Innovation in Cancer Care Delivery in the Era of COVID-19

Samyukta Mullangi, MD, MBA; Stephen M. Schleicher, MD, MBA; Emeline M. Aviki, MD, MBA


J Oncol Pract. 2020;16(11):718-719. 

In This Article

Justify Start-up Costs for Technology Adoption

Third, and likely most visible, the value proposition for telemedicine since COVID-19 has completely morphed. Before COVID-19, telemedicine adoption lagged for a variety of reasons, including the start-up costs involved in purchasing technology licenses and training providers, imperfect pay parity between telemedicine and traditional office visits (leading to fear that the cheaper telemedicine would soon cannibalize more lucrative revenue streams), resistance to deviating from the status quo by practicing providers, and restrictive regulatory barriers with complex licensing requirements. Now, telemedicine offers the safest means to continue to provide high-quality care for patients and also to generate revenue through new or existing nonurgent (and even some urgent) outpatient visits[5] to maintain business operating expenses. More recently, the Centers for Medicare and Medicaid Services (CMS) announced equal reimbursement for audiovisual telemedicine visits, although we would argue that even in the absence of complete pay parity, telemedicine would have thrived. Clinics that were wary of the significant start-up investment costs for telehealth are now witness to the choice between telehealth-generated revenue to maintain clinic survival and bankruptcy. Providers who previously chafed at transitioning from handwritten records to electronic health records are now in a matter of weeks opening telemedicine service lines for patients. Oncology patients in rural communities away from multidisciplinary health care systems now have easier access to providers. With the adoption of telemedicine by oncology care providers across the country, patients will benefit long after COVID-19.

COVID-19 has undeniably been an atomic bomb not just to our industry, but to society as a whole. The hardship inflicted by this pandemic will continued to be felt for a long time. However, to paraphrase Winston Churchill, we shouldn't let a good crisis go to waste. COVID-19 has caused providers to really consider the value of their services to patients and emphasize choices that are high value for patients. Where possible, it has incentivized physicians to take patient convenience into account to try and curtail patient touchpoints with the health care system. It has proven to be a great forcing mechanism for telehealth adoption.

One challenge that remains is the uneven technology capabilities of our patients, many of whom may not have access to smart phones or high-speed internet. Fortunately, rapid communications between providers and policymakers have resulted in CMS addressing these issues in an unprecedented timely manner.[6] It will be important that health systems collect data on efficacy, costs, and patient satisfaction so that we can have data to inform the postpandemic adoption of new care models that integrate telehealth to the extent that patients need or want it. Although it is unclear whether the regulatory loosening and reimbursement trends from Medicare will have staying power after COVID-19, we hope that at least the patient-centered changes we are witnessing in the delivery sector can last. Indeed, after we get through this crisis with the aid of a variety of innovative organizational transformations, it will be hard to imagine going back to business as usual.