Digital

Mayo Clinic’s cancer telerehab program boosts quality of life 

A six-month telerehabilitation program yielded improvements in advance-stage cancer patients’ pain and function. The gains in these areas reduced hospital lengths of stay and the need for post-acute care, demonstrating the effectiveness of easily scalable, high-impact technology interventions.

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“Our finding of reduced hospital use among participants in the telerehabilitation arms adds to growing evidence that proactively addressing functional impairment among vulnerable patients reduces hospital utilization,” wrote Mayo Clinic researchers in a JAMA Oncology report.

While the effective use of telephony described in the JAMA Oncology study should not be confused with telemedicine or telehealth, the AMA offers excellent guidance to physicians and health care organizations looking to provide remote patient monitoring. That advice can be found in the AMA Digital Health Implementation Playbook, which covers key steps, best practices and resources to accelerate the adoption and scale of digital health solutions. Download the Playbook now.

The JAMA Oncology study included 516 patients with stage IIIC or IV cancer, moderate functional impairment and a life expectancy of more than six months who were randomly assigned into one of three groups.

Group one was a control group. Patients in this group reported, either by telephone or web-based surveys, pain intensity, and whether pain interfered with enjoyment of life or general activity.

Patients in group two did the same, but also received telephone calls from fitness care managers who provided individualized instruction in a pedometer-based walking program and resistance exercises. In addition, these patients also visited physician therapists for further adaptions of their conditioning and analgesic regimens.

Group three participants had the same program as group two with the addition of pharmacological pain management led by a nurse pain care manager.

While hospital admissions were basically the same among the three groups, the lengths of stay varied greatly, with group two having hospitalizations that were about four days shorter (3.5) than the control group (7.4) on average. The group three patients did not see as much benefit, with an average stay length of five days.

The researchers cited studies showing that cancer pain is frequently severe and undertreated, limits patients’ engagement with rehab services, and is “among the most potent and remedial” causes for loss of function—such as the ability to walk upstairs.

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New payment models needed

The study authors suggest that finding a way to pay for rehabilitation services will eventually lead to savings that cover the cost of those services.

In an accompanying editorial, Manali Patel, MD, a Stanford University assistant professor of oncology, wrote that the improvement in patient outcomes and reductions in hospital length of stays could be considered in development of value-based payment models.

“The study findings add to the growing evidence that low-tech interventions can effectively improve the delivery of supportive cancer care services,” Dr. Patel wrote. “Embracing low-tech approaches to enhance local delivery of supportive cancer care, such as rehabilitation, may be a smart move to effectively improve patient-reported outcomes and keep patients at home.”

Current Procedural Terminology (CPT®) codes for telemedicine payment developed by the AMA-convened Digital Medicine Payment Advisory Group could be a major step toward these suggested reforms.

This was previously suggested in a special report on telehealth co-written by Michael Hodgkins, MD, MPH, the AMA’s chief medical information officer, that appeared in the Oct. 19, 2017, edition of The New England Journal of Medicine.

“Currently, gaps in the Current Procedural Terminology (CPT) codes that document telehealth encounters frustrate payment for services such as remote monitoring of patients and the use of online services for patient care,” Dr. Hodgkins and his co-authors wrote. “A more complete set of codes will also provide more precise data to address the paucity of systematic economic evaluation of the benefits of telehealth in both fee-for-service and value-based models of care and payment.”