Background: Oncology nurse navigators and multidisciplinary models of care have been shown to improve outcomes for patients with cancer.1,2 The navigation team at Lehigh Valley Health Network (LVHN) coordinates 16 multidisciplinary clinics (MDCs) monthly covering 6 disease sites. Newly diagnosed patients attend the clinic to meet their treating team, receive a care plan, and schedule follow-up appointments as appropriate. On March 6, 2020, the Secretary of Health and Human Services modified the 1135 Waiver, allowing Medicare to pay for office, hospital, and other visits furnished via telehealth, including patients’ residence.3 On March 23, Pennsylvania issued stay-at-home orders due to COVID-19.4 Navigators needed to develop alternatives for MDCs to meet the patients’ needs while minimizing face-to-face encounters and maintaining safety. The challenge for the navigators: how to create and organize telehealth visits for multiple providers in the MDC setting?
Objective: To create safe options to hold MDCs remotely, maintaining the same level of quality, during a time when at least half of the providers and navigators were working remotely during COVID restrictions.
Method: Setting up virtual MDC visits required the navigation team to assure Webex access for themselves, providers, and patients; educate providers; work with IT specialists and clerical supervisor to assure accurate scheduling, billing, and documentation; teach the MDC teams the new process; facilitate remote visits; and assure proper sign-off. Navigator super users and IT/Epic specialists determined they could change a scheduled multidisciplinary visit to a video or billable phone visit prior to appointment time. This put the appointment on all providers’ schedules and enabled connection to the patient portal. Navigators educated patients and providers on how to link to the visit if they were off-site.
Using the new scheduling process, navigators coordinated Webex meetings for the team to discuss the plan of care prior to the visit, and the patient joined through the patient portal at the appointed time. One provider led the video or phone visit, using the input from the team, and other providers were able to document in the same encounter within 24 hours. The navigator then ensured that subsequent testing and appointments were scheduled. For patients who were not appropriate or did not want an MDC, navigators facilitated an office visit.
Results: Average pre-COVID monthly MDC volume was 40. After the stay-at-home order, MDCs were put on hold, and the remote option plan was put in place. MDCs began again in April with 4 total visits, all remote, 2 by video and 2 by phone, and most done with at least 1 provider off-site. In May, there were a total of 9 visits, 4 by phone and 5 in person; in June, 16 visits, 1 by phone and 15 in person.
Conclusion: As MDCs ramped up during the COVID restrictions, the navigation team created a new option to safely connect patients, providers, and ancillary staff. Patients and providers appreciated having the opportunity to continue MDCs safely during COVID restrictions, and the remote MDC visit continues to be an option for patients and providers who are off-site.
- Munoz R, Farshidpour L, Chaudhary UB, Fathi AH. Multidisciplinary cancer care model: a positive association between oncology nurse navigation and improved outcomes for patients with cancer. Clin J Oncol Nurs. 2018;22:E141-E145.
- Strusowski P. A multidisciplinary model for cancer care management. Oncol Nurs Forum. 2006;33:697-700.
- Centers for Medicare & Medicaid Services. Coronavirus waivers & flexibilities. www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers. 2020.
- Pennsylvania Government. Governor Wolf and Health Secretary issue ‘stay at home’ orders to 7 counties to mitigate spread of COVID-19. www.governor.pa.gov/newsroom/governor-wolf-and-health-secretary-issue-stay-at-home-or ders-to-7-counties-to-mitigate-spread-of-covid-19. 2020.