Healthcare News of Note: Patients in the U.S. shouldered more than $21B in cancer care costs in 2019

• In 2019, the national patient economic burden associated with cancer care was $21.09 billion, according to the latest Annual Report to the Nation on the Status of Cancer.
• COVID-19’s stress on the healthcare industry contributed to worse rates of falls, pressure ulcers and central line-associated bloodstream infections, according to a new analysis.
• A few leading states are leveraging contracts with Medicaid managed care organizations (MCOs) to require health plan investment in the community being served.

Over the last few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.

1. Cancer care in the U.S.: Latest out-of-pocket costs totaled $16.22 billion, while patients’ time cost $4.87 billion

Cancer patients in the U.S. shoulder a large amount of cancer care costs, according to part two of the latest Annual Report to the Nation on the Status of Cancer, published Oct. 26 in The Journal of the National Cancer Institute.

“In 2019, the national patient economic burden associated with cancer care was $21.09 billion, made up of patient out-of-pocket costs of $16.22 billion and patient time costs of $4.87 billion,” according to a news release. Traveling to and from healthcare, waiting for care and receiving care were the time costs incurred by patients.  

“While this analysis is about the costs that are directly incurred by patients, which are critical to patient finances, the total overall costs of cancer care and lost productivity in the United States are much larger,” the release states.

The report describes the cost of cancer care by cancer site, stage of disease at diagnosis, phase of treatment and age group.

Cancer care cost by site

According to the report, in 2019, national out-of-pocket costs were highest for the following types of cancer :

• $3.14 billion for breast
• $2.26 billion for prostate
• $1.46 billion for colorectal
• $1.35 billion for lung

“Analyses of the differences in patient economic burden by cancer type found substantial variation in patient out-of-pocket costs, reflecting differences in treatment intensity and duration as well as survival,” the report states.

Cancer care cost by phase of treatment

Regardless of stage at initial diagnosis, patient cost was highest for those in the end-of-life phase of care, averaging $3,823 per year, according to the report. The initial phase of care had the next highest estimate, at $2,200 per year, while the “continuing phase” of care was least expensive, at $466 per year.

2. Press Ganey: Healthcare safety scores fell amid the pandemic

COVID-19’s stress on the healthcare industry contributed to a higher rate of safety events such as falls, pressure ulcers and central line-associated bloodstream infections (CLABSIs), according to a new analysis by Press Ganey.

Press Ganey reviewed patient outcome data from its National Database of Nursing Quality Indicators (NDNQI^®) submitted by 11,325 units from more than 1,575 U.S. hospitals, according to an Oct. 21 news release.

Jeff Doucette, CNO with Press Ganey, stated in the release: “Hospitals are in survival mode because of the virus, and this has driven unprecedented levels of burnout, turnover and staffing gaps. Our healthcare workers must give their energy and almost singular focus to COVID-19, and the ripple effect has exacerbated safety lapses and drift in hospitals.”

Safety-area highlights

Among the safety areas highlighted in the news release are increases in:

• Inpatient falls across medical, step-down, surgical and med-surg units throughout 2020.
• Stage 2 hospital-acquired pressure injuries across all seven unit types — adult critical care, medical, step-down, high-quality, moderate-acuity, surgical and med-surg — in Q4 2020.

Strategies to get the industry back to its zero-harm goal

The importance of proactively detecting and avoiding “drift” and creating the safest possible working conditions can be accomplished through five strategies, the report states. Among them:

• Measuring safety culture with routine employee pulse surveys. Gauging employees’ perceptions of safety and progress at routine intervals will help detect early signals of drift and where to dedicate additional resources to improve.
• Conducting independent safety audits to detect at-risk areas early. Third-party audits can spot and evaluate potential harm that busy team members may not notice.

Recommitting to the basics of safety, ensuring the safety culture starts at the top and encouraging and rewarding speaking up are the other strategies reviewed in the news release.

3. States are leveraging MCO contracts to require health plan investment in the community

“A few leading states are leveraging contracts with Medicaid managed care organizations (MCOs) to require health plan investment into the community being served,” wrote the authors of an article by Manatt, Phelps & Phillips, LLP, as published Oct. 25 on JD Supra.

“States are in a unique position to promote a ‘whole person’ approach to health that embraces the full continuum of care across physical health, behavioral health and health-related social and economic needs through MCO contracts,” wrote the authors.

Examples of what states are requiring of their Medicaid MCOs include:

Arizona requires its Medicaid managed care plans to spend 6% of annual profits on community reinvestment activities and to regularly obtain community input on local and regional needs prior to undertaking those activities.

North Carolina  allows plans that fail to meet the enforceable medical loss ratio (MLR) standard to take some or all of the money they otherwise would need to return to the state and invest it in activities to address social drivers of health in the community.

Tennessee requires MCOs to commit to a level of community reinvestment spending as part of their application response, and upon award, this level of spending becomes the MCO’s minimum community investment requirement annually thereafter. 

HFMA bonus content

Dr. Ranga Krishnan of Rush University System for Health discusses the future of mental health payment and practice in the latest HFMA Voices in Healthcare podcast. He addresses how provider organizations can address workforce shortages by becoming partners in training and by changing the way they provide care to patients. He also talks about improving mental and behavioral healthcare in a value-based payment environment.