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This blog is the seventh of an eight-post ACCCBuzz series highlighting the achievements of the 2020 ACCC Innovator Award Winners. You can learn more about the innovations being recognized this year and the people who pioneered them by joining us at the upcoming ACCC 37th [Virtual] National Oncology Conference, Sept. 14-18.
The degree of success that participating cancer programs have had meeting the quality metrics established by the Oncology Care Model (OCM) depends in part on their ability to monitor and decrease their patients’ unanticipated hospital admissions and emergency department (ED) visits. Tennessee Oncology has participated in the OCM—a program of the Center for Medicare & Medicaid Innovation—since its inception in July 2016. Since then, the cancer center has achieved cost savings in all five of the program’s performance periods. Its quality multipliers for those periods have ranged from 75 percent to 100 percent.
A community cancer center based in Nashville, Tennessee Oncology is an independent practice that provides oncology/hematology services at more than 30 locations. The cancer center is also a founding practice partner of OneOncology—a partnership of oncologists and industry experts who work to advance community-based cancer care.
Larry Bilbrey, Tennessee Oncology’s care data systems manager, says achieving success in the OCM program has not been easy. When patients in treatment experience side effects and seek care at local emergency departments, their oncology providers may only find out afterward—if at all. Obtaining the patient treatment information that results from these trips to the ED has been historically difficult. “We chased that white whale for so long,” says Bilbrey. “How can we get this data and try to be proactive, or even reactive?”
“Unless the hospital calls me, or if the patient calls me to say they're in the hospital, we don't know,” adds Johnetta Blakely, MD, MS, MMHC, the executive director of health economics and outcome research at Tennessee Oncology. “Nobody wants to go to the ED or the hospital. Until you know when and why patients are going to the hospital, it's hard to put something in place that will prevent patients from ending up there.”
To address these issues, Tennessee Oncology has partnered with an IT vendor to customize and install a patient portal and database (known as a hospital event platform) that sends oncology providers real-time notifications when one of their patients presents at the ED, is admitted to the hospital, and/or is discharged from the hospital. The pandemic has postponed Tennessee Oncology’s contract with its vendor, causing the hospital to delay the implementation of the new event platform for now. Tennessee Oncology is taking the extra time to finalize workflows and determine the best location within the practice to implement the platform. “This is something that we really want to do,” says Dr. Blakely. “I think sometimes you just have to be able to be flexible.”
Because the main data depository being used to notify Tennessee Oncology about patient status was created by a vendor used by a previous state-wide project to track hospital admissions among Tennessee Medicaid patients, the platform the practice is implementing does not rely on electronic health record (EHR) systems. Thus, varying hospital EHRs will not affect Tennessee Oncology’s ability to receive real-time patient notifications.
Once notified, care coordinators will be able to log into the platform’s portal to view information about a patient event. The platform’s decision algorithms will help providers determine which action is needed. To help fast-track patient treatment, care coordinators can send the hospital or ED a patient’s most recent bloodwork, MRI, or other necessary information. The patient’s oncologist can contact the hospital or ED attending physician to help determine the best course of action.
For example, Dr. Blakely—also the chair of the performance improvement committee at Tennessee Oncology—may be notified by a care coordinator that a patient has presented in the ED, and she can contact the attending physician to discuss if hospital admission is necessary. If the patient is at the hospital in which Dr. Blakely is located, she may see the patient herself in her office. “Intervening in this way can help, so the patient doesn't actually require an ED visit,” says Dr. Blakely.
If patients do require the services of a hospital or ED, Tennessee Oncology follows up with patients within 48 hours of them being discharged. “If we have that information, we can have our care coordinators take action to follow up with patients, so they don't get readmitted,” says Bilbrey.
To bring this quality improvement project to fruition, Tennessee Oncology has created a transitional care team consisting of nurses, medical assistants, and medical records staff to coordinate patient care. An IT and implementation team provides tech support for the project.
Larry Bilbrey will deliver an in-depth presentation about the development of Tennessee Oncology’s hospital event platform at the ACCC 37th [Virtual] National Oncology Conference, September 14-18. Register for the session, “Utilizing Technology to Identify Patient Co-Morbidities and Reduce Hospital and ED Admissions.”
Attend the ACCC 37th [Virtual] National Oncology Conference to learn about the accomplishments of the other 2020 ACCC Innovator Award winners on topics ranging from the creation of a 3D educational tool that reduces patient distress, to onboarding experienced non-oncology nurses, to address staffing shortages.