Tag Archives: ACCC Annual National Meeting

Is Your Cancer Program Indispensable?

In April, ACCC held its 40th Annual National Meeting, with a focus on policy, economics, and business. The session on “Strategies for Growth in Cancer Care Delivery,” with Sg2 Vice President Trever Burgon, PhD, was standing room only. ACCCBuzz invited Dr. Burgon to share some key takeaways from his talk. Read on and find out why the term “indispensable” is the way you want patients and payers  to describe your cancer program.

Person in information spaceby Trever Burgon, PhD, Vice President, Sg2

Let’s start with a provocative statement: There is no service line more important to your hospital, practice or health system’s future competitive position than cancer services. Here are three areas of evidence to support this claim:

1. Growing demand – An aging population and expanding treatment options will drive strong demand for cancer services. At the recent ACCC 40th Annual National Meeting in Arlington, Va., I shared data from Sg2’s Impact of Change® forecast model, which projects demand for healthcare services over the next decade. Much of this growth will happen in the outpatient setting, in fact, Sg2 forecasts stronger outpatient growth for cancer than for any other service line. Nationally, we anticipate that demand for ambulatory cancer care will increase 15% over the next five years and 31% over the coming decade. Demand growth will be softer on the inpatient side, increasing only 3% over the next decade. There is an important nuance in these inpatient numbers. Many inpatient surgical procedures will see strong growth of +9% over the next 10 years, while non-surgical admissions are expected to fall by 5%. This expected decline will be the result of improved patient management in the ambulatory setting and expanded access to appropriate palliative and end-of-life care which will reduce avoidable hospitalizations. Meeting this demand will require hospitals and health systems to develop and expand strong systems of care that coordinate services across the care continuum, from screening and diagnosis to outpatient and inpatient treatments through survivorship and end-of-life care.
2. Changing economics – Per person, cancer is the most expensive disease to treat in the U.S. For providers and health systems, cancer care represents an important source of revenue that helps subsidize other care delivery services. At the same time, spending on cancer is increasingly coming under the scrutiny of public and private payers looking to control healthcare spending costs. As we heard multiple times at the recent ACCC meeting, various new payment reforms, including robust benefits management, bundled payments, and narrow networks, all have the potential to materially impact cancer services. Successfully navigating these changing economic structures has the potential to impact the entire enterprise.
3. Connecting with patients and families – Cancer occupies a unique and important part of our healthcare landscape. It is a terrifying disease that will impact virtually each one of your patients and prospective patients either through a personal diagnosis or that of a loved one. Meeting the needs of these patients and their families with seamlessly coordinated, patient-focused services that span the care continuum represents a powerful opportunity to engage and care for these consumers over their lifetime. Guiding a patient from initial diagnosis to treatment, providing critical but under-reimbursed psychosocial support services, or ensuring that patients’ end-of-life treatment plans are aligned with their quality of life goals, can be some of the best opportunities to establish your program as the go-to place of care for all of a family’s healthcare needs. If you can provide this level of coordinated, patient-centered care for a complex disease like cancer, you can do it for any disease.

What must cancer programs do to position themselves for success in the face of growing demand, changing economics, and unique opportunities to connect with patients? Build a differentiated program that is indispensable to both patients and payers.

There are many ways to build this type of program and no two cancer programs will establish their indispensability in the same way. One area that will be consistent across all successful programs, however, will be a robust system of care that delivers value by ensuring patients and data flow seamlessly between the many providers and sites that span the cancer care continuum. At ACCC’s Annual National Meeting in April, we discussed a number of clinical opportunities for differentiation, including protocol-driven lung screening, easy-access one-day multidisciplinary clinics, and cancer-program-embedded outpatient palliative care services. In addition, we examined a number of oncology-specific bundled payment and accountable care pilots that progressive organizations are using to differentiate themselves with payers.

There are not enough resources to build every clinical program you would like, and not all of the new payment pilots will be successful and scalable. But these types of investments and innovations will be the key to making your cancer program indispensable in your market. And it will be these indispensable programs that succeed, to the benefit of your hospital, practice, or health system and more importantly, your patients.

Alternative Payment Models, Risk-Sharing Ahead, Says ACCC Keynoter

meetings-AM2014-Patel(1)by Amanda Patton, Manager, Communications, ACCC

With polarization on Capitol Hill impeding the legislative process, ACCC 40th Annual National Meeting keynote speaker Kavita Patel, MD, of the Brookings Institution told attendees: “If you are looking for change, I would point you to your own selves in the mirror, not to Washington, D.C.”

