Advanced Practice

Remote partnerships with APPs reduce access gaps

Editor’s note: HemOnc Today’s columns for advanced practice providers (APPs) tackle common issues APPs face, discuss day-to-day practice and regulatory concerns, and share research advances. To contribute to this column, contact Alexandra Todak at stodak@healio.com.

It is interesting that the overall rate of cancer may be declining in the United States, but the total number of people with cancer continues to increase.

It is expected that the access gap will continue to widen for oncology patients over the next decade.

Mark Hyde, PhD, PA-C
Mark Hyde

Additionally, as the renaissance of oncology progresses (ie, rapid development of more elegant and targeted treatments and combinations), the required knowledge base for oncology practitioners is likely to become overwhelming. In some areas, where geographical population spread further complicates the above issues, additional practice models will need to be developed.

The conundrum faced under these circumstances is common to any rapidly growing field: How do we maintain quality while adapting to demand by increasing capacity and limited by uncertainty in the future of funding models?

Technology-based care

Whatever approaches are needed will likely need to be in the realm of “thinking outside of the box.”

Among the current approaches used to reduce the access gap are partnering with APPs and using technology-based care delivery platforms (telemedicine in all its forms).

Limitations to these approaches exist primarily due to outdated practice and billing rules and restrictions.

Although fixing reimbursement models to remove the financial disincentives to new approaches is among the most important necessary changes, it will take time and a continued iterative process. Therefore, more immediate improvements must be initiated.

The model developed at Huntsman Cancer Institute (HCI) — including affiliating with smaller, more remote oncology practices — has proven a valuable method of extending an academic-level oncology practice into communities that traditionally have not had this available. In two of these smaller community practices, the APPs have become central to the operation.

In two practices, an APP is present full time to manage oncology patients. A hematologist/oncologist is on site two to four times a month to see new patients and manage complex treatments and cases. An affiliation with our institution allows the community APP access to a number of resources of the larger institution and, maybe most importantly, a network of subspecialized MDs, APPs and pharmacists to answer their questions.

Support and education are provided in a formal setting with two onsite conferences each year, through online and teleconferencing, and with as-needed shadowing opportunities. A team from HCI makes regular visits to all affiliated clinics to review quality measures and troubleshoot any issues.

The result has been, as hoped, an extension of our institutional level of care into these smaller communities. This model may serve to make care more accessible to patients with cancer who need a tertiary level of care but have geographic restrictions due to illness or age.

Impact of outreach

According to Kerry B. Carr, FNP-BC, AOCNP, of St. John’s Medical Center in Jackson, Wyoming — one of our outreach clinics — the fact that their patients are 5 hours from the closest cancer center can make their cancer diagnosis even more daunting.

“The St. John’s Medical Center affiliation with Huntsman Cancer Institute provides a streamlined approach for these patients to be seen quickly at St. John’s,” Carr said. “Patients are usually seen by the oncology nurse practitioner within a week of their diagnosis. They are plugged in to a supportive oncology team locally to help with their needs. The local oncology NP can triage and perform further workup, diagnostic testing and education quickly in their hometown.”

This is done while an overseeing Huntsman oncologist is consulted to expediate the patient’s treatment plan, Carr added.

“To be able to offer the Huntsman Cancer Institute quality of medical treatment to patients locally is a gift to our community,” she said.

The partnership between Huntsman and Madison Memorial Hospital in Rexburg, Idaho, has furthered patient access to oncology services in this community and increased provider access to education, enabling focus on quality measures in clinic processes, according to Troy O. Hanson, NP.

“Being able to network through shadowing opportunities has enabled me to make the transition to an oncology nurse practitioner smoother by getting supportive face-to-face feedback that I can take to my own practice and use,” Hanson said. “Being an oncology provider that can use a partnership with a regional center for oncology, such as Huntsman Cancer Institute, is beneficial to both the rural clinic and patient. It also benefits the regional center to gain experience with a new model of treatment and survivorship in a different geographical setting.”

Huntsman’s relationship with these clinics is just one example of how academic cancer centers can extend their outreach and impact. With the total number of patients with and survivors of cancer increasing, and the limited access to cancer care in the rural areas in which many of these patients live, telemedicine provides a unique opportunity to extend access to high-quality care.

For more information:

Mark Hyde, PhD, PA-C, is director of advanced practice at Huntsman Cancer Institute at The University of Utah. He can be reached at mark.hyde@hci.utah.edu.

