Exploring Non-drug Related Services in Healthcare

The integration of non-Evaluation and Management (non-E/M) services into community oncology clinics offers a transformative solution to these challenges. This innovative approach to care delivery not only addresses critical gaps in cancer care, such as care coordination, patient navigation, chronic disease management, and preventive services, but also generates significant financial and operational benefits while simultaneously improving patient outcomes and enhancing provider satisfaction.

Dr. Kashyap Patel, CEO of Carolina Blood and Cancer Care Associates and Vice President for the Community Oncology Alliance (COA), has successfully implemented non-E/M services, demonstrating their potential to overcome many obstacles facing oncology practices. By identifying and billing for services already being provided by his team, Dr. Patel’s practice has improved care coordination, reduced care fragmentation, enhanced patient and provider experiences, and increased revenue—all without the need for additional staff. “We’ve seen this improve quality of care for the patient and caregiver, with less dependence on the system and monetary return for the practice,” says Dr. Patel. “When we address these things upfront, quality of life for the patient and provider improves, and there’s less risk of unnecessary, preventable hospitalizations. It’s a win-win for everyone.”

Dr. Patel’s team shares this sense of fulfillment and purpose. As Ola Gulledge, a medical assistant at the practice, stated, “It’s very rewarding to all of us because, at the end of the day, we know that we made a difference. Often, while we’re starting their IV or taking vital signs, we’ll ask if anything has changed since we last talked, or if they’re having issues with transportation or getting their medication.” Providing these additional layers of support not only improves patient outcomes but also creates a sense of pride and accomplishment among the care team. 

Other community oncology practices can take similar steps to address these challenges and diversify their revenue streams by introducing billable non-E/M services that improve care coordination, patient outcomes, and financial sustainability. Key strategies include:

1. Chronic Care Management (CCM): For patients with multiple chronic conditions lasting at least 12 months¹, CCM focuses on care coordination, care planning, medication management, patient education, behavioral health integration, and social support services. This approach aims to improve patient outcomes and reduce hospitalizations.²
2. Principal Care Management (PCM)³: For patients with a single complex chronic condition that increases risk of hospitalization, physical or cognitive decline, or death. PCM includes frequent monitoring, specialist coordination, caregiver communication, disease management education, and emergency planning. ²
3. Principal Illness Navigation⁴: This service helps patients and caregivers navigate the complexities of care transitions, ensuring seamless coordination between specialists and reducing patient burden.²
4. Community Health Resource Integration: This service addresses social determinants of health, such as food insecurity, housing instability, and transportation challenges, to support holistic patient care while aligning with Medicare Quality Payment Program (MIPS) requirements for compliance and performance bonuses.²
5. Cognitive Assessment: With nearly 1 in 5 Medicare patients experiencing mild cognitive impairment—and up to 75% of cancer patients facing chemotherapy-induced cognitive impairment—this service assesses and manages cognitive issues during and after treatment.⁵
6. Advanced Care Planning: Structured discussions about medical care preferences and advance directive completion help align care with patient wishes, increase patient and family satisfaction, and reduce unwanted aggressive care at the end of life.⁶

By implementing these services, oncology practices can diversify revenue streams, improve care coordination, reduce fragmentation, and enhance both patient and provider experiences. Addressing social determinants of health and preventing complications can also reduce overall healthcare costs by lowering hospitalization rates and improving outcomes

Community oncology practices that adopt comprehensive non-E/M service programs will position themselves for long-term success in an evolving healthcare environment while delivering the highest quality, most holistic care to their patients. As Dr. Patel concludes, “Being able to meet these needs for our patients makes me feel I’ve served my purpose as an oncologist.”