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Practice Management Curriculum Communicating with






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  • ASCO survey, N=167 (response rate of 31.5%) 70% community oncologists 23% academic oncologists 2% fellows 3% administration, industry, government service
  • ASCO survey, N=167 (response rate of 31.5%) 70% community oncologists 23% academic oncologists 2% fellows 3% administration, industry, government service
  • ASCO survey, N=167 (response rate of 31.5%) 70% community oncologists 23% academic oncologists 2% fellows 3% administration, industry, government service
  • ASCO survey, N=167 (response rate of 31.5%) 70% community oncologists 23% academic oncologists 2% fellows 3% administration, industry, government service
  • Estimated treatment costs – this information, even if an estimate, provides some stability rather than uncertainty Value – the benefits and outcomes of the treatment(s). This may provide some perspective on fighting their disease no matter what the cost may be.
  • Variety of health insurance companies and plans within those companies can create challenges for both the practice and the patient. For example, many patients think of BC/BS as the same for everyone – but there can be an unlimited number of different BC/BS plans. You must understand the nuances of each patients’ plan.
  • Actual participants depend on practice structure and organization; the point of this slide is to introduce the title/concept of “financial counselor”
  • NOTE: Medicare Advantage plans can be particularly troublesome and patients may need education about benefits and co-pay obligations
  • If you PMS can’t do this, it may be time for a new PMS! Focus on top 5 or 6 payers – 80/20 rule.

Practice Management Curriculum Communicating with Practice Management Curriculum Communicating with Presentation Transcript

  • Practice Management Curriculum Communicating with Your Patients about Cancer Care Costs
  • After this session, you will be able to:
    • Describe why the costs of cancer care are problematic
    • Discuss stakeholder perspectives on the cost of cancer care
    • Describe the importance of patient-physician discussions and challenges surrounding those discussions
    • Understand the characteristics, skills and duties of an effective financial counselor
    • Identify tools and resources to assist in communicating the costs of cancer care
  • Cost of Cancer Care
    • The cost of treating cancer is a burden for most families who are affected by the disease
      • 25% of families affected by cancer report that cost of treatment are a “major burden”
      • 25% report having used up all or most of their savings
      • 11% report being unable to pay for basic necessities
    Source: USA Today/Kaiser Family Foundation/Harvard School of Public Health National Survey of Households Affected by Cancer (conducted Aug 1-Sept 14, 2006)
  • Cost of Cancer Care
    • Cancer spending growth will accelerate
      • Costly new treatments and new medical technology
      • Increase in number of cancer cases as population ages
    • Drugs used to treat cancer represent a large expense for patients, hospitals, and oncology practices
      • High co-pays/coinsurance amounts
      • Drug cost sometimes exceeds reimbursement from payers
  • Stakeholder Perspectives on Costs: Physicians
    • Focus on quality care and “healing”
    • Desire to provide evidence-based care with the greatest benefit or outcome
    • Face rising costs/expenses within the practice
    • Have increasing need to integrate cost implications treatment considerations and the evaluation of therapeutic alternatives
    • Struggle between social responsibility and overall patient constraints
  • Stakeholder Perspectives on Costs: Patients
    • Cost of treatment and out-of-pocket expenses may be an obstacle in obtaining care (delays in treatment or even noncompliance)
    • Ability to make optimal treatment decisions
    • Impression that price of treatment may be related to outcome or quality care
    • Depletion of savings and personal bankruptcy
    • Employment status concerns during treatment
    • Concern about burdens placed on family members
  • Stakeholder Perspectives on Costs: Payers
    • Control costs
      • Increase in patient financial responsibilities and possibly limit coverage
      • Increase in prior authorizations, developing formularies, scrutiny of off-label coverage
      • Updating policies and contractual agreements (changing reimbursement)
    • Measure quality and outcomes
    • Support evidence-based medicine
  • Stakeholder Perspectives on Costs: Industry
    • Goal is to develop new devices, drugs and biologicals aimed at improving diagnosis and treatment
    • Rising developmental/production costs
      • Leads to increased prices for new products
    • Patient assistance programs for those who cannot afford to pay
