Urgent care centers reducing emergency department (ED) use is nothing new, but a small and growing number of hospitals and oncology practices are using urgent care centers specifically for cancer patients. These centers allow patients to have same day appointments with specialists with extended hours. The goal is to better manage pain, side effects, and keep patients out of the ED, which is not only costly, but may expose them to infectious diseases.
Patients arrive at these centers sometimes surprised that they do not have to bring the care team up to speed on their condition and background: their records are already there. In addition, they get care from nurses, physicians, and other members of the care team who specialize in cancer and know about side effects and drug interactions. Common side effects of traditional chemotherapy include severe pain, nausea, fever, and dehydration. Newer immunotherapy treatments activate the immune system and can result in serious reactions if the body also attacks healthy organs and tissues. Oncology specialists can quickly evaluate and make sense of these symptoms, ideally helping the patient feel better faster, and potentially avoiding unnecessary procedures.
Johns Hopkins Hospital has reported savings from oncology patients’ use of its six-bed urgent care center, which is located next to its infusion center. Approximately 80 percent of cancer patients who receive services at the urgent care center are discharged home, at an average total hospital charge of $1,600. This contrasts with the 20 percent of cancer patients who visit the hospital’s ED and go home. These patients have an average total hospital discharge of $2,300, plus the cost of the ED visit. Other hospitals reporting early successes include New Mexico Oncology Hematology Consultants in Albuquerque, and University of Texas Southwestern Medical Center in Dallas.
Analysis: Initiatives such as these oncology urgent care centers align well with emerging payment and delivery models to encourage high-quality care. The CMS Innovation Center is developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care, including the Oncology Care Model (OMC). Under this model, physician practices are entering into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. CMS is also partnering with commercial payers in the model. The practices participating in OCM have committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation, and national treatment guidelines for care.
A final rule from CMS last November says that starting in 2020, hospitals may be penalized if patients who are receiving outpatient chemotherapy visit the emergency department or are admitted to the hospital.
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