Providing Cancer Care from a More Comforting Place

Over the course of the last decade and a half, outpatient cancer care has seen tremendous growth, thanks to many factors.

Some of these factors include regulatory, legal, and economic reasons, namely the Medicare Prescription Drug Improvement and Modernization Act of 2003, which changed the calculus of infusion therapy reimbursements.¹

The explosion of community care clinics that serve rural areas has also contributed to the growth of outpatient care. And in many examples, these care settings have shown success in clinical therapeutic contexts, including precision medicine (as reported during the American Society of Clinical Oncology’s 2018 annual meeting).²

But mostly, the shift toward outpatient care has leaned into patient preference. The ability to stay out of the hospital environment and in a smaller, more comforting and familiar setting is often linked with higher patient satisfaction.³

Plus, outpatient models allow another benefit beyond the familiarity of a smaller clinical environment: Outpatient reimbursement for patient assistance programs like financial counseling. And it’s all at a lower price point, reports the Journal of Hematology Oncology Pharmacy. Generally speaking, chemotherapy administered in an outpatient facility costs less than that of inpatient scenarios.⁴

The Diversity of Outpatient Clinic Types

Though chemotherapy infusion centers might be the first thing people think of when they hear “outpatient oncology,” the range of these out-of-hospital clinics can vary quite widely.

In addition to palliative care clinics, which continue to grow,⁵ and clinics that provide other treatments like radiation, survivorship programs also mark a continued driver of outpatient care settings. This trend takes place as more specialists recognize the need to offer post-curative care for both pediatric and adult cancer survivors. Plus, as a transitory leg of care, survivorship programs give survivors alternative providers to support their needs, which eases the bandwidth off medical oncologists.⁶

For example, Dana-Farber/Boston Children’s offers a pediatric survivorship program with parent resources to ease the transition from treatment to normal life.⁷

Likewise, the University of Pittsburg Medical Center Head & Neck Cancer Survivorship Clinic bases its services on patients’ individual needs, from swallowing therapy to hearing health.⁸

Facility Advancements for Outpatient Care Settings

With the rapid growth of outpatient oncology — from palliative clinics and infusion centers to survivorship programs — it makes sense that facility planners and remote-enabled technologies are racing to keep pace with it all.

As a result, outpatient centers have continued to evolve to meet the needs of patients and providers alike, aided by state-of-the-art advancements that bring inpatient procedures into outpatient settings.

The Blood and Bone Marrow Cancers Program from Johns Hopkins Medicine represents a unique example of this advanced type of outpatient-to-inpatient care. Most notably, the facility provides ancillary patient services, from counseling to nutritional guidance and even special housing for some cases. Plus, certain procedures — like bone marrow transplants — take place in the outpatient setting.⁹

Another example is the Memorial Sloan Kettering Josie Robertson Surgery Center, which has helped move surgical oncology further into the outpatient environment. Technology has greatly accelerated Memorial Sloan Kettering’s evolution, thanks to telemedicine conferencing that enables doctor-patient communication and tracking systems so that patients aren’t bed-bound.¹⁰

Overcoming Limitations of Outpatient Procedures

That tech-enabled movement into the outpatient space, particularly for surgical oncology, represents an opportunity for other centers to follow suit. That’s because surgery is typically among the top reasons a patient would receive care in an inpatient, rather than outpatient, setting.

For example, in a study involving prostate cancer patients, the most common treatment inpatients received was surgery (57 percent), compared to radiation for outpatients (76 percent).¹¹

For years, this marked a considerable limitation to outpatient clinics, but with Memorial Sloan Kettering and Johns Hopkins’ examples, it’s very likely the industry might see more surgical oncology clinics in the future.

Other barriers to outpatient services include those of sheer size. Often, smaller clinics (especially those more rural and disconnected from larger urban areas) have limited access to specialty expertise, which triggers more referrals into the city.