      • Scaling back some programs and/or limiting eligibility
  • A Survey of Oncologists on Communication
    • Perceptions
    Schrag, D and Hanger, M: Medical Oncologists’ Views on Communicating With Patients About Chemotherapy Costs: A Pilot Survey. Journal of Clinical Oncology 2:233-237, 2007 Always/Mostly Sometimes Rarely/Never I have a sense of my patients financial well-being 54 33 13 Paying for cancer treatment is difficult for my patients 37 52 11 Costs influence my patients’ decisions about treatment 23 46 31
  • A Survey of Oncologists on Communication
    • Attitudes and Philosophy
    Schrag, D and Hanger, M: Medical Oncologists’ Views on Communicating With Patients About Chemotherapy Costs: A Pilot Survey. Journal of Clinical Oncology 2:233-237, 2007 Strongly Agree/ Agree Neither Agree nor Disagree Strongly Disagree/Disagree It is important to be explicit with patients about the financial consequences of treatment options 80 10 10 It is important for patients to understand the cost of their treatments even if they do not bear it directly themselves 72 17 11
  • A Survey of Oncologists on Communication
    • Behaviors
    Schrag, D and Hanger, M: Medical Oncologists’ Views on Communicating With Patients About Chemotherapy Costs: A Pilot Survey. Journal of Clinical Oncology 2:233-237, 2007 Always/Mostly Sometimes Rarely/Never I am comfortable discussing costs of cancer treatment with patients 37 32 31 I discuss the costs of cancer treatment with my patients 42 32 26
  • A Survey of Oncologists on Communication
    • Behaviors
    Schrag, D and Hanger, M: Medical Oncologists’ Views on Communicating With Patients About Chemotherapy Costs: A Pilot Survey. Journal of Clinical Oncology 2:233-237, 2007 Always/Mostly Sometimes Rarely/Never I refer my patients to a third party such as a practice administrator or billing representative 46 30 24 I refer my patients to a third party when recommending high-cost treatments 63 19 18
  • Survey Summary
    • 80% of oncologists agree or strongly agree that it is important to be explicit with patients about the financial consequences of treatment options
    • BUT only 37% are always/mostly comfortable discussing costs of cancer treatment with patients
    • What does this all mean? Discussions on cost of treatment do not always occur
  • Why is communicating with patients about cost important?
    • Key component of providing high-quality care
    • Treatment discussions and decisions can be optimized
    • Contributes to overall well-being of the patient
    • Minimizes financial risk for patient and practice
    • An estimated cost of treatment (by cycle, regimen, or overall treatment)
      • Acknowledgement that treatments/options may be costly
    • An explanation of the “value” of the proposed treatments
      • Benefits/outcomes
    • Financial and supportive services
      • What the physician/ practice can do and what the patient/family can do
    • Periodic review of financial responsibility
    What Patients Need
  • Goals of Communicating with Patients about Cancer Care Costs
    • Help patients understand treatment options and cost implications
    • Identify patients at financial risk
      • Communicate with the patient care team to develop appropriate treatment options
      • Investigate patient financial assistance programs
    • Improve practice-patient relationships
    • Contain or minimize expenses/costs to both the patient and the practice
    • How do you lay the ground work for communication?
  • Cost is Important for All Patients
    • Uninsured
    • Underinsured
    • Even patients with “good” health insurance have increasingly substantial copayments
  • Challenges in Communicating about Cost of Cancer Care
    • Physician and practice challenges
      • Treatment data (benefits/outcomes) is not always readily available or publicly accessible
      • Cost-effectiveness data on most cancer therapies are “scarce”
      • Utilization data on effective treatments is not available
      • Physician time constraints
      • Reimbursement/economic challenges
      • Difficult conversations to have
  • Challenges in Communicating about Cost of Cancer Care
    • Patient and family challenges
      • Uncomfortable discussing financial situations or concerns with physicians
      • Believe the physician does not have time for this type of discussion
      • Concern that treatment recommendations and/or decisions will be based on financial status
      • Concern that practices don’t offer assistance or payment options
        • Assistance finding outside resources, offering payment plans
  • Cost of Care Discussions in the Practice
    • Cost of care discussions require a team approach
      • The oncologist
        • May or may not be comfortable with cost discussions
        • Time is at a premium
      • The financial counselor
      • Others?
