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Practice Matters
News about health policy and practice management issues of importance to oncologists
Friday, April 24, 2015

 

Like most people interested in the future on cancer care payment, I have been tracking the COME HOME community oncology medical home pilot ever since the Center for Medicare & Medicaid Innovation announced that it was awarding $19.8 million to help seven cancer care practices adopt the medical home model.

 

The pilot wraps up in July, and it will be a while before we learn how it worked out for the practices. But a sneak preview published in Health Affairs last year suggested that the model was not financially sustainable.

 

My palms have been sweating ever since I read that because so many oncology administrators and oncologists have been working for the past three years to prepare for the oncology medical home model.  

 However, my worries were for naught. I recently spoke with Steve D’Amato, BSPharm, BCOP, executive director of New England Cancer Specialists (formerly Maine Center for Cancer Medicine), one of the COME HOME pilot practices. 

 

In March, D’Amato started a term as president of the Association of Community Cancer Centers, and he obviously believes the oncology medical home model is here to stay. In fact, he is making that the theme of his ACCC presidential term. In an interview, he discussed why that is a top priority:

 

Why did you choose the oncology medical home to be the theme of your presidency?

Steve D’Amato: “I chose it because it is a multidisciplinary approach to comprehensive, patient-centered care that focuses on quality, evidence-based care, and value, among other attributes. It also builds on the themes of past presidents of ACCC.”

 

What are the main features of an oncology medical home that are different from the way most oncology practices operate?

“I think most oncology practices probably have many of the domains of the oncology medical home in place, such as financial advocates, a certified electronic health record, a patient portal, and evidence-based pathways. But there’s more to the oncology medical home, from my perspective. New England Cancer Specialists, through being part of the COME HOME initiative along with six other practices, has built an infrastructure that ties everything together and positions us for future payment reform endeavors.

 

“The other parts of the medical home that some practices might not have in place are a standard triage system to facilitate same-day urgent care visits, treatment pathways, and expanded hours during the week and on weekends. This has proved to be very successful in decreasing ER visits and hospitalizations.

 

“We also have seen a decreased length-of-stay in patients admitted to the hospital. So another part of the oncology medical home is that tight integration with primary care and other providers that’s extremely important as well as patient engagement, so that patients are really involved in decision-making as they move through the cancer treatment.”

 

Do you think all cancer care practices will evolve to use the oncology medical home model in the foreseeable future? Why or why not?

“The medical home was started by primary care, and the oncology medical home pioneered by Dr. John Sprandio takes resources to implement. I think that practices with the financial and physical capital will have an easier time adopting this model. Others will find it more difficult without support.

 

“We believe that this model is the right approach for oncology patient-centered care, and I really don’t see ourselves going back the way we operated before the COME HOME project.”

 

“Really, the payers need to take some responsibility and give the practices the support to implement this model because the payers will benefit from it. The COME HOME model certainly was designed for Medicare patients—although we implemented it for all of our patients because we only have one standard of care within our practice. I think the CMS Oncology Care Model will help support practices. In addition, negotiating with private payers to help fund this infrastructure will benefit everyone overall.”

 

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Listen to a podcast of our conversation in OT's May 25th iPad issue.


Tuesday, April 21, 2015

U.S. oncologists on average received $302,000 for patient care and $15,000 for non patient-care activities in 2014, according to the newly released Medscape Physician Compensation Report. Their total compensation increased by four percent from a year earlier.

 

That information comes from an online survey completed by 19,500 physicians representing more than 26 specialty areas between Dec.  30, 2014, and March 11, 2015. Two percent of respondents were oncologists. The margin of error for the survey was ± 0.69% at a 95% confidence level. Survey results were announced by WebMD Health Corp., which owns Medscape.

 

I found a lot of interesting nuggets in the survey findings, but first things first: Oncologists may be the hardest-working physicians (not one of the survey questions, just my assumption) but they were not the most highly paid in 2014. The top-pay award goes once again to orthopedists, who on average received $421,000 for patient care and $29,000 for activities unrelated to patient care in 2014.

 

On the other end of the spectrum, pediatricians on average received $196,000 in total compensation in 2014 while family medicine physicians received $205,000.

 

Are you satisfied?  If they could rewind their careers, only 45 percent of survey respondents said they would select their own specialty again—although 64 percent would still choose medicine as a career. Here’s an interesting tidbit: Family medicine topped the list of specialties that would choose the medical profession—with 79 percent saying they would do so—but only 32 percent said they would train to be family physicians.

 

If job satisfaction is important, you might want to retrain to become a dermatologist. That specialty topped the list for satisfaction when survey analysts rolled three responses into a single satisfaction metric: 55 percent of dermatologists said they would choose medicine again as a career; 73 percent said they would choose dermatology; and 61 percent reported satisfaction with their income.

