Dr Ray Page Details Using Triage Pathways and Scaling Them Across Multiple Practices

Triage pathways can transform practices and save practices and CMS money by keeping people out of the emergency department and hospital, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

Triage pathways can transform practices and save practices and CMS money by keeping people out of the emergency department and hospital, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.


What are the key lessons about using triage pathways and scaling them across all your practices?

The triage pathways is just an interesting concept that our practice has utilized for a number of years now and its basically the concept of being able to use scripted symptom-management pathways that are evidence-based and approved by our physician board that as patients are calling into the office, no matter where they’re calling in from, they call into a centralized phone bit bank to talk to a certified triage nurse and that nurse can go through a scripted protocol and from that we can make a determination on whether the patient just needs a prescription called in over the phone or maybe they need to come into the office and get some hydration and antiemetics or get evaluated in the office or whether or not it’s a true emergency to where they actually need to go to the emergency room or the hospital to get emergent care taken care of. So, that’s part of the process that we have involved.

With the experience that we’ve had in the past, we worked with Lee Newcomer, with United Healthcare, and we did an episodes of care project with them starting back in 2009, and 1 of the things that we did with that was to optimize, early on ways of managing our patients to try to keep them out of the emergency rooms and the hospitals. The positive results with that study with United Healthcare as a private payer was that we had substantial cost savings with them and it wasn’t with tight control of managing drugs in episodes of care bust most of the savings for United Healthcare came from us more efficiently managing the patients and keeping them out of the hospitals and the emergency rooms.

Shortly after that our practice got engaged with Barbara McAneny’s Come Home oncology medical home program, where we established a community-based oncology medical home program and there’s numerous elements with that including the use of triage pathways, and Barbara McAneny also just recently published the results of her study that showed that the triage pathway’s methodology was effective in keeping people out of the emergency room in hospitals so that showed some cost savings with the government entity with Medicare also. And so our practice worked with a company called Navigating Cancer who does a great job of establishing the tools that we need in order to develop these electronic pathways and scripted pathways and have them communicate and incorporate into our electronic health record all those triage tickets that occur with all the other phone calls. So we’ve developed a platform with Navigating Cancer, and that’s proved to be very successful in our practice.

As we got that improved in our practice, we expanded that, and we rolled that out to another sister-practice in [Quality Cancer Care Alliance] and that’s the Northwest Medical Specialties Group with Sibel Blau’s group in Tacoma, Washington. They incorporated that same triage pathway system.

Now, let me emphasize that triage pathways goes way beyond just incorporating a scripted triage pathways where our nurses handle the phones but it actually involves a large dose of practice transformation to where you have to, in many ways, turn your practice upside down to accommodate those patients. So, you have to centralize your phone banks, you have to open up slots in your clinic schedule to be able to work-in people during the day and at the end of the day, you have to have slots in your chemo chairs to handle those sick people that come in at the end of the day. You have to expand your office hours into the evenings and even onto the weekends.

So, there’s a lot of practice transformation that occurs in order to successfully carry out the utilization of these triage pathways, but under that structure of utilizing the Navigating Cancer-based triage pathway system that we developed, and we rolled it out to Northwest Medical Specialties group also, we recently showed, in publication that just recently came out in the Journal of Oncology Practice with Ron Barkley as the primary author that we showed that our 2 practices had substantial cost savings shown in the [Oncology Care Model] data that’s out there. And we, just our 2 practices, saved Medicare millions of dollars by keeping people out of the emergency room and hospital.

I think the triage pathways platform is something that is important when we look at value-based care and currently through Quality Cancer Care Alliance we are rolling that out and we have expanded that out to 11 of our 19 practices so far and I’m looking forward to looking at that data, analyzing that data, and hopefully having subsequent publications that I hope will show that this can be plugged in to many different practices in many different states and many different practice environments and get those same kind of outcomes.

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