Cancer clinic closings linked to increased health care spending
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Increased travel time for oncologic care due to cancer clinic closings appeared to be associated with greater Medicare spending and patient cost responsibilities, according to study findings published in Journal of Clinical Oncology.
“Our finding ... demonstrates a negative financial impact for vulnerable patient populations,” Gabrielle B. Rocque, MD, MSPH, assistant professor in the department of medicine and the division of hematology and oncology at University of Alabama at Birmingham, and colleagues wrote. “As community access to cancer health care services decreases, health care spending could increase, and patients who are forced to travel may experience higher costs. Moreover, vulnerable and rural patients who are less likely to travel long distances will face a higher risk [for] seeking care at sites lacking oncology care.”
Healio spoke with Rocque about the study and the potential implications of the findings.
Question: What prompted this research?
Answer: I had been conducting a lot of work in health care reform, and we were concerned about how to support patients living in rural communities or farther from medical care. We are seeing a lot clinic and hospital closings in smaller communities. This places patients in a position where they have to travel for their health care. We wanted to understand more about the potential implications of clinic closings and the experience for patients who are traveling. We wanted to examine what this might look like in a future state with more consolidated health care, as there has been a lot of interesting data in the literature about consolidation vs. providing care locally. I would argue that oncology care should be delivered at home.
Q: How did you conduct the study?
A: We looked at a previous data set that included patients from the southeastern United States who received cancer care across 12 institutions in five states. We looked at how far they traveled for their oncology care and their hospital and emergency care. We categorized that hospital and emergency care as being at the same place as their cancer care, farther away or closer so that we could get a better understanding of utilization patterns.
Q: Can you elaborate on your findings?
A: We found that approximately one in four patients traveled more than 1 hour to receive their cancer care. For those patients who traveled greater distances during their initial phase of care, they were more expensive to Medicare and their personal payment responsibility was higher, as well. These findings have implications not only from a societal and system perspective but also from a patient perspective. Patients end up spending more out of pocket for health care, and this does not take into account the cost of travel or time away from family, friends or work due to that travel. We also found that hospitalization rates were between 4% and 13% higher for those who traveled greater than 1 hour compared with those who traveled 30 minutes or less.
Q: Did any of the findings surprise you?
A: One of the interesting things about the study that would not surprise most clinicians is that patients who travel are largely getting hospitalized at home.
Q: What should oncologists do with this information?
A: As we think about consolidation, we need to also think about how we partner with our communities to provide them appropriate high-quality care. This involves local providers feeling comfortable helping us manage patients in an increasingly complex world of oncology, where novel agents have side effects and toxicities that are less well-known to providers in community settings. What is helpful about this work is that it begins to quantify this type of care in our communities, so that we can start to think about what type of partnerships and outreach we need. This provides some information for practices to begin to unpack their own needs to engage patients in a more distant community.
Q: Do you have plans for additional research on this topic?
A: Absolutely. This is a topic of great interest to me and many others in terms of how we support our communities and particularly patients living in rural areas. I have had the privilege of participating in ASCO’s rural task force, and we are having a lot of conversations about how we can better engage our communities. We are starting telephone and web-based care. The University of Alabama at Birmingham recently expanded its telehealth services to include palliative care support for patients remotely. We are also building a process to engage patients via a mobile or computer-based app to complete symptom monitoring surveys, which may help us to be more proactive for patients who do not come to the clinic as often but who have symptoms to address.
Q: Is there anything else that you would like to mention?
A: I am a believer in value-based health care and providing quality and better supportive care to patients through payment reform and redesign. At the same time, it is incredibly important that we think about reporting requirements for small practices that may not have the resources for data capture and analysis and everything that is required within a value-based health care model. I hope that we pay attention to this and think strategically to provide more support to ensure that patients in diverse communities have access to the supportive care services that are available by participating in a value-based health care initiative. – by Jennifer Southall
Reference:
Rocque GB, et al. J Clin Oncol. 2019;doi:10.1200/JCO.19.00175.
For more information:
Gabrielle B. Rocque, MD, MSPH, can be reached at University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL 35294; email: grocque@uabmc.edu.
Disclosures: Rocque reports no relevant financial disclosures.