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Practice Matters
News about health policy and practice management issues of importance to oncologists
Sunday, September 14, 2014

The deteriorating ability of patients to pay for cancer treatment is clearly laid out in the newly released Trends in Cancer Programs report of findings from the Association of Community Cancer Centers (ACCC) annual survey of oncology practices.


The online survey of ACCC members was conducted between mid-January and mid-April of this year. Of the 679 ACCC member programs, 110 completed the survey; follow-up interviews were conducted in May.


Survey results show that:

·    41 percent of responding practices saw an increase in the number of uninsured patients in the previous 12 months—while 54 percent saw an increase in the number of underinsured patients.

·    35 percent of respondents said that at least 10 percent of their patients are unable to pay for treatment.


In light of that, these survey findings seem to be a problem:

·    Only 28 percent of practices said that their patients “almost always” or “frequently” ask about the cost of treatment before their therapy starts.

·    Only 14 percent of practices said that, when total treatment costs are communicated upfront, patients “almost always” or “frequently” ask for more affordable treatment options.


And these findings seem surprising to me:

·    Only 43 percent of respondents said their physicians take cost into account during treatment planning.

·    And only 39 percent said the cost of treatment and the patient’s financial responsibility are estimated prior to the start of treatment.


Without candid upfront conversations about a patient’s ability to pay, a patient is making an uninformed decision that may carry huge financial consequences for his or her family—and an oncology practice risks going unpaid for treatment that the patient may have chosen to avoid if costs had been considered.


It is devastating that these conversations must be conducted, but it is unwise and unfair to all parties not to have them. Patients who have just been handed a cancer diagnosis cannot be expected to be thinking about the financial implications of that diagnosis, so oncology practices must take the lead.


To see highlights of the ACCC survey results, click here. (The full report is available to ACCC members.)

Thursday, September 11, 2014


The quality of care for their patients is a hot topic for oncology practices, and they are finding ways to improve it, to measure it and to report it.


So says the newly released Trends in Cancer Programs report of the Association of Community Cancer Centers (ACCC) annual survey. (Click here to see the highlights; the full report is available to ACCC members.)


Indeed, 51 percent of respondents to the most recent survey said they are using the American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI) metrics to measure and track quality-- up from 36 percent in the previous year. Further, 47 percent said they are participating in the government’s Physician Quality Reporting System program--up from 34 percent the previous year. And 55 percent of respondents said they are using internally developed guidelines to measure their performance.


The trends survey, now in its fifth year, was conducted online between mid-January and mid-April of this year. Of the 679 ACCC member programs, 110 completed the survey; follow-up interviews were conducted in May.


Quality data is being used for a raft of reasons that would have been unimaginable just a few years back. Among them:

·        To help identify and develop quality improvement projects;

·        To benchmark and provide standards to community physicians;

·        To support contract negotiation and physician compensation efforts; and

·        To post on practice website


Only 28 percent of survey participants said their payers require or contract for quality measurement, but many respondents are proactively sharing quality data because they know payers will demand it in the future. And oncology practices are working to make sure they have a good report to make. They told ACCC they are working on quality improvement initiatives that address issues including:

·        Time of referral to time of first appointment;

·        Time of appointment to treatment start;

·        Imaging wait times;

·        Chemotherapy in last two weeks of life;

·        Radiation therapy 30 days before death;

·        Pharmacy delivery time;

·        Palliative care referrals;

·        Hospital readmission rates; and

·        Distress screening.

Wednesday, September 03, 2014

Palliative care has become standard practice in leading healthcare organizations—100 percent of the top 20 National Institutes of Health-funded medical schools, 97 percent of the Council of Teaching Hospitals and Health Systems’ member organizations, and 87 percent of the National Cancer Institute-designated comprehensive cancer centers have palliative care teams—but it is also becoming common in the nation’s smaller hospitals.


In fact, 1,734 hospitals with 50 or more beds—that is 61 percent of all U.S. hospitals that size—had palliative care teams in 2012. By contrast, just 658 hospitals of that size had palliative care teams in 2000.


That finding comes from just-released survey data from the National Palliative Care Registry maintained by the Center to Advance Palliative Care (CAPC). The report reflects responses from 355 palliative care teams that provided information about their 2012 experience to a survey administered in late 2013 and early 2014, said Rachel Augustin, CAPC’s director of research.


