Home > Meetings : 5th Annual Hospital Summit Wrap-up
ACCC's 5th Annual Hospital Summit: Meeting Wrap-up
Attendees learn current and future trends and how to position their cancer program to take advantage of new opportunities.
On December 11, 2009, almost 100 cancer care professionals gathered in Vienna, Va., for ACCC's 5th Annual Hospital Summit. They met with thought leaders in the oncology field and learned strategies to best chart a path forward under healthcare reform, new Medicare rules, and a difficult economic climate.
The following presentations are available:
"The Oncology Professional Shortage: Who Will Care for Our Patients?"
Luana Lamkin, RN, MPH, President, ACCC, St. Luke's Mountain States Tumor Institute
"Oncology-specific Pay for Performance: Its Time Has Come"
William Guss, MBA, PharmD, Aptium Oncology, Inc.
"2010 CMS Final HOPPS Rule"
Matthew Farber, MA, Association of Community Cancer Centers
"Strategic Planning in Oncology"
Ron Howrigon, Fulcrum Strategies
"How to Make the Best Use of Your Cancer Registry"
Toni Hare, RHIT, CTR, Champs Mangagement Services
"Cancer programs are adapting to the recession," said Lee Blansett, MBA, of Kantar Health, who commented on preliminary results of the 2009 ACCC survey of member cancer programs. He said that 86 percent of respondents report reduced travel and education; 65 percent renegotiated vendor contracts; 61 percent delayed equipment purchases; and 59 delayed construction projects. Close to six in ten made changes to their cancer program as a result of the current economic recession. (Complete ACCC survey results will be published in mid-2010.)
The good news for hospitals is that they are positioned for success, said Blansett. Hospitals enjoy more diversified revenue streams and service lines than community practices. And despite the recession, a majority of cancer programs characterize their programs’ financial status as good or very good, according to the 2009 ACCC survey.
According to Blansett, hospitals' share of chemotherapy treatment is growing steadily, while oncology practices are seeing their share of chemotherapy decline. Patients referred to hospitals for chemotherapy treatment rose from 11 percent in 2007 to 18 percent in 2009, according to a MattsonJack Davinci practice managers’ survey. "Community practices' referrals to hospitals are rising," said Blansett. "If practices can't afford to treat, they will refer."
At the same time there's a growing trend to hospital-based practice arrangements. "I encourage you to talk to oncology practices. There's an opportunity for you to expand your role in the marketplace," said Blansett.
ACCC's 2009 survey did reveal an unfavorable pattern: Cancer programs have seen a drop in commercial insurance-based patients and an increase in the volume of uninsured and underinsured patients with high co-pays they cannot afford to pay. More patients require help affording their medication and transportation expenses.
The bottom line trend: By and large hospitals are satisfied; practices are not, said Blansett.
A Perfect Storm? The Oncology Roundtable Outlook
Cancer patient demand and uninsured patients are up. Hospital margins are down. Are we in a perfect storm, asked Allison Cuff Shimooka, MBA, managing director of the Advisory Board's Oncology Roundtable.
No, she suggested. Although the indigent and uninsured population are increasing, patient volume is up across the board. "That should continue forward no matter what happens with the economy," said Shimooka. Twenty-seven percent of programs report increased patient volume up to 5 percent; 28 percent of programs report increases of 5 percent or greater.
"Overall oncology is a bright spot for most hospitals. The magnitude of the challenges varies market to market. Recession impacts are largely regional," said Shimooka.
However, there is an "underlying sense of trepidation about the future of oncology," according to Shimooka. Cancer costs are growing exponentially. Costs are high even for insured patients. Insured patients spend an average of $35,000 on cancer treatment throughout their illness. Twenty percent of insured cancer patients spend all their savings on treatment.
For hospitals, access to capital during this recession is limited, but not a pressing concern, said Shimooka. Sixty-three percent of oncology budgets stayed the same or increased over the last twelve months. Sixty-two percent of cancer programs anticipate no budget cuts in the next twelve months.
"Most hospital cancer programs are not worried about what limited access to capital will do to their growth. They know their competition is in the same boat as they in terms of accessing capital. Many have already spent heavily on capital equipment. Over the past few years there was an oncology spending spree. Almost two-thirds of programs already have STS and robotic surgery, for example," said Shimooka.
