In early December 2019, the Association of Community Cancer Centers (ACCC) Immuno-Oncology Institute hosted a Telemedicine Roundtable, convening Institute leadership and experts from relevant areas of health care. Participants shared perspectives on telemedicine in oncology, current telehealth uptake among cancer programs and practices, and the potential to leverage an expanding range of technologies. These new technologies aim to enable increased interdisciplinary collaboration; better patient education; greater access to clinical trials; and wider dissemination of expertise, knowledge, and education for members of the multidisciplinary care team.
None of the stakeholders present at the Roundtable discussion could have anticipated the rapid, widespread deployment of telehealth solutions that would occur months later. In mid-March 2020, with the COVID-19 public health emergency accelerating, the federal government began to ease restrictions on the use of telehealth. Over several weeks, the Centers for Medicare & Medicaid Services issued a series of waivers and flexibilities, along with coding and billing updates, that would level many of the historical obstacles to widespread use of telehealth across the US health care system.
Many of the barriers to broader adoption of telehealth solutions in cancer care delivery are reflected in findings from the ACCC 2019 Trending Now in Cancer Care survey. Respondents did not include telehealth among the top programs and services to be added over the next 12 months. Live polling conducted during the 2019 ACCC National Oncology Conference revealed that 44% of attendees were not currently using telehealth. Top barriers cited were reimbursement (74%), regulatory requirements (58%), and operational changes required, eg, staffing or technology (58%).
In the face of the COVID-19 pandemic, these barriers have been temporarily removed. Providers, patients, payers—virtually all stakeholders in the nation’s health care system—have turned to telemedicine. Confronted with a highly contagious, community-spread disease to which the cancer patient population is at increased risk, these technologies have been a lifeline for keeping patients and providers safe, enabling effective social distancing, facilitating the continued delivery of cancer care services, and helping hard-pressed health care facilities in COVID-19 hot zones to rapidly implement efficient workflows to accommodate reduced staffing.
Responding to the continued uncertainties of the COVID-19 pandemic has required nimbleness, adaptability, collaboration, and ingenuity from the oncology community. ACCC is listening and responding to the needs of its membership and the wider oncology community. In response, ACCC has provided curated online resources, a COVID-19 webcast series with episodes that focus on the “how-to” of setting up telehealth services from scratch and correct coding and billing in the midst of changing policies and procedures. ACCCExchange, the online member forum, continues to connect multidisciplinary team members for questions and answers in real time.
In March 2020, a few weeks before the announcement of the COVID-19 public health emergency, Susan Dentzer, senior policy fellow at the Duke-Margolis Center for Health Policy, challenged attendees at the ACCC 46th Annual Meeting and Cancer Center Business Summit to imagine cancer care “without walls.” Calling out the many components of health care that do not require the “laying on of hands,” Ms Dentzer argued for moving these aspects of care into the virtual space of telemedicine. She emphasized that obstacles in the way of wider telehealth deployment (eg, privacy and security concerns, potential disruption of existing business models, lack of payment models, uneven broadband access, and the need for workforce retraining) have nothing to do with optimizing patient care. The COVID-19 pandemic has decimated these obstacles with a non-negotiable demand to adapt care delivery to address the crisis.
In closing her comments, Ms Dentzer agreed that virtual care will never completely replace the face-to-face clinic visit. “I think we will evolve hybrid models,” she said. “Some kind of balance for when you need an in-person consult and when it can be virtual. Thinking through that balance is the way we will evolve it.”
In the wake of COVID-19, ACCC looks forward to collaborating with oncology stakeholders to understand how best to achieve this balanced evolution of sustainable telehealth solutions in support of patient-centered, value-based cancer care.
Access the knowledge, experience, and information from leading organizations in oncology on the ACCC COVID-19 Resources page.