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Oncology Practice Management - February 2014, Vol 4, No 1 - Best Practices
Sheryl A. Riley, RN, OCN, CMCN
sherylRiley

As oncology care managers, we are in a constant struggle to prove our value to our employers. The industry generally admires and values the role we play as part of the patient care model, yet employers are startled when we request worthwhile compensation. Employers seem to be in a constant quandary over our value and do not immediately see the return-on-investment we inherently possess.

Finances Influencing Oncology Care

Much of this confusion is driven by the current compensation models in the medical profession. In the past 10 years, I have seen the value of physician practices, hospital and managed care plans, as well as the vendors that serve them, being squeezed financially by governmental regulation and price cuts for services rendered. This type of environment is not patient-friendly or patient-focused as regulators would lead you to believe.

Regulators want the public to believe that these changes and new rules are for the consumers’ benefit, so they do not get overcharged; however, these changes force practices to make a choice between staying profitable and remaining open, or providing patients with the most effective and appropriate care for their condition(s). They further force care-giving institutions and physician practices to make decisions for their patients driven solely by the cost and not by quality. This is not a direction that is beneficial for providers or for patients. Unfortunately, these new policies create a type of disincentive that, in turn, leads to poor quality of care and limited access to care for our oncology patients and their families.

One thing that has remained universal over the years in healthcare is, “good care follows the dollar, not the other way around.” The start of accountable care organizations and the patient-centered medical home (PCMH) in the mid-2000s was the beginning of a new era in patient care, and one that we, as oncology care managers, applauded and embraced. These models place patient care back into the hands of physicians who ultimately have the proper training to direct patient care. Although these models were ideal for placing physicians back in charge of patients’ care rather than third-party payers, it required that their practices make significant changes to daily operations.

Because current governmental regulations and these care models are at odds with one another, it makes it all that more difficult for nurses to show physicians their need for appropriate compensation. Physicians will need to obtain the highest Centers for Medicare & Medicaid Services STAR rating and reimbursement level possible to support well-qualified and highly trained oncology nurses, as well as the supporting staff required to run and manage a PCMH. The demands are high and the budgets tight. These practice-related decisions demand that physicians exercise excellent technology and are operational and business savvy. Oncology nurses who are knowledgeable in electronic care management software, electronic medical records (EMRs), and managed care will greatly assist in this process. They will need to become center stage if the practice or organizations are to succeed.

Successful Practices

Knowledgeable oncology care managers can not only coordinate and assist in the management of patients and families, but also create and develop the key components needed for a successful practice. Those components include:

  • EMR and care-coordination software will be key to the quality and financial success of each organization
  • Identifying patients in the practice or institution that can benefit most from the PCMH; those patients are the sickest and have the highest risk of failure in the community
  • Big data: the collection of as much patient data as possible to identify, engage, and retain patients in the program
  • Operational efficiency: utilizing innovative information technology (IT) systems and support to assist the practice and organization in moving from paper to electronic records. Finding ways to improve patient touches and patient self-management, and de­-crease failure rate and readmissions
  • Actionable data: reporting that helps the physician and oncology care manager improve treatment and manage patients, adverse effects to improve care
  • Highly educated and trained subset of oncology care managers with IT and managed care expertise
  • Key support staff, such as social workers and intake office staff, to engage and manage resources and services
  • Quality metrics for achieving a STAR rating of 5.

Physicians and care-giving institutions need to stop contemplating and get started: you can do this by hiring well-qualified oncology care managers and watch your practice take flight.

Acknowledgment

I would like to thank Cortney C. Riley, PT, DPT, CSCS, for her assistance in editing this article.

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Last modified: August 20, 2015
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