Most cancers remedy is pushing a brand new frontier: chemo at dwelling, additionally on the go | well being
PHILADELPHIA – While battling cancer, Lisa Oney is not cuffed to a hospital bed for days and remains there while she is infused with chemotherapy drugs.
She does chemo at home – even on the go. Sometimes the life-saving medicine pours into her while she drives to pickup trucks at Target on the side of the road.
Thanks to a new program at Penn Medicine, 33-year-old Oney carries her chemotherapy drugs in a backpack with a small pump that feeds the drug into her body. “I can run around and take care of my children,” she said. “I can go places.”
Typically, her specific chemotherapy would require multiple five-day hospital stays over 18 weeks. The problem was that Oney had to be at home in Souderton to take care of her 3 month old son and 3 year old daughter.
“I couldn’t do that,” she said, referring to the hospital visits. “My husband wouldn’t be able to work.”
Also, due to COVID-19, Oney and her husband Kevin O’Driscoll cannot accept help from friends and colleagues. The risk of getting infected with the coronavirus or something else is too great.
Home chemotherapy is a rising trend due to patient convenience and widespread fear of hospitals during the pandemic. But as much as patients love it, legacy healthcare billing systems, particularly Medicare, remain a formidable obstacle to the practice.
According to Justin Bekelman, the radiation oncologist who heads the Penn Center for Cancer Care Innovation, some chemotherapy treatments started moving home on a small scale, but then began, according to Justin Bekelman, the radiation oncologist
During the home process, Penn’s nurses drive to the patient homes to set up the complex lines and perform the injections for the cancer treatment, which in Oney’s case lasts for days. Afterwards, the rucksack-carrying patients can shape their lives freely.
Bekelman said Penn had good reasons to start the effort. “It’s obviously patient-centric and will improve the patient’s cancer treatment experience,” he said, “but our infusion suites were also full.”
Most experts see the move as positive for employers and taxpayers, who bear much of the cost of health care. Insurers pay less for patients who choose an option at home, as opposed to having an IV at their main facility or even at a specialist practice.
Aetna, a major health insurer in the Philadelphia area, said last year that a single infusion of a specialty drug in a hospital, even outpatient, costs more than $ 20,000. The savings from moving to an independent ambulance center could exceed 50%. Home treatments save about the same, experts said.
But home chemotherapy means a lot less money for hospitals, Bekelman noted, which makes it harder to expand treatments.
“We need a payment model that fully holds healthcare providers no matter where we are giving treatment,” he said. “This is a key incentive for healthcare systems to invest in more care at home and in other lower-cost locations – a shift that should ultimately save insurers money.”
A more logical payment system would encourage changes like chemotherapy at home. And there has been a move in that direction, said Larry Levitt, a health policy scientist with the Kaiser Family Foundation. One approach would be to decouple insurance payments from certain procedures, he said.
“The concept is to pay providers a lump sum for specific patients or conditions,” Levitt said.
He added, “The key is to put security in place to prevent providers from skimming on care.”
Not a new concept
Home care companies have been talking about providing chemotherapy at home for at least the mid-1990s, but little has come of it.
John Sprandio, an oncologist with offices in Delaware and Counties of Chester, welcomes chemotherapy at home but warns that it’s actually more expensive to provide than many believe.
“In terms of efficiency,” Sprandio said, “it is obviously more cost effective to give these drugs to the majority of patients in a group where you have a team of a dozen nurses and 28 or 30 treatment areas equipped to handle anything are.” . ”
Large professional associations such as the American Society of Clinical Oncology and the Community Oncology Alliance have now formally spoken out against the practice. Last year statements cited concerns that patients might have a bad drug reaction if doctors weren’t around.
Richard Snyder, chief medical officer of Independent Blue Cross’ parent company, said he believed the trend was safe.
“Doctors and hospitals tend to be creatures of habit,” said Snyder. “We keep doing what seems to work for us and so we are not inclined to change our habit of giving the drugs in a hospital or in a higher-cost setting.”
Snyder described Penn as a pioneer in moving chemotherapy home, where the patient is likely to be as safe as possible from exposure to COVID-19 and other infections.
Penn’s Cancer Care at Home program rose from 39 patients in March to more than 300 in a month as patients were eager to avoid hospitals. For the entire past year, almost 1,500 Penn patients received chemotherapy at home.
Patients with breast cancer, prostate cancer, and lymphoma are currently candidates for the program, Bekelman said. Penn hopes to add patients with lung cancer, head and neck cancer, and others, but that depends on higher reimbursements and other changes to insurance plans.
Bekelman said the goal is not to delegate all cancer treatment, but to determine that it can be safely done off-premises.
He noted that there were some limits as the risk of side effects was too high with some chemotherapy drugs.
Other cancer treatment providers in the Philadelphia area are not as active. Jefferson Health’s Sidney Kimmel Cancer Center has only helped about 50 patients at home in recent years. The Fox Chase Cancer Center said it has no plans to join the trend. Neither did the MD Anderson Cancer Center at Cooper Hospital in Camden.
Nationally, CVS Health has partnered with Penn to try to bring more chemotherapy treatments home. This month, CVS, which owns Aetna, announced that its Coram infusion unit will be working with Cancer Treatment Centers of America to begin this beginning in Atlanta.
The insurance problem
Restricting wider acceptance of chemotherapy at home is an old payment system that offers much greater reimbursement if treatments are given in a hospital.
Comparisons for such costs at different locations are difficult to find. However, a 2019 report found that the average claim for an injection of infliximab to treat autoimmune diseases in a doctor’s office was about $ 3,100, compared to $ 5,800 in a hospital outpatient department. Bekelman said the same pattern applies to chemotherapy drugs and that reimbursement at home is similar to that at a doctor’s office.
Jefferson’s Sidney Kimmel Cancer Center has received very different reimbursement rates for the home infusion. Some plans reimburse “on par with the on-site IV, while others reimburse at very low levels or not at all,” said Karen E. Knudsen, a top oncology expert at Jefferson, in an email.
Timothy Kubal, an oncologist who runs the infusion center at the Moffit Cancer Center in Tampa, Florida, predicted that many more cancer treatments could be done at home in a decade, with many talks about what the right price is. “
The patient’s perspective
Most of the cancer patients Penn treated at home – rather than in an infusion center – receive injections for breast and prostate cancer. Penn Home Infusion nurses work on patients’ schedules so they don’t have to waste time on the job, Bekelman said.
Avoiding hospitalization, like Oney, the patient from Souderton, is an even bigger thing during the pandemic.
“We have generally seen that it can be difficult to be in the hospital, not having a family, the food is different. Depression can set in, so overall I think this is a good trend if patients can manage at home, ”said Kelly Harris, CEO of the Greater Philadelphia Area Cancer Support Community.
Oney was diagnosed with lymphoma in November, just two weeks after their son was born. Before receiving steady treatment at home, she received her first round of chemotherapy in the hospital to make sure she had no side effects.
There was none. But later one evening, Oney, a neonatal nurse at Grand View Hospital in Upper Bucks County, got a headache as soon as the IV started – possibly because she forgot to take the medication out of the refrigerator early.
Oney received a quick response from Penn’s oncologist who told her to take ibuprofen. “It’s all very connected,” she said.
While being at home to avoid the miserable side effects of chemotherapy isn’t a blessing, she thinks it is a blessing to be able to avoid them overnight in the hospital.
I am grateful to be home with my children, ”she said. “I couldn’t imagine not seeing her for five days every three weeks.”