COA Consensus: Telemedicine Is Here to Stay, but Practice Transformation Could Stall

Oncology practices are grappling with financial uncertainty, supply shortages, and fear among patients. Already facing risk from cancer, they are immunocompromised and now face a new threat from coronavirus disease 2019 (COVID-19).

However, according to a panel convened Friday by the Community Oncology Alliance (COA) on legislative priorities, the runaway success of telemedicine during the pandemic means this new tool will likely become a permanent part of the treatment landscape. The session was part of day 2 of the 2020 Virtual Community Oncology Conference.

Moderated by COA Executive Director Ted Okon, MBA, the discussion featured:

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• Deborah Kamin, RN, PhD, Vice President, Policy & Advocacy, American Society of Clinical Oncology
• Brad Tallamy, Senior Director, Government Affairs, AmerisourceBergen
• Ben Jones, Vice President, Government Relations, The US Oncology Network
• Christian G. Downs, JD, MHA, Executive Director, Association of Community Cancer Centers.

Okon kicked off the session by asking each panelist to list the 3 top issues that COVID-19 has created for cancer care. Although their perspectives varied, all cited lost revenue and general instability, at a time when patients are most vulnerable. Tallamy said the crisis has created “newfound awareness” of the fact that the bulk of US generic medications are manufactured overseas—and some in Congress think this must change. Downs said hospitals not hit hard by COVID-19, including those in rural areas, have different issues—canceled procedures and visits are adding to their red ink.

Jones echoed concerns heard elsewhere of the need to keep practices stable—hence, CMS’ program to advance payments—because access could be an issue once the pandemic ends. Downs agreed there will be “pent-up demand” for surgeries, and COA President Michael Diaz, MD, of Florida Cancer Specialists predicted during a recent webinar with The American Journal of Managed Care^® that the post—COVID-19 months could bring a wave of cancers being diagnosed at later stages due to missed screenings.

Jones also raised the topic that, without COVID-19, would have been the top issue at a COA gathering: the challenges of practice transformation. “We’re in the midst of this transition to value-based care,” he said, citing proposals for Oncology Care First, a model from the Center for Medicare and Medicaid Innovation (CMMI) to succeed the Oncology Care Model (OCM), as well as a controversial Radiation Oncology alternative payment model that was set to take effect by this summer. Work on these models is in limbo, and whatever CMMI decides to do—and when—will affect cash flow in practices that have already been hit hard by the pandemic.

“There's a significant amount of anxiety from the practice’s perspective—they’re under pressure,” Jones said. “They recognize that we're in the middle of practice transformation that can be truly disruptive at a time like this.”

The most important challenges, he said, involve patients. “Our patients in particular, they're immunocompromised, and they're under an enormous amount of stress as it is,” Jones said. “If you couple that with the fact that almost 27 million Americans are newly unemployed over the last 5 weeks, there has to be a measure that accounts for that … In short, these patients have to have access to seamless care.”

Telemedicine. All agreed that the one bright spot of the experience has been the rise of telemedicine. After years of smaller steps, CMS has issued multiple guidance documents to allow the technology to flourish, with some practices going from a few visits a week to hundreds. Tallamy said it was a “no brainer” that CMS should allow this expansion to continue. Telemedicine makes sense with the OCM, he said, “which already has incentives to keep folks outside of the hospital.”

Downs said until the pandemic, the barrier was always whether patients would be comfortable with telemedicine. “Patients are comfortable—that’s one box we can check going forward,” he said.

There will be reimbursement issues—commercial payers will have to be sold on paying equal rates, especially when patients can only take a phone visit for lack of technology. The panelists agreed that, in general, an initial visit should take place in person. Okon credited CMS and Administrator Seema Verma, MPH, with moving quickly in this area. “I give her a lot of credit,” he said.

The panel listed issues they will be watching as the election approaches:

• Home infusion. COA has come out firmly against home infusion for chemotherapy; ASCO’s Kamin said she anticipates battles with pharmacy benefit managers over this issue. “We do not believe it is a safe alternative,” she said.
• Drug prices. Kamin said this issue will not go away, but the panelists discussed how the need for the pharmaceutical industry to come up with a vaccine would strengthen the manufacturers’ position.
• 340B reform. This perennial hot topic among COA members may take a back seat as hospitals seek to shore up revenue.
• The uninsured. The ranks of people who lose employer-based coverage will soar, and it remains these newly uninsured or underinsured will pay for cancer care.