Disclosure: Hyde reports no relevant financial disclosures.

Editor’s note: HemOnc Today’s columns for advanced practice providers (APPs) tackle common issues APPs face, discuss day-to-day practice and regulatory concerns, and share research advances. To contribute to this column, contact Alexandra Todak at stodak@healio.com.

It is interesting that the overall rate of cancer may be declining in the United States, but the total number of people with cancer continues to increase.

It is expected that the access gap will continue to widen for oncology patients over the next decade.

Mark Hyde, PhD, PA-C
Mark Hyde

Additionally, as the renaissance of oncology progresses (ie, rapid development of more elegant and targeted treatments and combinations), the required knowledge base for oncology practitioners is likely to become overwhelming. In some areas, where geographical population spread further complicates the above issues, additional practice models will need to be developed.

The conundrum faced under these circumstances is common to any rapidly growing field: How do we maintain quality while adapting to demand by increasing capacity and limited by uncertainty in the future of funding models?

Technology-based care

Whatever approaches are needed will likely need to be in the realm of “thinking outside of the box.”

Among the current approaches used to reduce the access gap are partnering with APPs and using technology-based care delivery platforms (telemedicine in all its forms).

Limitations to these approaches exist primarily due to outdated practice and billing rules and restrictions.

Although fixing reimbursement models to remove the financial disincentives to new approaches is among the most important necessary changes, it will take time and a continued iterative process. Therefore, more immediate improvements must be initiated.

The model developed at Huntsman Cancer Institute (HCI) — including affiliating with smaller, more remote oncology practices — has proven a valuable method of extending an academic-level oncology practice into communities that traditionally have not had this available. In two of these smaller community practices, the APPs have become central to the operation.

In two practices, an APP is present full time to manage oncology patients. A hematologist/oncologist is on site two to four times a month to see new patients and manage complex treatments and cases. An affiliation with our institution allows the community APP access to a number of resources of the larger institution and, maybe most importantly, a network of subspecialized MDs, APPs and pharmacists to answer their questions.

Support and education are provided in a formal setting with two onsite conferences each year, through online and teleconferencing, and with as-needed shadowing opportunities. A team from HCI makes regular visits to all affiliated clinics to review quality measures and troubleshoot any issues.

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The result has been, as hoped, an extension of our institutional level of care into these smaller communities. This model may serve to make care more accessible to patients with cancer who need a tertiary level of care but have geographic restrictions due to illness or age.

Impact of outreach

According to Kerry B. Carr, FNP-BC, AOCNP, of St. John’s Medical Center in Jackson, Wyoming — one of our outreach clinics — the fact that their patients are 5 hours from the closest cancer center can make their cancer diagnosis even more daunting.

“The St. John’s Medical Center affiliation with Huntsman Cancer Institute provides a streamlined approach for these patients to be seen quickly at St. John’s,” Carr said. “Patients are usually seen by the oncology nurse practitioner within a week of their diagnosis. They are plugged in to a supportive oncology team locally to help with their needs. The local oncology NP can triage and perform further workup, diagnostic testing and education quickly in their hometown.”

This is done while an overseeing Huntsman oncologist is consulted to expediate the patient’s treatment plan, Carr added.

“To be able to offer the Huntsman Cancer Institute quality of medical treatment to patients locally is a gift to our community,” she said.

The partnership between Huntsman and Madison Memorial Hospital in Rexburg, Idaho, has furthered patient access to oncology services in this community and increased provider access to education, enabling focus on quality measures in clinic processes, according to Troy O. Hanson, NP.

“Being able to network through shadowing opportunities has enabled me to make the transition to an oncology nurse practitioner smoother by getting supportive face-to-face feedback that I can take to my own practice and use,” Hanson said. “Being an oncology provider that can use a partnership with a regional center for oncology, such as Huntsman Cancer Institute, is beneficial to both the rural clinic and patient. It also benefits the regional center to gain experience with a new model of treatment and survivorship in a different geographical setting.”

Huntsman’s relationship with these clinics is just one example of how academic cancer centers can extend their outreach and impact. With the total number of patients with and survivors of cancer increasing, and the limited access to cancer care in the rural areas in which many of these patients live, telemedicine provides a unique opportunity to extend access to high-quality care.

For more information:

Mark Hyde, PhD, PA-C, is director of advanced practice at Huntsman Cancer Institute at The University of Utah. He can be reached at mark.hyde@hci.utah.edu.

Disclosure: Hyde reports no relevant financial disclosures.