However, notes one paper in Cancer Control, that limited availability of specialized expertise could be solved by educational technologies that pair experts with local providers virtually, notably through e-consults with subject matter experts and CME materials shared through interactive learning modules.⁵

Other Benefits of Tech-Powered Outpatient Education

Of course, providers aren’t the only group that stands to gain from such learning tools. On the patient side, remote monitoring, telemedicine, and hotline access mimic the around-the-clock care of an inpatient model, but with the freedom of outpatient visits. And having those technologies available for the patient — where they can pick up the phone with any question or concern — is essential.⁵

According to research, those education-based technologies reduce the incidence of emergency visits, too. In one study involving lung cancer patients, implementing such patient education tools yielded a 30 percent reduction in ED visits.¹²

Streamlining Data from Inpatient Hospital to Outpatient Clinic

Tying the inpatient/outpatient process together, of course, requires an easy-to-use workflow dashboard. From making patient records available system-wide to transitioning chart data to external providers, such systems streamline the data in a consistent way to make it seem like the patient is seen under just one roof, even when they’re not.

Structures where inpatient and outpatient clinics have different EHRs can make things more complicated, but not altogether impossible.¹³ Still, workflow systems like Centricity consolidate images, records, reporting, and surveillance for ease-of-use among primary and specialty providers.¹⁴

As these all-in-one dashboards grow — and more centers implement them — it’s likely to boost the already thriving outpatient movement. That movement helps patients in many ways, but most importantly with this single aim: providing care from a more comfortable place.

References:

Cancer Care Migrates to Outpatient Setting. The Journal of Healthcare Contracting. http://www.jhconline.com/cancer-care-migrates-to-outpatient-setting-2.html. Accessed June 21, 2018.
Session at ASCO Shows Community Oncology Success in Precision Medicine. MedCity News. https://medcitynews.com/2018/06/session-at-asco-shows-community-oncology-success-in-precision-medicine/. Accessed June 21, 2018.
Economic and Patient-Reported Outcomes of Outpatient Home-Based Versus Inpatient Hospital-Based Chemotherapy for Patients With Colorectal Cancer. Support Care Cancer. https://www.ncbi.nlm.nih.gov/pubmed/20496154. Accessed June 21, 2018.
Transitioning from Inpatient to Outpatient Chemotherapy Saves Money, Increases Patient Satisfaction. Journal of Hematology Oncology Pharmacy. http://jhoponline.com/ton-online-first/17001-transitioning-from-inpatient-to-outpatient-chemotherapy-saves-money-increases-patient-satisfaction. Accessed June 21, 2018.
New Frontiers in Outpatient Palliative Care for Patients With Cancer. Cancer Control. http://journals.sagepub.com/doi/pdf/10.1177/107327481502200412. Accessed June 21, 2018.
Managing the Complexity of Outpatient Oncology Care. CardinalHealth. https://www.cardinalhealth.com/en/essential-insights/managing-the-complexity-of-outpatient-oncology-care.html. Accessed June 21, 2018.
Survivorship Care: David B. Perini, Jr. Quality of Life Clinic. Dana Farber/Boston Children’s. http://www.danafarberbostonchildrens.org/why-choose-us/cancer-survivorship/transition-off-therapy.aspx. Accessed June 21, 2018.
UPMC Head & Neck Cancer Survivorship Clinic. University of Pittsburgh, Department of Otolaryngology. http://www.otolaryngology.pitt.edu/centers-excellence/upmc-head-neck-cancer-survivorship-clinic. Accessed June 21, 2018.
Inpatient/Outpatient Program and Support Services. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/blood_bone_marrow_cancers/inpatient_outpatient_support/index.html. Accessed June 21, 2018.
The Future of Outpatient Cancer Surgery Takes Shape with New, First-of-Its-Kind Facility. Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/press-releases/future-outpatient-surgery-takes-shape-new-first-its-kind-facility. Accessed June 21, 2018.
Evaluating Treatments and Corresponding Costs of Prostate Cancer Patients Treated Within an Inpatient or Hospital-Based Outpatient Setting. Future Oncology. https://www.ncbi.nlm.nih.gov/pubmed/25675125. Accessed June 21, 2018.
Reduction of Emergency Department Utilization Via Access to Outpatient Cancer Care. ASCO Meeting Library. https://meetinglibrary.asco.org/record/103157/abstract. Accessed June 21, 2018.
How Do You Manage Documentation When Inpatient, Outpatient EHRs Are Different? HealthcareIT News. https://www.healthcareitnews.com/news/how-do-you-manage-documentation-when-inpatient-outpatient-ehrs-are-different#gs.aJf93MQ. Accessed June 21, 2018.
Centricity – Healthcare IT. GE Healthcare. http://www3.gehealthcare.com/en/products/categories/healthcare_it. Accessed June 21, 2018.