Today's issue of the New England Journal of Medicine included findings from a randomized controlled trial that enrolled 151 patients with metastatic non-small cell lung cancer. Patients were assigned to either receive standard oncology care or standard oncology care plus palliative care. As would be expected, patients who received palliative care reported higher overall quality of life as well as less depression, pain, and nausea. But in addition, this group also lived almost three months longer, despite the fact that many of the patients opted for less agressive treatments.
In an accompanying editorial , Diane Meier and Amy Kelly point out that despite the fact that over 80% of large US hospitals now offer palliative care, this service remains underutilized. A critical barrier is that physicians and patients continue to view palliative care as "a last resort" tantamount to "giving up" on treatment. This study has the potential to help combat these misconceptions and encourage people begin to see palliative care as a complement to curative therapy rather than an alternative.
I wrote this piece for last month's Oncology Insights and we have received very strong feedback on it, so I wanted to post it on the blog to ensure you all saw it as well.
Medical Oncology and the Medical Home
With the passage of the health reform law earlier this year, the concept of the medical home has gained greater traction across the country. Currently there are over 60 different medical home pilots nationally, with more emerging every week. At the Advisory Board, we formally define a medical home as a practice with the following characteristics:
- Comprehensive care delivery, ensuring complete chronic care management across a variety of conditions and preventive care including recommended vaccines, preventive tests, and lifestyle counseling
- Improved patient engagement through dedicated time for patient education and involvement in care plan and design
- Enhanced patient access to ensure providers can meet urgent care needs and answer patients' ongoing care management questions
- Coordination of care across the continuum to ensure providers are capturing and sharing a complete record of health care utilization
- Use of a care team including physicians, clinical office staff, and non-clinical office staff to ensure delivery of the goals of the medical home practice
- Implementation of a disease registry to provide the data to support panel patient management by the care team
The value of this model in primary care is clear: By engaging more proactively with chronic disease patients to manage symptoms and chart their disease progression over time, providers can reduce acute events and thus decrease resource utilization while also improving outcomes. Many of these same principles would apply to oncology, hence the emerging interest in the concept of the medical oncology medical home.
Applying this model to medical oncology
The potential for this model was first brought to our attention when a medical oncology practice in Pennsylvania, Consultants in Medical Oncology & Hematology (CMOH), became the first medical oncology practice in the nation to earn Level III recognition from the NCQA as a medical home (click here to learn more). To achieve this status, they were required to meet a host of requirements including (note: this list is not exhaustive):
Medical Oncology and the Medical Home
Recently we ran a piece in the Daily Briefing summarizing a piece written by the NY Times discussing whether or not robotic surgery actually saves hospitals money in the long run by reducing complications etc. Then my colleague Matt Garabrant wrote a comprehensive response to the article. I've reproduced both for you below as I know it's a controversial topic.
Daily Briefing article summarizing NY Times feature citing cost reductions
By reducing length of stay (LOS) and complications, robotic surgery can help hospitals reduce overall treatment costs and produce a net savings of $1,200 per surgery, an expert contends in the New York Times.
Seeking to explain the growth of robotic surgery, Catherine Mohr--a professor of surgery at Stanford University School of Medicine and director of medical research at Intuitive Surgical, which created the da Vinci Surgical System--argues that the economics of minimally invasive surgery (MIS) are "simple": robotic surgeries save hospitals money.
Mohr writes when MIS was first introduced in 2000, only about 1,000 robotic surgeries were performed worldwide and the cost for each procedure--including technology, training, supplies etc.--was largely prohibitive, totaling nearly $11,500 per surgery. However, by 2009, researchers had established the "superior outcomes" of MIS--including shorter LOS, less post-operative pain and accelerated recoveries--and more than 200,000 robotic surgeries were performed that year. For prostatectomies in particular, robot-assisted procedures grew at an "unprecedented" rate, accounting for 75% of all prostate surgeries performed in 2009 (see related coverage in the Feb. 17 Daily Briefing)(Mohr, "Freakonomics," Times, 7/20).
Does robotic surgery save hospitals money?