With the Senate having passed the SGR reform patch the night before, Patel noted that despite the fact that SGR reform was one of the few things with bi-cameral support in Congress, ultimately, we once again have a one-year “doc fix.” This is the 17th time Congress has enacted an SGR patch since the formula went into effect in 2002.

Still, Patel believes there is potential for Congress to act on long-term reform next year.

The current “SGR fix” legislation reflects Congress’s focus on “value” and value-based alternative payment models, she noted.

“At some point, it will be important for your community to think about what that would look like at your programs.” She believes medical oncology may be well suited to what Congress is thinking about with alternative payment models.

While cancer care has evolved so greatly over the past several decades, our reimbursement policies to pay for that care have not evolved.

Among the alternative payment models, Patel believes the medical home model may be suited to oncology, while bundling is a poor fit.

“If people think there’s going to be bundling in oncology, they are wrong,” she said.

So is fee for service gone forever? “No,” says Patel. “The answer is there is always going to be room for fee for service in certain settings.”

But, some form of risk-sharing is definitely in the cards. “In 10 to 15 years, the majority of people in this room will have some sort of risk-based contract…that will become the norm in the next several decades.”

However, she warned that if you turn to Congress for a solution, they are likely to turn it around and ask you to show them viable solutions—and this is a good thing.

At the end of the day, I think we need more clinical voices in the policy setting arena, “ she said. “You don’t want Medicare or Congress thinking about cancer care without [our] voices.”

Payment Reform—Beyond the Buzzwords

dollarsignby Amanda Patton, Manager, Communications, ACCC

Pay for performance. Bundling. Episodic payments. ACOs. PCMHs. Payment reform buzzwords are now part of the oncology landscape as providers try to envision what the future will look like.

As healthcare reforms move us away from a volume-based payment model toward new value-based models—it’s hard for those on the front lines of cancer care to gauge exactly where oncology is in the transition process.

On April 1, ACCC Annual National Meeting keynote speaker Kavita Patel, MD, MS, will present an insider’s view of the progress to date in the shift from fee for service payment in oncology to quality and value-based models. Dr. Patel is a Fellow and Managing Director in the Engelberg Center for Healthcare Reform at the Brookings Institution.  She has been leading efforts around payment reform in oncology in the private and public sector, including advising the recent Specialty Physician Payment Model Opportunities Assessment and Design (SPPMOAD) project of the Center for Medicare & Medicaid Innovation (CMMI).  Additionally, her current research focuses on payment models in cardiology, gastroenterology, and primary care.  Her knowledge is built on practical clinical experience as a primary care physician as well as her experience serving as a senior advisor to President Barack Obama and the late Senator Ted Kennedy.

In a recent conversation, Dr. Patel gave us a preview of the issues she’ll discuss at the ACCC’s upcoming Annual National Meeting. Read on for a glimpse into how she thinks oncology care delivery may look in the future.

In the near term, Patel believes oncology is likely to experience more pressure to drive down the cost of drugs by forcing doctors not to use high-cost drugs; more pressure for demonstration of adherence to guidelines and pathways; and increasing documentation requirements about patient-reported measures such as pain and symptom management.

Looking further down the road, the many new payment models under consideration make the future a little fuzzier. “Right now in cancer it’s really just fee for service; anything that’s not fee for service would be interesting—ACOs, medical homes, pay for performance, bundled payments, capitation, global budgets,” Patel said. But the move away from fee-for-service is a certainty.

Whatever shape new payment systems take, Dr. Patel thinks it could affect the composition of the oncology workforce. “Our traditional roles might have to be adapted,” she said. “Right now doctors are getting paid to see a lot of patients.” If oncology shifts to value-based payment models, there may be a change in who delivers some patient care. “It might not be doctors and it might not even be nurse practitioners; it may be oncology community health workers.”  Who might fill the role of oncology community health worker? Often these staff are lay persons who can help patients navigate the delivery system and serve as a point of coordination and outreach on the many issues which impact health beyond the four walls of a doctor’s office, such as transportation, housing and nutrition, she said.

Dr. Patel will share more insights and help set the stage for meeting sessions that will provide a deeper dive on topics such as strategies for growth in cancer care delivery, alternate payment models in oncology, the role of physician extenders on the cancer care team, and more at the ACCC Annual National Meeting, March 31-April 2, in Arlington, Virginia.