Day 1 at AMCCBS: COVID Fallout and Policy Concerns

The ACCC 47th Annual Meeting & Cancer Center Business Summit (AMCCBS) opened today with an overview of the rapidly changing national political climate and what it may mean for healthcare policy in the months and years ahead. KavitaPatel, MD, MS, FACP, a fellow at the Center for Health Policy at the Brookings Institution, began by recognizing the immensity of the impact that COVID-19 has had on healthcare delivery across the country. “No one could have predicted at the end of 2019 that a new disease would kill more than 500,000 Americans within a year and bring the world to its knees,” said Dr. Patel."COVID-19 is the start, middle, and end of what will define healthcare practice and policy in 2021 and beyond."

Dr. Patel addressed the actions that the Biden administration can take first to advance its healthcare policy agenda. Some of the changes that the Biden administration wants can be enacted by executive order, which is an increasingly popular tool to advance legislation from the executive branch. But while Biden can take some crucial steps to stem the effects of the pandemic without congressional support—such as invoking the Defense Production Act to accelerate the production of medical supplies or working with governors to enact mask mandates—there are many things he cannot do alone.

Among the things that Dr. Patel said the federal government must do to stem the damage of COVID-19 are creating a unified approach to testing and enhancing the federal collection of healthcare data. Dr. Patel also noted that Biden’s stated commitment to increase funding for the National Institutes of Health and the National Science Foundation—as well as his plan to provide $300 billion in innovation funding to industries including health, medicine, and biotechnology—will help the U.S. be better prepared when the next pandemic strikes.

Another issue touched on by Dr. Patel is drug pricing, which she noted captured considerable attention during the Trump administration. The state of “most favored nation” status and other efforts to reign in drug costs remains in flux, and Dr. Patel said she does not think they will be fully settled until they land in court. “Anything that will change the trajectory of drug pricing in oncology will be met with a lawsuit,” she said. “We will need legislative action in this area.”

In reference to CMS’ Oncology Care Model program, Dr. Patel said that, to date, the program’s data shows little impact on cost of care, even though it has helped improve care coordination. Calling it “extremely complex,” Dr. Patel predicted that the Oncology Care Model program will soon end. “The program will not make the cut to be so compelling that it becomes permanent," she said.

Panel: Cancer Care in the COVID-19 Era

A six-person panel consisting of physicians and nurses from cancer programs and practices across the country shared personal experiences at the intersection of cancer care and the ongoing pandemic. A point everyone quickly agreed upon was the lasting impact of the rapid transition to telemedicine in the early weeks and months of the pandemic. Although several people said the provision of telehealth has slowed some since many programs are now open to in-person visits again, they agree that there is no going back to pre-pandemic levels. “Telehealth is here to stay,” said Luis Isola, MD, director of cancer clinical programs at Mount Sinai Health System & Tisch Cancer Institute. “It has become part of the fabric of the care we provide.”

Surge in Telehealth

David Dougherty, MD, MBA, medical director of the Dana Farber Cancer Institute Network, noted that aspects of telehealth have “given patients a higher degree of self-efficacy, allowing them to better manage their own care." Other panel members noted that telehealth has given them a new appreciation of the essential role that family members play in their loved ones’ care, as many patients did not previously have the technological access or know-how to participate in telehealth on their own.

But on the flip side of telehealth’s positive impact of being able to provide quality at-home care is the fact that many patients simply do not have the means to access telehealth services. Sibel Blau, MD, medical director at Northwest Medical Specialties and president and CEO of the Quality Cancer Care Alliance, said that her practice hired technology coordinators to visit nursing homes and give patients access to the technology they need to receive remote care. “We need to give access to care to all patients, regardless of how remote they are,” said Dr. Blau. Other panelists said they had patients whose socio-economic status made telehealth impossible. "It's essential to keep in mind social determinants of health,” said Adam Riker, MD, FACS, chair of oncology at Anne Arundel Medical Center DeCesaris Cancer Institute. “We could not do telehealth with many of our patients because they do not have access to tools like Zoom or MyChart®."

Staff Stress

The emotional and physical burden of patient care during the pandemic has had a huge impact on nursing staff, the panelists agreed. “Nurses are extremely stressed,” said Mary Miller, MSN, RN-BC, OCN, nurse manager at Franciscan Health Cancer Center Indianapolis. As a result, she said, many have left their positions for less stressful work. “We have lost 14 of our nurses in the ICU alone who are now traveling nurses,” Miller said. She added that she has found that frequent and open communication with nursing staff helps, to some extent, manage their fear of the unknown. “We hold regular video chats with staff to keep them updated on what we are doing and why we are doing it,” said Miller. “It helps if they understand the reasoning behind our decisions.”

Jody Pelusi, PhD, FNP, AOCNP, an oncology nurse practitioner at Honor Health Research Institute, said that it’s important to remember that the stress factors affecting staff can extend far beyond those found in the workplace. “Nurses cannot come to work because they have children at home, and schools are closed,” said Dr. Pelusi. “Some of them even have food insecurity issues. We need to take care of staff so they can take care of patients.”

Dip in Cancer Screenings

All panelists agreed that the effects of the plunging cancer screening rates brought on by the pandemic will be felt far into the future. To bring people back in for their regular screenings, Dr. Riker said that the Anne Arundel Medical Center DeCesaris Cancer Institute has recorded a series of two-minute videos that teach patients the importance of maintaining their screenings and explain to them the actions the cancer center is taking to keep them safe. Fighting patient fear to come in for screenings is crucial, said Dr. Isola: “The lack of screening for cancer due to the pandemic is going to become evident over the next few years.”

Assessing the changed landscape of a healthcare system still in the throes of a global pandemic, David Dougherty, MD, MBA, medical director of the Dana Farber Cancer Institute Network, said it’s important to consider how COVID-19 has been and can be a source of disruptive innovation—for good. “COVID-19 has not ignited new problems,” said Dr. Dougherty. “It has exacerbated the issues already there. We need to think about how we can apply the innovations wrought of necessity into long-term solutions.” Dr. Isola agreed: “What we have learned from this crisis is that we can be problem solvers.”

Want to join in the conversation? Register for the week-long ACCC 47th Annual Meeting & Cancer Center Business Summit here. View the agenda to find out what’s up next.