Other findings:

·    The 355 palliative care teams cared for, on average, 4 percent of hospital admissions—up from just 1 to 2 percent a decade ago. The teams with the highest penetration rates, meaning the percent of admissions treated by a palliative care team, cared for an average of 7 percent of annual hospital admissions.

·    Palliative care programs with higher staffing levels see patients earlier in their hospital stay—and reduce the length of time the patient remains in the hospital. Teams that have the highest staffing levels saw patients, on average, at 3.9 days into an admission and patients were discharged an average of 4.7 days later. By contrast, palliative care teams with the lowest staffing levels did not see a patient, on average, until 8.3 days into the stay which typically continued for another 8.2 days.

Sunday, August 24, 2014

If you have not been following the conversation about bundled payments for cancer care, it is time to get up to speed. A consensus that bundled payments is the best payment reform strategy is emerging, and we will see many pilot and demonstration projects starting soon.


The Centers for Medicare & Medicaid Services has been experimenting with bundled payments for orthopedic and cardiac procedures for years and it expanded the concept to include more than 40 medical conditions when the Bundled Payments for Care Improvement initiative launched last year. Oncology services are not included yet, but CMS is definitely planning to give bundled payments for cancer care a try.


At a webinar last week, Patrick Conway, MD, chief medical officer for CMS, and Erin Smith, CMS’ point person for new payment methods for specialty care, shared CMS’ current thinking about a new oncology care model. Scroll down to slide 11 to see the nitty-gritty details.


In another presentation, Ezekiel Emanuel, MD, PhD, chair of medical ethics and health policy at the University of Pennsylvania, reported that a consortium of oncologists, payers, patient groups, and policymakers convened by the Center for American Progress (CAP), where he is a senior fellow, is enthusiastic about bundled payments for cancer care. That said, I got the impression that CAP and CMS are working toward the same goal, but have diverging ideas about how to get there.


Members of the CAP consortium are planning to publish a recommended model and guiding principles and encourage a multi-payer demonstration, Emanuel said.


To date, the consortium has agreed that:

·    Bundled payments should start with high prevalence cancers, specifically metastatic non-small-cell lung cancer and adjuvant and metastatic colon cancer.

·    Both private health plans and government payers should participate in a bundled-payment demonstration so that oncology practices have enough patients covered by the new payment system to make it worth their participation.

·    Payment episodes should be based on the total cost of care (meaning everything from drugs to hospital inpatient care.)

·    The oncologist should be the “accountable” provider, as opposed to a hospital, even if a hospital employs the oncologist.

·    The financial risk to oncology practices should be phased in over time to give practices the opportunity to make the changes necessary to succeed with bundled payments.

·    All payers and providers should use a standardized set of meaningful quality measures. To see what CAP is thinking, scroll down to slides 11-13 of Emanuel’s presentation to see examples of the quality measures its members have in mind.


Bundled payments—is this the right idea for payment reform in oncology? Let me hear what you think!


Sunday, August 17, 2014

If you want to check out what the federal government is about to reveal about your financial doings, the time is now.


On Sept. 30, the Centers for Medicare & Medicaid Services will unveil the payments and other “transfers of value” from the medical industry to physicians and hospitals through its Open Payments initiative.


To check out the accuracy of the government’s information, you may want to register in CMS’ Enterprise Portal—as quickly as possible. The review and dispute period ends Sept. 8.


If you’re thinking “of course the information will be accurate,” remember that the Department of Health and Human Services has had some challenges with technology lately. In fact, its Open Payments website recently got confused between David E. Mann, MD, a retired electrophysiologist in Kentucky, and David E. Mann, MD, an oncologist in Florida, prompting CMS to temporarily suspend registration of the Open Payments so it could figure out who took money from whom. Registration resumed on Friday.


It is enough to make you grit your teeth in frustration, but there is a reason and another and another that the public needs to know who is taking money from pharmaceutical and medical device companies.






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About the Author

Lola Butcher
LOLA BUTCHER, MPA, MA, an award-winning Contributing Writer for Oncology Times, writes about health policy and business trends. She is a frequent contributor to Hospitals & Health Networks, Modern Physician, Neurology Today, and other health care trade publications. This blog was recently recognized with an APEX Award for Publication Excellence.