 

By contrast, 67 percent of oncologists responding to the survey said they would choose medicine again but only 51 percent said they would choose oncology. And just 44 percent said they were satisfied with their income.

 

Where to go for big bucks?  North Dakota, Alaska, and Wyoming are the three top-earning states for physicians overall. Yes, those of you in Washington, D.C., get to rub shoulders with the power elite but you’re paying a price for it. The District of Columbia tops the list of lowest-earning states for physicians, followed by Rhode Island and Maryland.

 

You Could Be Making More Money, FYI

Since we’re talking about money, I must mention a few big numbers that caught my eye earlier this month. Modern Healthcare published its annual “Highest-Paid Physicians at Not-for-Profit Healthcare Systems” list in its April 6 issue, and oncology took five slots on the list.

 

The ranking is based on IRS Form 990 filings and reflects 2012 total compensation. So it is outdated information, but interesting nonetheless:

    Mark Urken, MD, Chief of the Division of Head and Neck Surgical Oncology, Department of Otolaryngology at Mount Sinai Beth Israel (formerly Beth Israel Medical Center in New York), ranked fourth on the list with total compensation of nearly $4.4 million;

    Robert W. Holloway, MD, a gynecologic oncologist at Florida Hospital Medical Group in Kissimmee, Florida, had $2.9 million in total compensation that year;

    Tahir Ali Naqvi, MD, a staff hematologist/oncologist at Community Hospital of Anderson in Anderson, Indiana, had total compensation of $2.8 million in 2012 (MH noted that he left the hospital in 2014);

    Philip Gutin, MD, chairman of the Department of Neurosurgery at Memorial Sloan Kettering Cancer Center in New York, had total compensation of $2.7 million; and

   Jatin Shah, MD, chief of the head and neck service at MSKCC, also had total compensation of $2.7 million.


Thursday, April 16, 2015

The best summary of how the Medicare Access and CHIP Reauthorization Act of 2015 will affect physician pay that I have seen so far comes from Stuart Guterman, vice president for Medicare and Cost Control at The Commonwealth Fund. I have interviewed Stuart many times and this man knows Medicare like nobody else.

 

The details you need to know, lifted almost verbatim from his blog post entitled With SGR Repeal, Now We Can Proceed with Medicare Payment Reform” are:

    Physician fees will increase by 0.5 percent in June 2015 and each year from 2016 through 2019. Then they will remain level through 2025—but high-performing physicians and those who participate in alternative payment models will have the opportunity for additional payments.

    A merit-based incentive payment system (MIPS) will be established beginning in 2019. The MIPS will replace three previous incentive programs: meaningful use of electronic health record technology, the Physician Quality Reporting System and the physician value-based modifier program. The MIPS .will assess the performance of each physician based on quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health record technology.

    Physicians who participate in alternative payment models such as accountable care organizations (ACOs) can receive extra payments, such as shared savings or care management fees.

    In addition, a five percent bonus would be available each year from 2019 through 2024 for physicians who receive a “substantial portion” (not defined yet) of their revenues through ACOs and other alternative payment models.

   Providers who choose to participate in the MIPS would be subject to bonuses or penalties based on their performance. In the years between 2019 and 2024, $500 million in funding each year will be available to reward providers with exceptional performance.


Wednesday, April 15, 2015

 

What’s next now that the long-lamented Sustainable Growth Rate formula has been kicked to the side of the road?

 

The Senate voted last night—92 to 8—to approve the Medicare Access and CHIP Reauthorization Act of 2015, and President Obama is expected to sign the legislation quickly. First, a brief pause to celebrate what everybody in healthcare has been wanting for years.

 

“Today’s courageous vote by the U.S. Senate to finally end the Sustainable Growth Rate formula is a vote for the millions of patients with cancer who depend on Medicare to help them fight their disease,” Peter Paul Yu, MD, President of the American Society of Clinical Oncology, said in a statement.

 

“With Congress passing this historic legislation to finally end the 13-year SGR roller coaster ride, Medicare beneficiaries and their physicians can breathe easier knowing that they will no longer face the perennial threat of payment cuts that risk disruption of care and cause anxiety among patients.”

 

American Society of Hematology President David Williams MD issued a statement that included this: “ASH is pleased that members of Congress have united in support of real, structural changes to the Medicare program. The passage of this legislation charts a course toward greater value and sustainability throughout the health-care system.”

 

The American College of Surgeons pointed out in its press release that repeal of the SGR has been one of its top priorities for a decade. “The reforms set in place by Tuesday’s historic Senate passage of H.R. 2 offers peace of mind to America’s seniors, whose access to medical care through the Medicare program has been threatened for more than 10 years,” said Executive Director David B. Hoyt, MD.