Still, many projects are on hold until capital opens up. "How will hospitals fund capital growth if they can't borrow it? They will have to earn it," said Shimooka. Operating margins are essential to fund future growth.
Medical oncology practices are in a tighter market than hospital programs, according to Shimooka. Private practice medical oncologists have seen a dramatic decrease in profit per patient. From 2006 to 2007 they saw an 86 percent decrease (from $654 to $89 per patient). At the same time drug margins measured as gross revenue divided by total number of patients decreased from 17 percent to 11 percent in 2007.
"The good news is that as drug prices have increased, physician income has increased. In many markets physician income has stabilized," Shimooka said.
Still, many oncologists are seeking hospital employment; and many hospitals are interested in partnering more closely with physicians. Co-management and joint ventures continue to be the most popular arrangement, but the federal government is chipping away at the models with increased scrutiny and regulatory limitations. "Overall, we are seeing a decrease in partnership activity overall and rising skepticism about them," said Shimooka.
More tightly integrated models are becoming more attractive, she said, particularly for radiation and surgical oncologists.
"We are not seeing a wholesale shift among medical oncologists. They like their independence. As a result we are seeing emergence of an alternative: the medical oncology service agreement, by which the financial risk to the oncologist is reduced," said Shimooka, who called the arrangement "incredibly complex." The hospital leases medical oncology office space, becomes the provider of chemotherapy, performs billing and collecting, and provides service fees to physicians equal to the total direct cost, including compensation to the medical oncologist.
Healthcare Reform: Uncertainties and New Opportunities
"We are in the middle of incredible uncertainty," said Ron Howrigon of Fulcrum Strategies and 18-year veteran with the managed care industry. He gave a behind-the-scenes look at how the insurance industry views healthcare reform.
"Payers fear the public option. They fear a reduction in profits. A public option means insurance companies will cut reimbursements to providers to be competitive." And pay for performance in the eyes of the insurance companies means only cost control, not quality, according to Howrigon.
"Payers like divide and conquer," said Howrigon, meaning they don't mind if hospitals and practices compete with each other for patients and revenue. "Something we have to get past: hospital/physician relationships. Physicians are getting hammered on oncology drug revenue, so they're trying to replace that revenue with ancillary services. Some oncology practices are buying their own PET/CT, opening dispensing pharmacy, even bringing in breast cancer surgeons. They are taking revenue from the hospital and creating a real problem for the delivery system."
Howrigon suggested several strategies that hospitals and practices can implement to create opportunity:
- Joint ventures, including infusion and imaging, between facilities and physicians
- Consolidation to reduce overhead costs and increase leverage with payers
- Advocacy on the state and local levels to make sure providers are in front of the insurance industry
- Legislative relief through fair contracting laws that require insurance companies to notify practitioners about fee schedule changes.
In addition, he urged cancer programs to take their story directly to the employer community:
Develop your own tools to measure quality and cost effectiveness. Providers haven't told their own quality story well to the employer community. Tell them: 'We know our cancer care may be expensive, but our data show our survivor rates are higher than the national average. If you are diagnosed with cancer, don't you want the best cancer care?'
Bringing Out the Best in the Cancer Service Line
The theme throughout ACCC's Hospital Summit was to help cancer programs improve care and business outcomes.
The cancer registry can be a key source of information to determine financial incentives, meet accrediting regulations, and establish policy, said Toni Hare, RHIT, CTR, of Champs Management Services. She provided insight into making better use of registry data, how quality cancer data can affect cancer care locally and nationally, and how quality cancer data is applied to decisions affecting future planning.
The cancer registry connects directly to the quality process, said Hare. The registry can do more than collect information; it can help establish the study topic and define the measures, take action to improve patient care and monitor actions, and evaluate quantitative reports.
She noted one registry study on improving wait time from radiation consult to initial treatment for prostate cancer patients. Patients were identified from the cancer registry, data captured in the cancer registry database, and an outcome report was generated. Average wait time was 165 days. The action: the facility purchased and installed IMRT, an additional one hour was added to the RT clinic schedule, and improvement noted of 29 days.
Other speakers at ACCC's Hospital Summit explored pay for performance from an oncology perspective, innovative solutions to the oncology workforce shortage, and payment reforms.
Facebook
LinkedIn
Twitter
ACCCExchange Listserve