Examining Access to Nutrition Care in Outpatient Cancer Centers Proceedings of a Workshop (2016) / Chapter Skim
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4 Benefits and Costs of Care
4 Benefits and Costs of Care
Pages 55-68
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From page 55... ...
In collaboration with the National Comprehensive Cancer Network (NCCN) , in 2013 the NBGH issued a series of recommendations, including one nutrition recommendation, to help employers align employee benefits with evidence from across the continuum of cancer care.
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From page 56... ...
Because the United States does not have the benefit of a single payer system, the data get very messy very quickly, Lee remarked. Understanding How Malnutrition Affects High Priority Outcomes Lee emphasized the importance of considering outcomes, like mortality, that are important not just from a financial perspective, but also from a patient perspective, when examining the effects of malnutrition in oncology patients.
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From page 57... ...
Carefully Consider Comorbidities and Therapy-Related Effects In addition to high priority outcomes, Lee emphasized the importance of also considering comorbidities and therapy-related effects when evaluating cost of care. In a study of what Lee considered a relatively inexpensive and generalized intervention, specifically a palliative care consultation within 2 days of admission among oncology patients, May et al.
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From page 58... ...
Measure Costs and Benefits Commensurate with the Intervention and from Multiple Perspectives Lee challenged nutrition researchers to help payers understand the cost of nutritional interventions. He told the workshop audience how he used to joke with a colleague about diagnostic tests for $125,000 therapies that cost only a few hundred dollars and how they would refer to those few hundred dollars as "budget dust." However, as Kathryn Phillips and colleagues at the University of California, San Francisco, have shown, often there is no evidence that these "budget dust" diagnostic tests were actually conducted (i.e., before therapy)
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From page 59... ...
In his opinion, the model provides a tremendous opportunity to start measuring these costs and benefits in relatively carefully controlled studies. When direct measures of costs and financial benefits are too costly or difficult to obtain, Lee suggested that proxy measures be used.
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From page 60... ...
The Business Group, Shebel explained, is a membership organization of mostly large employers, including 70 of the Fortune 100.5 The employers Shebel serves work very closely with their health plans to ensure the benefits being offered to their employees meet certain evidence metrics. Because they are selffunded, NBGH members have a lot of flexibility within their benefit programs.
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From page 61... ...
The cost of medications, including parity of costs between oral oncolytics and infusion medications, is another key cancer care issue for many Business Group members and their employees. Cost should not be the main deciding factor for patients when choosing medications, Shebel said.
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From page 62... ...
who are board-certified specialists in oncology and that patients pay out-of-pocket as they would for other in-network services. The Business Group also recommends that employers adopt the NCCN Clinical Practice Guidelines in Oncology, which state that providers should conduct assessments to evaluate weight gain and loss and other nutritionrelated conditions, consult or refer to nutritional experts in the case of any abnormalities, and manage deficiencies resulting from anorexia, diarrhea, nausea, and vomiting.
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From page 63... ...
Finally, many employers are providing concierge services to their employees. Concierge services provide employees with a single "advocate" who helps with all health care needs, whether that is enrolling in benefits, improving health (e.g., losing weight)
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From page 64... ...
Lee replied that CMS is primarily interested in examining different models of reimbursement, rather than adding more professional groups to a fee-for-service model, creating a challenge for those groups not currently part of the current fee-forservice reimbursement model. He would suggest approaching Medicare Advantage plans and others, rather than CMS directly, at least in the near term, or participating in some of the CMMI initiatives and demonstrating the value of nutrition care using what he described as "their experimental design." "I think if we are going to go up to ask for reimbursement and support, we have to go armed, which means we have to have the data," Clinton remarked.
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From page 65... ...
That amount of care would be "woefully inadequate" given the limited reimbursement dietitians currently receive for providing diabetes care. While these new CMS models of reimbursement are going to be simpler, Clinton continued, in terms of eliminating paperwork and reimbursing a single set of money for the entire care process, which the hospital will have to figure out how to distribute among its providers (e.g., among the surgeon, the medical oncologist, the pharmacist, the RD, etc.)
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From page 66... ...
He said he often brings his own electronic health record up to date before he goes to the doctor. Interim solutions include, first, participating in professional registries and studies and, secondly, working with information technology groups to standardize data and move away from manual processes.
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From page 67... ...
"We have a way to go," she said, "to drill down all the way to nutrition care." NBGH makes recommendations to its members to provide evidence-based information to its employees who are newly diagnosed. Specifically, they promote patient information from the American Cancer Society, NCCN, and the American Board of Internal Medicine Foundation's Choosing Wisely campaign.
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