Revenue Cycle Management Update

Web Exclusives —August 11, 2020



The COVID-19 pandemic had an immediate and dramatic impact on revenue for US cancer centers. In mid-March, right before the national state of emergency was declared, community oncology practices working with the healthcare technology and services company, Flatiron Health, reported an overall average of approximately 4000 appointment cancellations per day. Over the following 2 weeks, that cancellation rate spiked to more than 7500 appointments per day.

“Digging deeper, we saw about a 60% increase in patient cancellations across the board: about a 50% drop in new patient visits and about a 33% drop in infusions,” said Nirav Shah, MBA, Flatiron’s Managing Director for Revenue Cycle Management, speaking at a recent webcast hosted by the Association for Value-Based Cancer Care (AVBCC). In this session, moderated by AVBCC Founder Burt Zweigenhaft, PhD, D.Litt, Nirav Shah, along with Parag Shah, President of Practice Solutions for Integra Connect, shared data-driven insights on the evolution of practice changes, from the early days of the pandemic through late summer, and discussed what will be necessary to survive in the new environment.

“As practices moved to telehealth, they had to also reconfigure their EMR and revenue cycle management platforms to make sure that they would be reimbursed for the services they provided,” said Nirav Shah. “So much was still unknown, and they needed a robust way to track key performance indicators to make decisions about performance based on data.”

For example, Flatiron helped its clients capture the reasons why some patients were unwilling to shift to telehealth, to adapt to patients’ concerns and improve the adoption rate. “We found that of patients who were unwilling to make the move, about 31% didn’t want to receive care until COVID was over, 24% needed additional services, 23% rescheduled at a future date, and 16% didn’t have access to technology,” Nirav Shah said. “By changing messaging and helping practices adopt new ways to engage, such as drive-through labs and injections and remote waiting rooms, we were able to significantly decrease the number of patients who were unwilling to participate in telehealth.”

According to Nirav Shah, as of late summer, chemotherapy visits had returned to near pre-pandemic levels, and the general cancellation and no-show rates among Flatiron’s clients had also largely stabilized. “Interestingly, this is consistent across all of our regions,” he said. “We had thought there would be nuances across regions, but while there are still a couple of states where the volume still hasn’t picked back up to pre-COVID, such as Arizona, surprisingly in states like Texas, Florida, and California, the cancellation and no-show rates as well as volume have started to normalize.”

Integra’s Parag Shah reported similar data from the company’s approximately 2000 providers, which range from community-based oncology centers to academic medical centers. “Some of the biggest challenges they have faced from an operational perspective include how to maintain operations over the long-term with a substantial percentage working from home,” he said. “What are your IT security solutions? How do you manage teams to ensure productivity? We worked on virtual meeting rooms and other team management solutions to maintain employee engagement.”

According to Parag Shah, sustaining that over the long-term in a work-from-home environment can be challenging. “When practices made the shift initially, we found that productivity actually went up. But as people started getting more comfortable, we started seeing a 5% to 6% drop in productivity. That can be significant, especially when you’re getting ready to do the month-end close. We’ve helped clients implement workflow monitoring tools and process changes for telecommuting to help keep employees engaged.”

Related Articles
Cancer Doesn’t Quarantine: A “Thank You” to Cancer Nurses and Navigators
June 2022 Vol 13, No 6
As a little girl, Tamika Felder dreamed of being on TV. She loved watching the news even at a very young age, had an unwavering curiosity about what was going on in the world, and set her sights on a career in television, which she later achieved. What she didn’t set her sights on was a cervical cancer diagnosis at the age of 25, a radical hysterectomy, and the devastating complete loss of her fertility.
Navigation as a Catalyst to Reignite Cancer Screenings
August 2021 Vol 12, No 8
With concerted efforts by navigators, we can increase preventive screening rates.
The Need for a Complete Cancer Care Team Is Critical as We Move Out of the Pandemic
Christian Downs, JD, MHA, Linda Fleisher, PhD, MPH, Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG, Mandi Pratt-Chapman, MA, PhD, HON-OPN-CG, Rani Khetarpal, MBA
May 2021 Vol 12, No 5
Leaders from the Academy of Oncology Nurse & Patient Navigators deliver a statement on appropriate planning to serve patients and their families in the wake of the COVID-19 pandemic.
Last modified: November 15, 2022

Subscribe Today!

To sign up for our print publication or e-newsletter, please enter your contact information below.

I'd like to receive:

  • First Name *
    Last Name *
    Profession or Role
    Primary Specialty or Disease State