The Business Struggle (opportunity) and Future of Oncology

The landscape is rapidly changing, and the demands for quality and efficiency continue to increase. On the financial side, many CFOs and Executive Administrators are looking at the numbers and struggling to figure out why the numbers just aren’t where they used to be. Is it financial leak, market share leak, reputation, outcomes? Many have implemented point of service collections programs that have been successful, but the need is still even greater. The team at Churchill Consulting can provide you with insight, answers, and solutions. The need for predictive strategy will become even more important as Cancer Care continues to see increased regulations, compliance policing, price transparency, and outcomes demands. The expertise of the clinical, administrative, operational and financial aspects are imperative to maintain quality patient care and financial viability in the Oncology service line.

What are the struggles:

·        New protocols- this means higher radiation doses in fewer overall treatment fractions. This is wonderful for the patients and makes clinical sense, but has become a financial barrier to smaller rural centers and something administrators do not completely understand. The decreased treatment fraction protocol equates to less revenue per patient. Essentially the only offset would be to treat more patients, and this is not how it works. As operational costs continue to rise, where does the service line look to save money? The quick and easy answer is staffing and productivity, but this can be counter-intuitive especially for quality. It may provide short-term results but alone will not be a sustainable solution. The entire process needs to be reviewed from payer contracts, collections to denials and community engagement. Our team has been and continues to be on the front lines, so we understand and can provide the solutions and strategies to ensure these Cancer Centers continue to provide the needed care to their population.

·        Denials and coverage for service continue to be a growing barrier. Insurance Companies have become far more restrictive as to what is covered. Though our technologies and abilities to more effectively treat cancer, these methodologies are often restricted. You must be able to articulate this with the payers and the patients. Tools such as AccuOnc become crucial in providing true, accurate estimates and ABNs that are unique to oncology. The payer gatekeeper approach will continue to grow as we move towards a capitated payment model based on diagnosis code. We consult on the strategies and approaches that decrease your denials and ensure that patients receive the “best care” not the “covered care.” Effective authorization practices on the front end and denial management on the backend are necessary and must be Oncology focussed. We provide specific expert education and solutions on these service line unique aspects that show a direct financial impact.

·        CMS and the OIG have also identified the Oncology as a service line where a high dollar amount of overpayment money exists and can be recouped. The Churchill Consulting Team has developed approaches, education, and software similar to what they are using to discover the financial risks and opportunities of the service line. In a department, CPT? codes are currently captured and exported to a billing system. As far as the department knows, it was done correctly. What about scrubber settings, manual entry methods, no charge codes or what if you use a third-party billing company. How do you ensure these are correct or can you? Churchill Consulting developed Intellicense? for this. It is the only Oncology specific review tool in the industry that can quickly and affordably identify your financial risks and opportunities and provide you with the baselines needed to trend accuracy. 100% review of the data is 100% certainty and piece of mind.

·        Education is always an issue and what applies at the hospital level is not always or usually applicable at the service line level. Another issue is there are so many rules that impact all of the job codes differently, and they are always changing. Can a department or system centralize this education and ensure everyone has access to the same rules that are always up to date. As new employees and Oncologists onboard from other practices or systems, they bring with them how they did things, which is not always correct and may expose your risk or decrease your opportunity. This is why DIRECTREES? was created by Churchill Consulting. It is the only comprehensive Oncology resource in the industry. In today’s complex department EVERYONE needs the information, it is not enough to just send a person to a conference and hope the information is disseminated and changes are communicated. The recent OIG Report identifying $25 million in IMRT overpayment confirmed this.

The obstacles and changes will continue to occur, how you react to them and your approaches will determine your financial viability and ability to provide the necessary patient care. Cookie cutter system approaches can not just simply be applied to the Oncology service line with the same result expectation.

We are happy to discuss your pain points or struggles as you navigate the everchanging Oncology market. See and hear why others trust the Churchill Consulting Team not as a Consultant, but as a partner and colleague.

From patients to a partner we understand all aspects of the service line.

Thank you for all that you do!!!

Jordan Johnson, MSHA, BSRT RT

Director of Compliance

Churchill Consulting a division of CruxQS

Patient Advocate

318-537-1509

[email protected]