Conversations with commercial payers about reimbursement mechanisms is a next step, says researcher Kathi Mooney.
From an innovative model of delivering hospital-level care to collecting patient-reported outcomes remotely to considering treatments because they don’t require an in-person visits, researchers at the 2020 annual meeting of the American Society of Clinical Oncology presented findings this weekend that looked to a future of cancer treatment that will keep people at home and away from healthcare facilities and possible exposure to COVID-19.
“It may be a silver lining to the terrible pandemic that we are experiencing that we have had to innovate quickly and demonstrate that safe care can be done at home to protect patients that are vulnerable,” said Kathi Mooney, Ph.D., RN, FAAN, interim senior director of population sciences at the Huntsman Cancer Institute in Salt Lake City, whose findings about a Huntsman “hospital at home” program garnered a lot of attention at the meeting.
Lynne Wagner, Ph.D., a professor in the public health sciences division of the Wake Forest School of Medicine, was the discussant of a session titled “Home to Stay!”
“The current pandemic has accelerated a rapid shift toward alternative care models to reduce COVID exposure and preserve finite health care resources,” said Wagner.
In an interview with Managed Healthcare Executive,® Mooney said hospital-at-home programs are common in countries with single-payer systems and include patients with conditions ranging from cellulitis to heart failure. The benefits include the familiarity of home surroundings, avoidance of hospital-acquired infection, and less de-conditioning from being in a hospital bed.
The study that Mooney and her colleagues organized included 367 patients, 169 patients that were admitted to the hospital-at-home program - dubbed H@H - and 198 in a comparison group who received usual care. The patients were not randomized; the comparison group was drawn from people who lived outside a 20-mile radius of the institute and were, therefore, not eligible for the hospital-at-home program. The program involves regular home visits by nurse practitioners and nurses. At this point, it does not include chemotherapy. Patients can be admitted to the program if they acute-level medical care needs after hospitalization or new unstable symptoms related to their cancer or its treatments. Just over three-quarters (77%) of the patients in the study had a stage IV cancer and the average age was 62.
The results that Mooney presented at ASCO were for the first 30-days after admission. The unadjusted results showed that the hospital-at-home patients were less likely to have unplanned hospitalizations (19.5% vs. 35.4%), shorted lengths of stay (1.4 vs. 2.6), and less likely to have an emergency department visit (14.2% vs. 23.2%, ). Their care was also less expensive: Estimated charges for the hospital at home patients were $10,238 compared with $21,363 for the usual care patients. However, there was no difference in the ICU stays.
Wagner said the results “support this model as a promising direction” for delivering high quality, cost effective care that reduces interaction with the “health care environment.”
Mooney said findings for the 90-day period after admission are similarly favorable for hospital-at-home program.
Starting in mid-March, enrollment in the program grew substantially as Huntsman took steps to keep cancer patients out of its facility because of COVID-19, Mooney said.
Mooney said one obstacle to hospital-at-home programs in this country are payment policies that stint on reimbursement for delivering care in the home instead of in hospital. So far, the Huntsman Cancer Institute has underwritten the cost of the program.
“Part of the work is to evaluate it, get the information out and then have conversations with commercial payers around reimbursement mechanisms,” said Mooney
Here are a few other findings presented at ASCO that touched on issues related to delivering care at home:
• 80% of prostate cancer patients were compliant with reporting electronic patient-reported outcomes (ePRO) from home over a 14-month period, according to Sarah Tressel Gray and her colleagues.
• Online reporting of symptoms (with advice about how to deal with them) by colorectal, breast and gynecological patients improved symptom control during the early weeks of adjuvant chemotherapy, according to Galina Velikova and her colleagues at the University of Leeds in the United Kingdom. However, the difference between the intervention and control group disappeared at 18 weeks.
• A comparison between granulocyte-colony stimulating factors (G-CSF) and ciprofloxacin for preventing febrile neutropenia in early-stage breast cancer patients treated with docetaxel-cyclophosphamide favored G-CSF for reducing febrile neutropenia. The researchers noted the large cost difference between the two approaches ($7-$20 for a course of ciprofloxacin versus $2,100-$7,000 for a G-CSF dose). Wagner noted that as an oral drug, ciprofloxacin could be taken at home so it may have some appeal, notwithstanding this finding.