Dr Lucio Gordan on Telehealth and New Care Initiatives in COVID-19

Coronavirus disease 2019 (COVID-19) is ever-present in discussions of oncology care and payment reform. As the Community Oncology Alliance (COA) Payment Exchange Summit tackles this and other key topics in payment reform, Lucio Gordan, MD, president and managing physician at Florida Cancer Specialists, discusses the impact that the pandemic continues to have on health care delivery and ongoing reform initiatives.

Transcript

COVID-19 has seen increased coverage of telehealth, which your practice has bolstered to reduce patient exposure to staff when possible. What new insights should payers take into account when reassessing those policies post-pandemic?

Thank you for the question about telehealth and the future of telehealth as it relates to the payer relationship. So, telehealth has been a lifesaver for us in our patients as far as allowing us to maintain access to care, especially in the first wave and second wave—March, April, and then July here in Florida. And unfortunately, it looks like it's going to happen again, sometime in December, here in the South. So it alleviates a lot of the stress because patients don't have to necessarily come to the clinic, and a lot of times we're able to do telehealth visits.

Number two, I think telehealth is an incredible tool for value. A lot of times patients who don't feel that they have the proper access to care, end up showing up in the emergency department or urgent care just because of a simple question or something that could be handled pretty quickly with a face-to-face electronic visit. And you know what happens when they show up in the emergency room or urgent care. There's at least a 50% to 70% chance they get admitted and then stay in the hospital and undergo unnecessary tests, which is very expensive and there's potential exposure. So I think telehealth should be should continue not only during COVID-19, which is a must just to prevent more complications of COVID exposure, but also in the future. I don't think anybody wants to go back to the past, pre-telehealth.

At Florida Cancer Specialists when we turned on telehealth, the first few days you know the uptake was relatively small because we're training our physicians but within a matter of a week, we had 25% of all encounters done via telehealth. This was in March, April and then it has come down to 15%. And then 10%. Our average is about 10% at this point. So telehealth is not like a panacea that will replace interaction with our patients, but I think it is adjunctive as far as access to care. I think the steady state will be anywhere from 10% to 15% of telehealth in the future.

Has the pandemic highlighted any disparities in telehealth availability in your practice, and what steps have been taken to try and make it accessible?

Yes, so unfortunately, any stresses to health care or social or economic areas in life will cause exacerbation of disparities, right? So we unfortunately know that individuals who are quote unquote, socially challenged from access to care, access to proper preventive treatments and actual treatments, they do worse from a clinical standpoint in a vast number of disease processes—diabetes, heart disease, COPD, and others. And there's this electronic challenge. A lot of us as Americans, especially in rural areas, and some of us who have more advanced age, may have trouble connecting with internet or having the fast speed connections to allow us to do video exchanges. So, it has exacerbated the disparity for sure. Until we have global fast access or 5G technology that's spreading in the country, in a uniform and normalized fashion, we'll continue to see issues related to telehealth inefficiencies to some extent.

What do you hope payers will take away from the COA panel discussion on the pandemic’s impact on oncology and payment reform?

Yeah, so I hope our colleagues in the payer industry will continue to to be flexible as they have. Again, I must emphasize how well we have worked together in general, especially as it pertains to telehealth and maintaining the revenue cycle, and operating well as f ar as payment for procedures in database operations as well. So kudos to our payers that have worked with with us fairly well.

You know, one thing that could be improved is prior authorization, again, there's a tremendous amount of wastage in prior authorization by payers. And it's estimated that a regular physician spends anywhere from 15 to 20 hours in prior authorization processes per week, the national costs of prior authorization patient is in the order of $30 billion per year. And you're not going to find any doctors or patients who will say that prior authorization improves quality of care access or outcomes. It's just, it can't happen. I understand why it exists, but I also don't understand why it exists because it doesn't add value to the whole equation of our health care delivery system.

So, I hope our payers take away from our presentation and others that telehealth should stay and be viable, that they don't omit payment or decrease payment for telehealth or electronic exchanges significantly, or otherwise, we'll go back to square one. Again, telehealth, in my opinion and that of other colleagues, is a very strong value-based tool and should be continued to be implemented and expanded nationwide.

As CMMI develops the Oncology Care First model, what specific lessons from the pandemic should be incorporated? Is the movement toward bundled payments the right one in this atmosphere?

Yes, great question about the timing of implementation of new methodologies of payment. I am fully behind value-based care initiatives. As you may know, Florida Cancer Specialists is probably the largest Oncology Care Model (OCM) practice in the country. And we are on 2-sided risk and we have done very well. And we are also doing value-based contracts with several large commercial payers in the country and are successful to a significant extent. But during COVID-19, it's really a bad time to do new models and experimenting or pushing the envelope too quick, too hard, because we are under a tremendous amount of stress, and none of us wants to fail and not deliver and have consequences in terms of 2-sided risk for our practices that could impact access to care to our patients.

For Oncology Care First, I'm happy that they pushed back 12 months for 2022. We may need more time, but we'll see how this plays out. I'm not convinced that vaccines will be available that quickly, like in January or February—maybe April, March, who knows, 2021. It will probably take three to four months or so to have a significant number of us vaccinated, and it's said that maybe 50% of us in America may choose not to get vaccinated, which is more complicated. So what I'm saying here is we're far from being close to the end of the tunnel here in terms of COVID-19. So I would hope that our commercial payers and CMMI, CMS look at us and look at these models with flexibility so that we're able to do things properly, without putting extra risk to the practices and as it relates to acts of care. So hopefully, we can continue to work together productively in a conducive manner.