The COVID-19 pandemic had an immediate and dramatic impact on revenue for US cancer centers. In mid-March, right before the national state of emergency was declared, community oncology practices working with the healthcare technology and services company, Flatiron Health, reported an overall average of approximately 4000 appointment cancellations per day. Over the following 2 weeks, that cancellation rate spiked to more than 7500 appointments per day.
“Digging deeper, we saw about a 60% increase in patient cancellations across the board: about a 50% drop in new patient visits and about a 33% drop in infusions,” said Nirav Shah, MBA, Flatiron’s Managing Director for Revenue Cycle Management, speaking at a recent webcast hosted by the Association for Value-Based Cancer Care (AVBCC). In this session, moderated by AVBCC Founder Burt Zweigenhaft, PhD, D.Litt, Nirav Shah, along with Parag Shah, President of Practice Solutions for Integra Connect, shared data-driven insights on the evolution of practice changes, from the early days of the pandemic through late summer, and discussed what will be necessary to survive in the new environment.
“As practices moved to telehealth, they had to also reconfigure their EMR and revenue cycle management platforms to make sure that they would be reimbursed for the services they provided,” said Nirav Shah. “So much was still unknown, and they needed a robust way to track key performance indicators to make decisions about performance based on data.”
For example, Flatiron helped its clients capture the reasons why some patients were unwilling to shift to telehealth, to adapt to patients’ concerns and improve the adoption rate. “We found that of patients who were unwilling to make the move, about 31% didn’t want to receive care until COVID was over, 24% needed additional services, 23% rescheduled at a future date, and 16% didn’t have access to technology,” Nirav Shah said. “By changing messaging and helping practices adopt new ways to engage, such as drive-through labs and injections and remote waiting rooms, we were able to significantly decrease the number of patients who were unwilling to participate in telehealth.”
According to Nirav Shah, as of late summer, chemotherapy visits had returned to near pre-pandemic levels, and the general cancellation and no-show rates among Flatiron’s clients had also largely stabilized. “Interestingly, this is consistent across all of our regions,” he said. “We had thought there would be nuances across regions, but while there are still a couple of states where the volume still hasn’t picked back up to pre-COVID, such as Arizona, surprisingly in states like Texas, Florida, and California, the cancellation and no-show rates as well as volume have started to normalize.”
Integra’s Parag Shah reported similar data from the company’s approximately 2000 providers, which range from community-based oncology centers to academic medical centers. “Some of the biggest challenges they have faced from an operational perspective include how to maintain operations over the long-term with a substantial percentage working from home,” he said. “What are your IT security solutions? How do you manage teams to ensure productivity? We worked on virtual meeting rooms and other team management solutions to maintain employee engagement.”
According to Parag Shah, sustaining that over the long-term in a work-from-home environment can be challenging. “When practices made the shift initially, we found that productivity actually went up. But as people started getting more comfortable, we started seeing a 5% to 6% drop in productivity. That can be significant, especially when you’re getting ready to do the month-end close. We’ve helped clients implement workflow monitoring tools and process changes for telecommuting to help keep employees engaged.”