July 1, 2016
Hackensack oncologists say they have saved more than $1 million in one year by reducing unnecessary scans for cancer patients, part of an overall effort to improve care and reduce costs.
And Morristown Medical Center is planning to open a specialized unit at the hospital this year where oncologists — rather than harried emergency room physicians — will treat cancer patients when problems arise to better triage and reduce unnecessary admissions.
The oncologists are among the 200 physician groups selected by the federal government to participate in a program that starts this month to lower the cost of cancer treatment for Medicare patients, a strategy that is already under way in North Jersey.
With more than 1.6 million new cases of cancer expected to be diagnosed this year and the cost of treatment projected to increase dramatically — 27 percent in a decade — the federal Centers for Medicare & Medicaid Services is turning to physicians to help the government rein in spending.
“CMS is taking the first move at reducing the total cost of care by changing care management, and I applaud them,” said Dr. Andrew Pecora, founder of Regional Cancer Care Associates and chief innovations officer and vice president of cancer services at Hackensack University Medical Center.
The initiative calls for more coordinated care for patients who are receiving chemotherapy, infusions or similar treatment: physicians must have immediate access to electronic medical records; and a navigator must be assigned to help patients in the confusing new world of specialists, appointments and treatments. And results from scans, blood tests and other diagnostics must be received in advance of patient appointments to avoid unnecessary physician visits and duplications in tests.
“The Oncology Care Model encourages greater collaboration, information sharing and care coordination, so that patients get the care they need, when they need it,” said Health and Human Services Secretary Sylvia M. Burwell.
More than 100 physicians in Regional Cancer Care Associates in Hackensack and Washington, D.C., and Atlantic Medical Group in Morristown will receive grants to hire more patient navigators. If the cost of providing care is less than what Medicare expects the group to spend, there’s the potential for the groups to share in the savings, physicians said.
Two primary goals
Throughout the nation, physicians, hospital executives, insurers and others in health care are focused on key goals: delivering precision medicine — a more personalized and effective way to treat cancer and other disease — and cutting medical spending.
Precision medicine takes into account a person’s genes, environment and other factors as well as type and stage of disease. Advances in this approach have already led to new treatments. Patients with breast, lung, and colorectal cancer, and melanoma and leukemia routinely undergo molecular testing that helps physicians select treatments to improve the chance of survival and reduce side effects.
At the same time, reimbursement patterns are moving away from fee-for-service models to new systems that reward preventing illness and better managing disease to keep people healthier — an essential shift as the nation’s 76 million baby boomers age.
“The fundamental question is, how do you align precision medicine and cost reduction?” Pecora said. “That’s the Holy Grail.”
Hackensack, under Pecora’s efforts, created a system to do just that. Known as COTA, it’s a digital classification network that tracks patient gender, age, family history, type and stage of disease, and treatments. A patient is assigned a number and the system tracks the numbers to determine outcomes. Seven years in the making, a U.S. patent was issued this week, Pecora said.
“Due to the skyrocketing cost of cancer care, we began our work on the system with a dedicated group of cancer specialists at the John Theurer Cancer Center at Hackensack,” Pecora said. “We were able to show improved clinical outcomes and reduced total cost.”
Physicians reduced unnecessary imaging such as CT and PET scans by 25 percent, which resulted in more than $1 million in savings in 2014, he said.
And the average 28-day stay for leukemia patients has been reduced this year to just 10 days with essential monitoring continued at home for most patients, Pecora said. The elderly are not included in that model, Pecora said.
Studies show that more scans did not improve longevity for many cancer patients, Pecora said.
Horizon Blue Cross Blue Shield of New Jersey, the state’s largest insurer, was an early investor in COTA and has participated with Regional Cancer Care Associates in developing specialized care for breast cancer patients that reimburses the physicians based on quality, not quantity of care received.
According to the National Institutes of Health, medical costs for cancer in the year 2020 are projected to reach at least $158 billion — an increase of 27 percent over 2010. A significant proportion of those diagnosed are 65 and older and Medicare beneficiaries, the government noted.
At Morristown Medical Center, cancer patients can expect improved emergency care by the end of the year when the specialized unit at the hospital opens, said Dr. Eric Whitman, medical director of the Carol G. Simon Center.
The hospital already has a good track record with lower-than-average rates of hospital visits for Medicare cancer patients, Whitman said.
The planned unit will lead to more precise diagnoses, shorter waits for treatment and fewer emergency visits and admissions, he said.
“When a cancer patient comes to the ER in the middle of the night, they might do tests we as oncologists wouldn’t do because we’re more familiar with what’s happening,” Whitman said. “This will streamline the whole process.”