COVID-19

Resources for community oncology

This page contains recommendations from Flatiron clinical and technology experts, as well as third-party resources, that we hope can help support community oncology practices during the COVID-19 pandemic.

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Flatiron network insights

Data from OncoEMR® practices show in-person patient visit volumes are returning to normal rates, while telemedicine continues to be utilized, though at a slightly lower rate.

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The early effects of COVID-19 on OncoEMR® practices

About a month into the COVID-19 response across the US, the data revealed some trends and challenges community oncology may face in the coming months. In examining practices using OncoEMR beginning on March 16 through April 15, we saw a notable drop in visits when compared to the previous six months:

  • 13% drop in daily visits during which a chemotherapy infusion was administered
  • 33% drop in daily non-infusion visits 
  • 60% increase in appointment cancellations 
  • 50% decrease in new patient visits

The above data are sourced from over 270 community oncology practices that use Flatiron’s OncoEMR® platform. The data may not be fully representative of Flatiron’s research-grade datasets and should only be considered directional.

Given this, practices will likely face financial pressures now and need to prepare to accommodate an influx of appointments in the coming months — including patients who are not yet diagnosed due to delayed testing. 

The administrative burden of this virus is mounting as well, such as challenges getting prior authorizations for cancer treatment.

For more on this story, read the full blog post by Flatiron’s CMO, Bobby Green, MD: What data tell us about the impact of COVID-19 in community oncology.

Clinical presentation 

Please see the CDC website for information on the evolving clinical picture of COVID-19. The impact of COVID-19 on immunocompromised patients is unclear, however the cancer population might be at higher risk. We recommend you refer to your state and local health departments for the latest information related to COVID-19 in your community.

The CDC recommends the following steps to prevent COVID-19:

  • Get the flu vaccine. 
  • Prevent the spread of illness through frequent handwashing, cover your cough or sneeze, and stay home if you are not feeling well. 
  • Avoid touching your face.
  • Avoid close contact with people who are sick.
  • Clean “high-touch” surfaces frequently (e.g., counters, doorknobs, phones, etc.). 

 

Evaluating and testing patients for COVID-19

Limited information is available to characterize the spectrum of clinical illness associated with COVID-19. Clinical criteria for considering COVID-19 testing have been developed based on what is known about COVID-19, and is subject to change as additional information is available. Clinicians should continue to work with their state and local health departments to coordinate testing. Please refer to the CDC website for additional information. 

 

Confirmation testing

Contact your local or state health department for more information about testing. 

Many practices are reviewing schedules in advance and converting office visits to telehealth appointments when appropriate. If your practice is interested in pursuing remote visits (telemedicine), the following configuration and workflow guidelines can help get you started, and contain links to payer and CMS billing guidance. This documentation is not intended to provide clinical, billing or coding recommendations for screening, diagnosis, or treatment of patients related to COVID-19.

 

Selecting a telehealth vendor

In order to get set up, you will need to choose a technology platform. As of March 17, 2020, CMS has adjusted guidelines for vendor requirements and recommendations. CMS’s guidelines do not require a specific vendor.

As of today, Flatiron Health is not recommending any specific telehealth vendor. Instead, our goal is to support practices with care delivery through your preferred telehealth provider or virtual communication channel. 

 

Documenting consent

As of March 17, 2020, Medicare outlines three different visit types; telehealth visits, virtual check-ins and e-visits. CMS or a third-party payer may require consent for these services. Please see CMS guidance as of March 17, 2020.

 

Place of service

Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. 

Previously, the CMS guidance was to bill telehealth visits with POS 02 (telehealth). However, as of March 26, 2020, CMS updated their guidelines to allow practices to bill telehealth visits with POS 11 (office) and a 95 modifier (denotes a telehealth system that provides two-way, real time audiovisual conferencing between a patient in and the provider)  for Medicare claims in order to get reimbursed at the non-facility rate. 

Note, modifier requirements may change for commercial payers. Payers have been updating their guidance daily, so please check their direct guidance for details and your local payer websites.

Please see CMS guidance as of March 26, 2020.

 

Telemedicine CPT codes

The full list of codes can be found on the current CMS Fact Sheet and on Flatiron’s Help Center (accessible to OncoEMR users).

 

Billing information

Please review the links provided below for payer-specific guidelines on reimbursement for telehealth services as of the date of this email. As of March 20, 2020, some payers have moved to reimbursing for remote visits as though they happened in person. In many cases, payers are requiring either a place of service change (to 02), modifier addition, or both. 

Payers have been updating their guidance daily, so please check their direct guidance for details and your local payer websites. Blue Cross and Medicaid are making state-by-state decisions on this guidance as well, so we recommend checking your local intermediary. This guidance is subject to continual change and we will continue to monitor and provide updates. 

Insurance coverage options

If patients have recently lost their health insurance due to unemployment or reduced hours, they are eligible to enroll into a government or marketplace plan during a special enrollment period. Patients under these circumstances may have also been offered COBRA continuation coverage from their former employer. See HealthCare.gov for more information and resources to navigate these conversations with patients. 

 

COVID-19 patient support

Several patient assistance funds are pulling resources to help alleviate patient financial burdens associated with the current pandemic. TailorMed has compiled an ongoing list of available COVID-19 financial resources. 

Based on guidance from the APhA, many insurers are starting to waive or relax their insurance refill policies to avoid multiple trips to the pharmacy. For patients on oral medications, be sure to check if the number of doses filled at a one time can be increased. 

Patients may be struggling to find transportation to the clinic due to limited public transportation and the current pause on the Ride to Recovery program. There are a number of programs that may be a good alternative to ensure patients are able to make it to required in-person visits. For any practices who would like to establish this service for their patients, below are a few options that can limit the costs by defining a capped budget, with established guardrails on which rides get approved (based on cost, ride distance, etc.): 

 

Oncology financial assistance options

As deductibles reset, the first half of the year is always peak season for ensuring your patient population is financially covered. This is especially beneficial as patients and practices may be experiencing increased financial pressures. 

See our resources below to ensure you are maximizing benefits for your patients:

For additional guidance, request a complementary consultation with Flatiron clinical and technology experts.