We recently received a question from a member looking for guidance about how to set up billing for multidisciplinary clinics. My colleague Allison Shimooka formulated the following response, and given the broad interest in the topic, I wanted to share it here:
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Multidisciplinary care increases breast cancer patient satisfaction
Adding to the growing list of benefits associated with multidisciplinary care, a new study from Health Services Research reports that breast cancer patients reported higher levels of satisfaction when their medical oncologists co-managed their care with other physician specialists.
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Increasingly, community-based cancer programs are seeking to provide a more coordinated, multidisciplinary care experience to their patients. There are a few factors driving this trend, both clinical and market-oriented, as clinics provide the opportunity to improve outcomes and provide a more patient-centered experience, as well as serve as potential mechanism to achieve market differentiation. Multidisciplinary clinics have long been at the core of academic cancer care, but we've been receiving a lot of questions about executing on the concept at community hospitals. Those programs working with multiple groups of private practice physicians, or a mix of employed and private practices physicians often encounter a number of obstacles when seeking to implement multidisciplinary clinics. Below I've listed out the most common issues. At the end of this post I've included links to our most recent research which addresses many of these issues.
Addressing economic inefficiency - or making it worth their while
Private practice physicians are already incredibly busy, never more so than now as they are under increasing financial pressure, and quite frankly, these clinics are often not that efficient - often there is a lot of down time. During the time it takes for one clinic in which they might see 3 patients, they can often see twice as many in their office. There are ways to address this issue. First, is to guarantee payment for their time to ensure they don't lose out financially. Another option is to try to optimize efficiency via the "virtual clinic" concept in which the patient might see all of the relevant physicians in their own office in a short period of time (a week for instance) and then they'd discuss the patient at a weekly conference. In these sorts of models a care coordinator or patient navigator is essential to make sure all of the moving parts come together as planned.
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The multidisciplinary clinic, in which a patient sees all of his or her providers - medical oncologist, radiation oncologist and surgeon - in consecutive visits, concluding with a consensus treatment recommendation has long been held up as the gold standard in cancer care. That said, there is surprisingly little data documening the value - at least from a clinical perspective. So, this press release
from the UNC Lineberger Cancer Center
caught my attention. UNC researchers recently published a study in the journal Urologic Oncology
showing a multidisciplinary approach to to care changed the initial diagnosis or treatment in almost 65% of cases. The study evaluated 269 prostate cancer patients who came to their multidisciplinary second opinion clinic. Changes in diagnosis were most common in bladder cancer (44%), followed by kidney (36%), testicular (29%) then prostate (22%). This is striking data and speaks to the importance of multidisciplinary collaboration in not only determining optimal treatment, but also simply confirming the diagnosis.
Recently we've been asked a few times about the privacy of data acquired during prospective treatment planning conferences - namely, can it be used in a malpractice suit. The inquiring member was informed by their legal counsel that only data from retrospective quality conferences, like mortality and morbidity (M&M) discussions can be protected. As such, they deliberately limit the amount of formal documentation of prospective conference discussions. Now that the NAPBC (National Accreditation Program for Breast Centers) is requiring more extensive documentation, they are worried about their legal liability.
We didn't know the answer to their query, so we reached out to a law firm, Kitch Drutchas Wagner Valitutti & Sherbrook, that is a member of the Advisory Board's Health Care Law Roundtable, to see if they could provide any assistance. Two attorneys there, Greg Drutchas and Keith Wright, looked into it for us. The statutes vary widely state to state, so much of their response is specific to the inquiring members state statutes, but they provide some insights that are broadly applicable, which I've shared with you below:
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