ACCC Forum Focuses on Technology Solutions to Mitigate Workforce Shortages

“Every company is now a software company,” Microsoft Chief Executive Officer Satya Nadella told attendees at the 2019 Mobile World Congress. ACCC President David R. Penberthy, MD, echoed this sentiment during his August 18 Tech Talk where 40 ACCC members came together to brainstorm technology solutions to mitigate oncology workforce shortages. The day’s discussion focused on a variety of artificial intelligence (AI)- and business intelligence (BI)-enabled platforms in use at three ACCC member programs: Northwest Medical Specialties in Tacoma, Wash.; Michiana Hematology Oncology in South Bend, Ind.; and St. Elizabeth Healthcare in Edgewood, Ky.

Northwest Medical Specialties

According to Amy Ellis, chief operating officer at Northwest Medical Specialties—a practice of 14 medical oncologists across 7 clinic sites in Washington—a pharmacist shortage coupled with the costs of adding full-time equivalents (FTE)s to an already lean clinical team resulted in the practice choosing the House RX technology platform to manage its medically integrated dispensing program. With House RX taking over resource-intensive tasks like prior authorizations and claims processing, the benefit to staff was immediate, alleviating hours spent on the phone with payers and reducing stress and burnout.

Northwest Medical Specialties also uses a technology called Canopy to improve staffing and operational efficiencies. In addition to service ticketing, a centralized worklist with smart routing and filtering capabilities, the platform offers triage pathways and ePROs (electronic patient reported outcomes), among many other features. “We use this care management tool to improve efficiency of staffing resources before hiring FTEs,” explained Ellis. “We don’t throw a person or FTE at a problem, especially given the workforce shortage and recruitment challenges we are all facing.”

When asked who at Northwest Medical Specialties makes the decision to adopt new technology, Ellis shared that the practice’s issues are first identified at its operations meetings. “Then we work as a team to define the problem. Can the problem be solved with a staffing solution? Can the problem be solved with a technology solution? Those types of discussion usually spur the adoption of new technology.”

Michiana Hematology Oncology

This 16-physician practice across 7 clinic locations in Indiana focuses on what it calls “back of the house” technology solutions to stay operationally and fiscally sound. “Technology requires a different set of skills than the skills it takes to run an oncology practice,” noted Susan Ford, chief executive officer at Michiana Hematology Oncology. “Outsourcing and automating some of our back of the house tasks allows me to say, ‘That’s not my headache,’ and focus on our core business—what our doctors do best—and that is caring for patients with cancer.”

Outsourcing revenue cycle management to the AC3 platform allows the practice to realize every dollar owed from payers. For Michiana Hematology Oncology, this technology investment increased net collections by 2 percent, reduced costs per claim by 31 percent, and increased cash collection efficiency by 22 percent. More, the technology continues to grow and evolve, as the addition of a retro-auditing feature allowed the practice to recover $2.8 million in payer-related underpayments and missed drug-related billing.

“Our practice expenses continue to go up [in terms of] staff compensation, bonuses, and initiatives to support work-life balance, yet reimbursement continues to decline. At some point these lines will cross,” cautioned Ford. “So, we [cancer programs and practices] need to have a plan to stay operationally and fiscally sound.” And that’s where technology can help.

St. Elizabeth Healthcare

Douglas Flora, MD, LSSBB, executive medical director, Oncology Services at St. Elizabeth Healthcare in Kentucky agreed with Ford’s statement. “Our focus should be on using AI as a means of doing capacity management at our cancer programs and practices,” he said.

To help mitigate its workforce shortages and improve operational efficiency, St. Elizabeth Healthcare adopted a real-time location system with color-based way-finding technology. Every patient, staff member, piece of equipment, and room are tagged, so the healthcare system can track cancer center activities in real time and develop an ‘air traffic control-like response’ when issues arise. Bottlenecks are immediately visible, allowing for real-time solutions like freeing up more exam room space or re-assigning staff. Faced with a severe shortage of front desk staff, this technology allowed the healthcare system to do away with both in-person check-ins and waiting rooms.

When asked how much cost-savings the healthcare system realized from this new technology, Dr. Flora admitted that “any savings realized has been spent in other ways.” For example, St. Elizabeth Healthcare invested in nurse navigators, whose services are critical to patient care but are often not reimbursed.

Aside from cost-savings, Dr. Flora sees technology as a necessary answer to oncology workforce shortages. “Our workforce is shrinking. Our staff are leaving for organizations like Amazon that can offer higher salaries,” he cautioned. “That’s why I’m strongly advocating for our cancer program and healthcare system to look at technology solutions to help our smaller workforce operate more efficiently.”

The Rest of the Story

But decisions about technology investments are complex—especially for cancer programs and practices operating on lean margins.

Northwest Medical Specialties found many benefits with Jvion’s AI-enabled technology that helped identify patients at risk for emergency room visits, hospital admissions, and mortality, yet the practice had to drop this technology platform when its MEOS (monthly enhanced oncology services) payments from the Oncology Care Model ended in June. It was an “unfortunate [decision] because we did see significant improvement in our referral to hospice, our palliative care utilization, and other metrics that we were tracking,” said Ellis.

When asked about the infrastructure necessary to adopt these types of technology solutions, especially for smaller cancer programs or practices with fewer resources, Ellis offered this advice, “You can allocate even one person—a technology champion—to understand the issues you are trying to solve, work to get stakeholder involvement and buy-in, and then research technology solutions that may be available.” Most important, Ellis emphasized that this person needs to be able to communicate why the technology is needed and how the technology will help staff and improve patient care.