        • Nursing
        • Business office
  • The Financial Counselor
    • Identify the staff responsible or dedicated to this task
      • May be a new position
      • Duties may be divided amongst several staff
    • Practice size, patient demographics, payer mix will help define the type of position
    • Experienced in accounts receivable, patient accounts, social work, or patient advocacy
  • Characteristics and Skills
    • Excellent communication skills
    • A good listener
    • Friendly, outgoing, non-threatening
    • Analytical
    • Experienced and knowledgeable about oncology care
    • A willing patient advocate
      • Patient focused and unafraid to inquire about patient’s finances
  • Key Duties
    • Establish a communication line
      • With patient and family/caregivers and physician
    • Develop a counseling process within the practice
      • Remember this should be a team effort – the physician and his/her staff
    • Educate patients and family/caregiver about insurance benefits, co-pays, co-insurance amounts, and any insurance limitations
  • Key Duties
    • Determine costs associated with treatment plans and identify areas of financial risk
    • Educate patients and their family/caregivers about practice policies, their insurance benefits and their financial obligations
      • Establish expectations for co-pay, co-insurance collections
    • Monitor patients’ insurance for changes in coverage and benefits
  • Key Duties
    • Help patients obtain outside financial assistance when needed
      • Includes governmental resources and drug assistance programs
    • Match the patient’s financial situation to an appropriate care setting
      • Some services may be outside of the practice
  • Key Duties
    • Meet regularly with the patient and the family/caregiver
      • Re-evaluate patient’s situation as necessary
    • Communicate, communicate, communicate
      • With the patient and the patient care team
  • Best Practices
    • Meeting with the financial counselor must become an integral part of the patient care process
    • New patients meet the financial counselor as part of the intake process
      • Include patient’s family or other caregivers
      • All chemotherapy patients should meet with the counselor before starting a regimen
  • Best Practices
    • Regular meetings should occur
      • Watch for changes in job status or insurance coverage
      • Re-evaluate eligibility for government or state programs and drug assistance programs
    • The financial counselor should be a resource for patients, their family or caregivers, clinical staff, and the physician
  • Meeting with New Patients
    • Before the first visit
      • Verify demographics and insurance benefits
      • Obtain applicable referrals, authorizations or pre-certifications
    • At the first visit
      • Review insurance benefits and financial responsibility
      • Introduce patient and patient’s family/caregivers to practice policies including co-pay, co-insurance collection policy
  • Meeting with Established Patients
    • Financial Care Support
      • Routinely inquire about changes to demographics and insurance information
      • Re-verify insurance benefits periodically or when known insurance changes occur
      • Review insurance benefits and financial responsibility if/when treatment plan changes
      • Answer questions about statements and other financial issues
  • Clinical Trials Present Additional Challenges
    • Extra time will be needed to verify insurance eligibility and coverage
      • Coverage for clinical trials varies considerably from one plan to another
      • Important to take the time to understand coverage before treatment starts
    • Confirm that “standard of care” services are covered in the clinical trial setting
  • Indigent Patients
    • Generally patients who are unemployed, uninsured, or underinsured
      • Assist patients in applying for local, state or federal assistance
      • Indigent patients are often eligible for drug assistance programs through pharmaceutical companies or nonprofit organizations
  • Indigent Patients
    • Treatment for patients receiving drug assistance still represents a cost to practices
      • This is OK
      • Practice needs to budget and monitor these costs (plan accordingly if possible on an annual basis)
      • Taking care of patients means taking care of the practice, too
  • Help Patients and Keep Your Practice Viable
    • High costs of cancer care and challenges of today’s economy create a difficult challenge for practices
    • We must balance the financial needs of our patients with the financial viability of our practice
    • An important time to review your practice’s revenue cycle processes
  • The Revenue Cycle
    • Review the entire revenue cycle from front office operations through collections
    • Ensure that your providers are documenting and charging for appropriate levels of care
    • Review your charge capture processes
    • Make sure that billers are submitting clean claims in a timely manner and appropriately managing accounts receivable
    • Ensure that insurers are paying you according to contract and in a timely fashion
  • Understanding Bad Debt
    • It is important to understand and monitor bad debt in your practice
      • Don’t include bad debt and charity care in your contractual allowances
      • Don’t use historical numbers for bad debt and charity
        • You want to ask “Am I doing as well as I can?” and “Is bad debt or charity care increasing?” NOT “Am I doing as well as I did in the past?”
  • Understanding Bad Debt
    • Do calculate an allowance for bad debt and charity care
      • First load your contractual allowances by payer
      • You must know what you SHOULD collect and what you DID collect
    • Your practice management system (PMS) should be able to do this
      • You don’t have to load every contract; focus on your top 5 or 6 payers and report against them
  • Keys to Reducing Bad Debt
    • Assess the practice’s financial exposure to bad debt posed by each patient
    • Help low-income and other patients with financial hardships
      • Obtain outside assistance to pay their medical bills
