This article first appeared in the St. Louis Beacon, Jan. 1, 2013 - The doctor in charge of the division of hematology and oncology at Saint Louis University sees both opportunities and challenges in the school's new comprehensive outpatient bone marrow transplant center, the first in the region.
Dr. Frederich Schuening says the center, which opened Dec. 4, is a winner from the standpoint of cost and patient satisfaction. But he concedes there is an ongoing issue of ensuring patients get competent care when they leave the hospital each day to spend time at home.
That has been a national issue for outpatient centers for at least a decade. One study done 10 years ago by Northwestern University Medical School noted that the quality of care is about equal for both inpatient and outpatient settings. But the study found that only about half the eligible outpatients could be served "because of a lack of caregivers. The financial burden associated with the caretaking role may underlie this finding."
Schuening says the issue still "can be a problem because we require that patients in an outpatient setting have caregiver support. About two-thirds of our transplants will be done" through the outpatient program. "That's a significant amount of activity." He adds that the problem "could be solved in most cases with the help of a social worker."
"If those patients at times develop fever, severe nausea, vomiting or diarrhea, which cannot be handled in the outpatient setting, then those patients need to be admitted temporarily for inpatient service."
He noted that not all of the outpatient care had to be provided by the same person. Patients "who don't have relatives or close friends who could volunteer could hire a caregiver just as one can hire sitters for the hospital," he said, adding that he wasn't sure how much of this service might be covered by health insurance.
"The insurance world out there is like a jungle," he says, noting that the matter is so complicated that the center has three insurance coordinators who work with patients. He says the center eventually expects to accommodate 250 patients a year, 60 percent of them as outpatients.
The center opened its doors with an unexpected turn of events. Schuening himself was diagnosed with leukemia, and he became one of the center's first patients.
“Never in my wildest dreams did it cross my mind that someday I would possibly benefit from this facility myself,” he said during emotional comments at the ribbon cutting ceremony the day before the center officially opened.
In a follow up telephone interview on Dec. 14, he said he was "experiencing the other side of the street," being both a patient and a medical provider.
"Today, I am at my office and on Monday (Dec. 17) I have to go back to the hospital to get another round of chemotherapy. I'd rather be in my office but we need to do what we need to do."
His background is in stem-cell transplantation and he set up a similar outpatient program at Vanderbilt before coming to SLUCare last year. He also has served on the faculty at the Hutchinson Cancer Center in Seattle, site of the first bone marrow tranplants in the 1960s.
“We built an outpatient facility at Vanderbilt in 2003,” he says. “That has been a great success. As a matter of fact, in the last two years, we had to expand the facility because it was becoming too small. The patients loved it.”
One big reason patients like himself love such facilities, he emphasized, is the freedom “to go home every day rather than spend several weeks as an inpatient, which I just did for four weeks and had a significant urge of getting out as soon as possible.”
Before the opening of the center, SLU hospital officials noted, the only option was for patients to spend several weeks in a bone marrow transplant unit. The center will allow patients to be treated in the 16-room outpatient center during the day, then go home in the evening. Schuening, who will now work part time, says patients will be able to receive stem cells from their bone marrow or from a donor.
Patients needing more than 30 minutes to reach the hospital will have the option of staying at the university’s Auxiliary House. He said the apartments would provide patients with “the comfort of home during an extremely difficult time in their lives.”
Since plenty of research confirms that outpatient treatment is just as effective as inpatient care for those needing it, he says, “we are not compromising safety.”
A second advantage of outpatient treatment is cost, says Phillip E. Sowa, president and CEO of Saint Louis University Hospital.
“This is a new concept of providing care for those afflicted with leukemia and some other types of cancer,” he says. “Inpatients are captive to a room for 30 days or maybe 60 days. Here you have your pre-transplant and post-transplant care on an outpatient basis. The cost of providing care in an outpatient environment will be more cost effective than inpatient care.”
He had no immediate figures on comparative cost but says the hospital expects to serve patients from the region as well as from south central Illinois and outstate Missouri.
“We hope the medical staff will reach out to medical oncologists in the community and beyond the community for collaboration of care so that patients are cared for in the best possible way and with compassion,” he said.
