BALTIMORE—Preliminary results from a national survey of trends in community cancer care conducted for the Association of Community Cancer Centers (ACCC) have found that 78% of the 84 responding ACCC members reported that the financial health of their centers was “good” or “very good.” But that number is down from 90% last year, and respondents reported a trend toward freezing hiring or scaling back capital expenditures for new equipment purchases such as linear accelerators and magnetic resonance imaging (MRI) machines.
Nearly 60% said they have delayed construction projects and frozen hiring. The survey was presented here at the ACCC's Annual Meeting, and is part of a three-year joint project by ACCC and Eli Lilly.
A primary goal of the survey is to help cancer care teams adapt in organizational ways to changes in the health care marketplace, noted ACCC Executive Director Christian Downs, JD, MHA. Across the United States, unstable, uncertain Medicare reimbursement rates are adversely influencing physicians' decisions on their practices, according to American Medical Association President J. James Rohack, MD.
“We are facing an environment in which we are going to have to do more with less,” said Lee Blansett, MBA, Senior Vice President of Kantar Health, who presented the preliminary findings of the survey at the ACCC meeting. Kantar Health is the consulting firm that conducted the survey. Respondents primarily represented community hospital comprehensive or community hospital cancer programs (73%). Most were not-for-profit and provide both inpatient and outpatient services. A minority of programs surveyed offer physician fellowship training.
The new survey found a growing trend among community oncologists making hospital-based practice arrangements, said Mr. Blansett.
“There is a slow shift in care sites, and hospitals' share of chemotherapy treatments is growing,” he added, noting that community oncologists are finding that reimbursement for office-based chemotherapy infusion is just too low to be economically feasible. Not only are community oncologists increasingly looking to partner with hospitals, but they are also increasingly referring patients to hospitals for chemotherapy. There is also a trend toward consolidation of community practices.
While hospital-based cancer programs are freezing hiring, delaying equipment purchases, and making other adjustments to the recession, in general, he said, “hospitals are weathering the recession better than community practices.”
As might be expected, however, cancer programs' coverage mix is worsening as privately insured patient volume drops and the uninsured/underinsured patient volume rises. In this survey, 73% of respondents reported an increase in the number of uninsured or underinsured patients who receive chemotherapy.
The new survey showed that cancer patients want convenience as part of their treatments; many have returned to work, and have requested weekend chemotherapy infusion (which is rarely available).
While oral anti-cancer drugs represent patient convenience, Mr. Blansett noted that only 24% of community cancer programs dispense oral anti-cancer drugs, and only 40% of those who do dispense orals have a quality-control initiative related to oral anti-cancer drugs (and when they do it is relatively informal). While the number of oral drugs is up slightly from last year's 21%, it is still relatively low.
Asked by OT why he thinks the percentage for oral anti-cancer drugs is so low, Mr. Blansett said there are two possible reasons. First, he said, “It's hard to make money on orals.” And second, he said, because many hospitals have closed their retail pharmacies, only a minority of chemotherapy infusion centers have an available retail pharmacy.
EMRs Increasing But Not Yet Universal
While expansion and/or equipment purchase plans for this year appear to be generally limited among community cancer programs, one area that has mushroomed is use of the electronic medical record (EMR). In 2009, 84% of ACCC survey respondents said they used EMRs, compared with 65% in 2008.
“EMRs are increasing, but are not universal,” said Mr. Blansett, who noted that among community cancer programs that do use EMRs, 54% use more than one EMR software system.
Private Practice vs Hospital Employment
A related presentation at the ACCC meeting explored the pros and cons of private oncology practice vs hospital employment. The joint presentation was given by Vicki G. Byler, MSN, RN, Director of Rex Cancer Center— a 439-bed community hospital accredited as a comprehensive community cancer center in Raleigh, NC—and Jeffrey M. Crane, MD, Staff Physician at Rex Hematology Oncology Associates at Rex Cancer Center.
The information presented noted that a community oncologist might become dissatisfied with conventional private practice because of such factors as practice governance issues, financial formulas, reduced reimbursement, lifestyle considerations, and unfavorable tax code changes.
A community cancer center administrator might be looking to hire a community oncologist who has left private practice because of the need to provide medical oncology as part of comprehensive cancer care in the cancer center, to maintain market leadership in oncology, to be competitive, to support radiation oncology patient volumes via a referral base, and a desire to expand into satellite centers.
In addition, a hospital is a bureaucracy, whereas a private oncology practice is not, noted both Ms. Byer and Dr. Crane. Thus to make the switch from private practice to hospital employment a successful one for oncologists, a physician must ensure that his or her contract stipulates that a physician vote on: staffing models, strategic planning; hiring and firing; quality assurance and improvements; scheduling; and compliance and regulatory issues.
(OT had a cover article about this trend in the March 10, 2009 issue, available atoncology-times.com— Click on Archives)