    • Arrange acceptable payment plans with underinsured and self-pay patients when needed
    • Carefully monitor the financial status and treatment plan of all patients for any changes that might reduce or increase their ability to cover treatment costs
  • Identifying Resources
    • An important part of the financial counselor’s responsibility
    • Drug specific resources such as manufacturer programs; disease specific resources such as nonprofit foundations
  • Treatment Plan Tool
    • Some practices use these multi-purpose tools available in the marketplace
      • Identifies the treatment options available to the patient
      • Provides an estimation of cost for the patient and a tool to develop payment plans
      • Important in both initial chemotherapy regimens and changes in treatment
      • Detail or summarize known outcomes
  • Treatment Plan Tool
    • Tool may include the following information
      • Regimen name
      • Drugs/doses
      • Regular procedures performed
      • Frequency/duration
      • Co-pay/co-insurance amounts (drugs and procedures)
      • Calculation of total patient out-of-pocket expense based on frequency and duration of regimen
  • Onmark’s Regimen Profiler www.onmarkservices.com/onmarksite/content/rca
    • Web-based tool
      • Practice-specific with daily updated drug pricing
      • Covers more than 500 referenced treatment regimens
      • Customizable payer fee schedules
      • Customizable supportive care drug regimens
      • Body Surface Area (BSA) calculator
      • Patient–friendly financial responsibility reports
    • Uses real-time cost data
    • Provides an estimate of financial impact for various protocols
    • Eases burden of cost management for practice
    ION’s Protocol Analyzer www.iononline.com/display.aspx?cid=ProtocolAnalyzerTutorial_596.cms
  • ASCO’s Cost of Care Brochure www.cancer.net/managingcostofcare
    • Information, tools and resources to help patients manage the financial impact of a cancer diagnosis
      • Introduction on the Costs of Cancer Care
      • Understanding the Costs Related to Care
      • Questions to Ask about Cost
      • Financial Resources
      • Health Insurance
      • Getting Organized
      • Glossary of Cost-Related Terms
    • Copies available at ASCO Bookstore or Cancer.net
  • Sources of Financial Assistance
    • Local resources
      • City governments
      • State governments
        • State Patient Assistance Programs
        • www.medicare.gov/contacts/static/allstatecontacts.asp
      • Internet search: “cancer advocacy groups” or “community-based support for cancer patients”
  • Sources of Financial Assistance
    • National Resources
      • Chronic Disease Fund www.cdfund.org
      • Health Well Foundation www.healthwellfoundation.org/index.aspx
      • National Organization for Rare Diseases www.rarediseases.org/programs/medication
      • Patient Advocate Foundation www.copays.org or www.pap.patientadvocate.org
      • Patient Services Inc. www.uneedpsi.org
  • Sources of Financial Assistance
    • National Resources
      • Patient Access Network Foundation (PANF) www.patientaccessnetwork.org
      • National Cancer Institute www.cancer.gov/cancertopics/factsheet/support/financial-resources
      • American Cancer Society www.cancer.org
        • Health Insurance and Financial Assistance for the Cancer Patient
  • Sources of Financial Assistance
    • Manufacturer-sponsored Patient Assistance Programs (PAPs)
      • Check with each manufacturer
    • Manufacturer-sponsored Discount Cards
      • www.togetherrxaccess.com
      • www.pfizerhelpfulanswers.com
      • www.merck.com/merckhelps/uninsured
    • Medicare Part D Low Income Subsidy
  • ASCO Resources
  • ASCO In Action
    • Bi-weekly e-newsletter via ASCO Express
    • Updates on legislative and regulatory issues
    • Updates on CMS initiatives
    • Links to important resources, tools, and legislation
    • Available online
  • Alerts & Breaking News
    • Alerts and breaking news on issues affecting oncology
    • Sent to ASCO members
    • Available on ASCO website
    • For Practice Managers and Executives
    • Highlights key issues
    • Resources for you, your practice, your staff, and your patients
    • To subscribe, email [email_address]
  • Journal of Oncology Practice http://jop.ascopubs.org
    • Regular features include
      • Original Research
      • Practice of Research
      • Business of the Business
      • Ethics Vignettes
      • Practical Tips
      • Strategies for Career Success
    • Manuscripts and letters to the editor may be sent to [email_address]
  • Practical Tips for the Oncology Practice
      • Detailed information about coding, billing, Medicare coverage guidelines
      • Includes excerpts from Medicare coverage manuals
      • Order at
      • www.asco.org/practicaltips
  • E lectronic H ealth R ecords
    • ASCO Electronic Health Record Initiatives at:
      • www.asco.org/ehr
    • Social networking site
      • ASCOConnections.org
    • EHR Lab at 2010 ASCO Annual Meeting
  • Why are we talking about Health Information Technology?
    • Patients
    • Payers
    • Practice
  • Clinical Tools & Guidelines
    • Executive summaries
    • Flow sheets
    • Patient guides
    • www.asco.org/guidelines
    • Coding & Reimbursement Assistance
      • http://www.asco.org/billingcoding
    • ASCO member benefit, provided free of charge to ASCO members and their staff
    • Available to non-members for a nominal fee per inquiry
  • ASCO University
    • Three online modules
      • Oncology Billing and Coding Primer
      • Coding & Billing Case Applications
      • Medicare Case Applications
    • Excellent resource for your staff
    • Includes Certificate of Completion
  • Practice Management Curriculum
      • Communicating Cancer Care Costs
      • Adapting to Medicare Changes
      • Generating Practice Efficiencies
      • Health Information Technology: From Policy to Practice
      • Effectively Integrating Non-physician Practitioners in Oncology Practice
      • Practice Check-up: Assessing the Financial Health of Your Practice
  • Contact Us
    • ASCO’s Cancer Policy & Clinical Affairs Department
      • 571-483-1670
      • [email_address] or
      • [email_address]