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Revenue Cycle Management in Oncology

Web Exclusives - COVID-19
Brian Gockerman, MBA
Managing Director, Unlimited Systems
Parag Shah
President, Practice Solutions, Integra Connect

Less than a month after California issued a stay-at-home order in response to the COVID-19 crisis, oncology practices are seeing declines in their revenue cycles. Mr Gockerman and Mr Shah analyzed the strategies needed to mitigate the downturn.

“To the extent that financial system activity is a proxy for clinical service volume, the trends document that the industry-wide decline and outbound claim-filing activity, from a dollar value and, more dramatically, from an encounter-volume perspective, occurred quickly but appear to be stabilizing at least for now,” Mr Gockerman said.

The rapid rollout of telehealth and the continuation of care for patients receiving treatment are sustaining the value of rendered services, he added. However, a 26% reduction in oncology visits and reduced activity at referring specialties raise the question of how COVID-19 will affect new treatments.

“Pain is not shared equally across cancer centers,” Mr Gockerman said. Despite the downward trend, variations are significant nationwide, with state and regional stay-at-home orders correlating to some extent with decreased revenue. Approximately 66% of cancer centers are operating at a level well below their typical numbers for January and February.

“Successful adoption of telehealth, efficient migration to decentralized business office models, and the good fortune for some that referral volumes continue to hold up is working for a subset of oncology practices,” he added.

The drop-in oncology practice volume was less than in other specialties, because many patients with cancer were already receiving active treatment when the pandemic struck.

“We should expect a lag in restoring oncology’s clinical service volume if there is only a slow return to normal in the patient volumes at classic referral specialties, such as GI [gastrointestinal], urology, and internal medicine,” Mr Gockerman said.

Mr Shah agreed that the near future for oncology practices is bleak, with the number of new patients being seen expected to plunge in late April and early May.

“In many of our groups, they’re already proactively trying to figure out how to ‘right-size’ their organizations,” Mr Shah said. Some practices are discussing 50% employee furloughs to achieve that.

Part of the uncertainty facing practices is a shift in the revenue cycle away from being transactional, he noted. There is also uncertainty about what is occurring beyond the walls of a practice. Payers and lockbox services also face a transition to working from home and other challenges that affect practices’ bottom line.

“The focus has now become, what are the things that are happening on the outside of your practice,” Mr Shah said.

“The key is to support best practices around revenue cycle as broadly as possible,” Mr Gockerman added.

Mr Gockerman and Mr Shah noted steps that practices can take to mitigate the economic damage, including:

  • Implementing system changes required for successful telehealth reimbursement from the Centers for Medicare & Medicaid Services (CMS) under a new rule
  • Enabling secure remote access to revenue cycle platforms
  • Enhancing typical application support with greater account management and monitoring, along with workflow and procedural interventions where necessary
  • Preparing for CMS Accelerated and Advance Payment Program expansion.
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