The Association of Community Cancer Centers reported that its members made more than 80 visits on Capitol Hill in recent weeks to push for the SGR repeal. "ACCC thanks the legislators in both houses who voted in support of SGR repeal,” ACCC President Steven L. D’Amato said in a news release. “We also salute our ACCC members for their persistent, multi-year advocacy efforts on behalf of SGR reform."

“The Senate finally answered the bell and completed the hard work done by the House,” noted a Community Oncology Alliance blog post.  “The flawed SGR-based Medicare reimbursement system for physicians’ services is now history. After some political theater, the Senate passed the… bill and the President signed it into law. In addition to eliminating the SGR from our language for at least 10 years, the bill ushers in a new era of payment reform to medicine.”

The American Society for Radiation Oncology ASTRO noted in a statement that repeal of the SGR has been a priority of the organization for many years—“passage of this legislation represents a long-awaited, historic victory for our patients. 

“Permanently repealing the SGR and replacing it with a stabilized reimbursement plan focused on quality will strengthen Medicare and allow us to enhance cancer care for the more than one million patients treated with radiation therapy each year,” said Bruce G. Haffty, MD, FASTRO, Chair of ASTRO’s Board of Directors.

“We commend the strong bipartisan leadership in the House and Senate, and President Obama for this extraordinary achievement that will ensure that patients have access to the care that they need. We are excited to turn the page on the SGR and to work with Congress and the President on additional needed Medicare reforms, including stabilizing specific radiation oncology payments and protecting patients and the integrity of the Medicare program by closing the physician self-referral loophole.”

And James Madara, MD, CEO and Executive Vice President of the American Medical Association issued a press release pointing out that the new legislation also directly helps poor children: "In addition to eliminating the flawed Sustainable Growth Rate (SGR) formula, we applaud our policymakers for ensuring access to care for children, low-income individuals, and families by extending funds for the Children's Health Insurance Program and community health centers.”

 

After the victory dance, physicians will start figure out the SGR replacement. I will be reporting on this in the weeks ahead, but the bottom line is this: Congress has authorized a 0.5 percent annual physician pay increase for the next five yearsa welcome break from the annual threat of big pay cuts for physiciansbut it is going to insist that physicians improve the value of care they deliver.

 

Any physician who is not on board with quality reporting, careful use of healthcare resources, and meaningful use of electronic health record technology is going to be even further out of step than he or she is today. Get ready.


Tuesday, April 07, 2015

Charles LeMaistre, MD, the long-time president of the University of Texas MD Anderson Cancer Center (1978-1996), is still racking up honors at the age of 91. He was recently inducted into the Modern Healthcare 2015 Health Care Hall of Fame at a ceremony in Chicago.

 

The magazine published a neat profile that I wish everybody who knows him could read, and I encourage you all to. Unfortunately, it’s behind a paywall. So, as a paid MH subscriber, I’m sharing some of the best bits with you:

  • A “Lassie” moment. LeMaistre’s life was influenced by an incident that occurred when he was 10 years old. Walking in the woods with his German shepherd, Inga, he suffered a ruptured appendix and fell to the ground. The dog went to his house and alerted his brothers, who carried him back in time for an operation that saved his life. “It was a lesson that I reflected on many times because there was some reason why I survived that,” he told Rachel Landen, a Modern Healthcare reporter.
  • Overcoming adversity. A week before he was to start the Naval Academy in Annapolis, LeMaistre suffered an eye injury that made him ineligible to enroll. Instead he enrolled at the University of Alabama in Tuscaloosa and eventually graduated from Cornell University Medical College.
  • Prevention first. The health care industry is just now turning its attention to the importance of prevention, but LeMaistre has been focused on it through most of his career. During a five-year stint at Emory University in the 1950s, he started a department of prevention. From there, he moved to Dallas and started working his way up the ladder at the University of Texas Southwestern Medical School. That’s where he got interested in fighting cancer. He was on the first surgeon general’s advisory committee on smoking and health that, in 1964, issued the report indicting tobacco as a cause of lung cancer.
  • The right priority. David Bachrach, a long-time colleague, told MH that “Mickey,” as he prefers to be called, once admonished some MD Anderson leaders who were fretting about the possibility for competition in funding from another institution that was seeking a National Cancer Institute designation. Bachrach said:

“Mickey, in his inimitable way, said, ‘Are you folks done talking about this? Because I want to clarify something. The enemy isn’t the institution. The enemy is cancer, and we will welcome anyone who is working for a cure to cancer.’”

 

    Still on the job. LeMaistre is petitioning people in high places—the President, Congress, and the Department of Health & Human Services—to protest high cancer-drug prices that jeopardize patients’ access to lifesaving treatment, according to the MH profile, which also notes that he is finishing a book about the history of the surgeon general’s committee. “I cherish the accomplishments of other people in the past,” he told MH. “But what I do is look forward.”

 

Read more of this excellent profile, and watch  a related video here.

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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.