment need to come to the clinic during the pandemic.

In March, OneOncology partner practices held on an average of 230 virtual visits a day and those number are trending significantly higher in April. While many tele-health visits are follow-up appointments, oncologists are also using tele-health services to see new patients too. Dr. Lee Schwartzberg, OneOncology’s Chief Medical Officer, says new consults are being scheduled now: “For example, when we have a hematology consult and the patient needs to be seen before labs are ordered, a tele-health visit can work very well.”

For some patients who are on treatment, Schwartzberg says the clinic visit was de-linked from a treatment visit, which allows for the oncologist and patient to have one tele-health visit and one in-person appointment for treatment and lab.

Community oncology, known for its agility and ability to scale innovation quickly, is adopting tele-health services to meet their patients’ needs while also pursing Quadruple AIM goals. As just one example, New York Cancer and Blood Specialists was even able to stand up a “drive thru” lab so patients don’t have to leave their cars and still can get get their blood tested while practicing proper social distancing. 

“By loosening the regulations at both the federal and state levels, we were able to evaluate patients for eligibility in clinical trials that we otherwise couldn’t because of state licensing requirements,” says Dr. Natalie Dickson, Chief Medical Officer at Tennessee Oncology. “Now we’re able to continue to provide access to these important clinical trials for new patients in other states.

Dr. Dickson, who is also the Chair of OneCouncil, the partnerships all-physician committee, says Tennessee Oncology began tele-medicine in 2017 in three service areas so the practice could better understand workflow efficiencies, best practices for remote patient engagement and how to code and bill for the services.

What began as a pilot project two years ago in practices has expanded dramatically and today all OneOncology practices are conducting visits and working through some of the challenges inherent with technology.

“It’s a little more difficult for older patients,” Dr. Dickson says. “But physicians are really excited about the potential and are able to spend a little more time with their patients to overcome any technology barriers.”

Patients tell their oncologists how much they appreciate the peace of mind a virtual home visit brings – especially now during the COVID-19 era.  Once patients and their physicians resolve any connectivity issues, tele-visits are proving to be easier than anticipated for both the physician and their patients.

Measurement is also key component. Dr. Dickson says practices are capturing the patient experience though data collection. “Since ultimately tele-health visits are intended to enhance value for our patients, we want to know exactly what our patients think of this service and how it can be improved,” Dr. Dickson concluded.