Cancer Does Not Stop for COVID-19, but Reform Becomes a Challenge

The coronavirus disease 2019 (COVID-19) pandemic has affected every aspect of health care, and oncology is no exception. But as studies begin to illustrate the fallout of the early months of the pandemic in regard to cancer care, it is becoming clear that the impact will not be short-lived.

The theme is woven throughout the agenda at the 2020 Community Oncology Alliance (COA) Virtual Payer Exchange Summit on Oncology Payment Reform on October 27-28, where providers, payers, and employers have an opportunity to frankly discuss ongoing issues and successes in care reform. But COVID-19 has not distracted from the heart of the matter: identifying the pieces that allow oncologists to provide quality care to cancer patients.

“It’s typically the health care system has been about utilization or consumption. We have moved toward a situation where we want to pay for quality and value and outcomes. Show me what you've done, show me how it's different. And we'll get reimbursed accordingly,” Bo Gamble, director of Strategic Practice Initiatives at COA, said in a talk on that state of payment reform that kicked the sessions off.

During a session on the first day, a panel discussed the ways COVID-19 continues to impact cancer care and payment reform. Moderated by Ted Okon, MBA, executive director of COA, it included Debra Patt, MD, PhD, MBA, vice president at Texas Oncology; Lucio Gordan, MD, president and managing physician of Florida Cancer Specialists and Research Institute, and member of the COA Board of Directors; and Glenn Balasky, executive director of Rocky Mountain Cancer Centers in Colorado.

The first point of discussion was a study released by Avalere Health and COA last week, on which Patt was lead author and Gordan was a co-author. Their research showed that cancer screenings, biopsies, and treatment administrations saw an alarming drop in the early months of the pandemic compared to the same time frames in 2019. Perhaps more ominously, some of the most common treatment procedures saw an even sharper decline in July, a phenomenon Patt attributes to the lack of screenings and therefore diagnoses earlier in the year.

“Cancer doesn't stop during COVID-19. Cancer continues. I suspect in 2020, about half of cancers are likely to go undiagnosed,” Patt said. “And of course, we were concerned because the natural consequence of that delay would be a stage migration to patients at a higher stage of disease and their cancers are more likely to be associated with higher morbidity and mortality.”

Aside from the worst of the fallout, which are the negative ramifications from a patient experience standpoint, Patt and Gordan also pointed out that later diagnoses and more complicated treatments make it more difficult for patients to participate in the workforce and cost the system more money. To keep patients from struggling with later stage disease, Gordan stressed the importance of getting information about critical screenings out to patients.

“I think, as we may not have done the best job in terms of COVID-19 pandemic control, I think we can do a very good job in terms of getting our patients back to a screening and early diagnosis of diseases, including cancer and others,” Gordan said. He and Okon have developed a plan for a major public service announcement campaign to do just that, they said.

And with a third wave of the pandemic seemingly imminent, Okon turned to Balasky for a picture of the situation in states like Colorado that did not see the worst of the first wave, versus where Patt and Gordan’s practices are based.

“We've managed all these streams of chaos. But then underneath all this chaos, things have started coming back… Now I could tell you sitting here, four or five months past those lockdowns, we're actually seeing more new cancer patients arriving than we were pre-COVID,” Balasky said.

While neither Patt nor Gordan have seen numbers at those levels in their respective practices, both have utilized telehealth to help reduce the gaps in patient traffic created by the pandemic. Telehealth growth is one silver lining that has come from the crisis, Patt said. Her practice has been seeing about 20% of new patients 25% of established patients on telemedicine, she said.

Despite the efforts in telehealth, however, things are not back to normal just yet. “I think that helps close the gap, but we have not increased from our pre-COVID rates, and we have not done anything to close the gap that's been created in the last 6 months,” Patt said.

On the administrative side, juggling so many new policies and the issues presented during the pandemic has made it difficult for practices to make progress in every initiative they would like to, according to Balasky.

“The side effects of COVID onto our practices are affecting our ability to do what would really be exciting,” Balasky said. “You know, telemedicine and to increase that engagement…. But can we get at those new opportunities when we'd like to, when we're definitely being constrained?” He said that delays in alternative payment models are a blessing and a curse, because everyone wants reform but practices have too many COVID-19 matters to deal with right now.

That also applies to oncologists themselves. Gordan said he agrees with the recent decision to delay the start of the CMS Radiation Oncology (RO) Model that was slated to begin in January of 2021—a sentiment that the rest of the panel echoed.

“It's not that we are afraid or reluctant to embrace any value-based care Initiatives,” Gordan said. “Community oncology has proven beyond any doubts that we can do it and we can deliver. We're nimble, we're less expensive than other places, and we delivered outstanding care with excellent patient satisfaction. It's just that timing is complicated.”

The pandemic has also taken a serious mental toll on many, and in closing, Patt said she now has to build time into visits to discuss COVID-19 management and address general wellbeing with patients.

"There is not a patient that leaves my office without talking about it,” Patt said. “It's not because I like to talk about it, it's because it is it is what is all consuming to them. It's what's paralyzing. It's what's led people to forego seeking medical evaluation when they've had symptoms, and sometimes abandoned treatment. It's a very serious issue, and I feel like we need to think about that: how we serve our patients behavioral health needs better.”

During an ongoing public health crisis, the panel agreed that although reform is something everyone wants, the strain that the pandemic has placed on practices limits what can be done while still allowing physicians to provide the care that cancer patients need.