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Doctor Shares Challenges of 21st Century Cancer Care


Five years after President Obama’s Affordable Care Act was passed, medical professionals are discovering both glimmers of hope and potential challenges in patient care, the chief medical officer-cancer at Mount Sinai Hospital told a gathering on April 8.

Dr. Randall Holcombe detailed the ways in which hospitals now treat cancer in a talk, “Patient-Centric Cancer Care in the Era of the Affordable Care Act,” given at the Lincoln Center campus. He said the law has facilitated greater use of electronic records and emphasized quality of both general and increased palliative care.

Successes in cancer treatment have also increased the odds of survival, said Falguni Sen, PhD, director of Fordham’s Global Healthcare Innovation Management Center. But as survival rates are estimated to increase 37 percent between 2010 and 2020, likewise the cost of care is estimated to increase—from $140 billion this year to $200 billion in 2020.

As U.S. health care is a for-profit industry, Dr. Holcombe said providers’ perspectives differ from patients: Patients’ number one benchmark for quality is the experience of their physicians, whereas providers look to patient outcomes and survival rates.

Where interests converge is care coordination, said Holcombe. Electronic records can help with that.

“New incentives are coming from the centers for Medicare and Medicaid services to try and improve coordination among providers,” he said. “For oncology care, its critically important” to get everyone on the same page regarding treatment.

A recent poll among physicians at Mount Sinai hospital showed a growing change of heart over electronic sharing of patient records. After one month of use, only three percent of physicians agreed that electronic medical records improve quality of patient care; after eight months, 25 percent agreed.

“The Affordable Care Act is on target in encouraging the use of electronic medical records. It can really improve the quality of care and I think that providers can recognize that,” he said.

Discussant Dr. Marcus Reidenberg, professor emeritus of pharmacology at Weill Cornell Medical College, and Dr. Holcombe

Discussant Dr. Marcus Reidenberg, professor emeritus of pharmacology at Weill Cornell Medical College, and Dr. Holcombe

Another way to bring treatments together, said Dr. Holcombe, is Patient Centric Coordinated Care Embedded Services (PACES) program, which brings an array of services under one roof.

It features supportive oncology, a cardiology program, psychiatric services, and generalists who can assist with co-morbidities such as diabetes. Additional services include oncology nursing, social services, nutrition and financial counseling.

While the structure benefits patients, many of these supportive services are resource-intensive. Providing patients with nutrition services, for example “are losing money” because they are a non-reimbursable, non-billable visit, he said.

“But we do it because we think it’s better for quality of care, and we hope that it will reduce costs in other ways, such as unplanned admissions.”

The goal is to move away from “disease care,” toward real “health care,” which emphasizes keeping people from getting sick in the first place, he said.

There are challenges, though. Dr. Holcombe noted that the Affordable Care Act puts great weight in evidenced-based treatments. But when it comes to cancer, sometimes researchers need the freedom to experiment with new, less-known procedures. He also cautioned against letting bureaucracy stymie the main goal.

“Everybody knows that when you go to a big institution, it’s harder to be as personable as it is in a small practice,” he said. “If we’re going to [treat]in large practices, we’re going to have to make sure that we don’t depersonalize care and always put patients first.”

The talk was sponsored by the University Global Healthcare Innovation Management Center’s EmblemHealth’s Value Initiative.


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