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ACCC's 4th Annual Hospital Summit Highlights Trends in Cancer Care
Cancer service line leaders and administrators gathered December 12, 2008, outside of Washington, D.C., for ACCC’s fourth annual Hospital Summit. They came to learn about trends in cancer care and gain strategies to position themselves to meet the challenges of these tight economic times. Three trends stand out:
- A major site shift of cancer care is underway. Community oncology practices will see further financial declines under average sales price (ASP) contracts. As community oncologists reduce infusions, hospitals’ role will increase.
- Quality and transparency top the concerns of hospital leadership. However, cancer programs often do not have a method for consistently and accurately measuring the quality of the care they provide.
- New partnership models are coming, some in direct competition with hospitals.
Hospital Summit Photo Roundup
ACCC President Ernest R. Anderson, Jr., MS, RPh, (center) with ACCC President-elect Luana R. Lamkin, RN, MPH, (right) and ACCC Board Member Becky L. DeKay, MBA.
Diane Naimark, Manager, Accreditation and Certification Operations, with The Joint Commission.
Christy Harrison, RN, MS, from Tallahassee Memorial HealthCare’s Cancer Center, takes notes.
Nancy Fisker, MBA, RN, from Aspirus Regional Cancer Center in Wausau, Wisc., and Camille Utter, BSN, OCN, from Scotland Memorial Hospital in Laurinburg, N.C.
Randall Oyer, MD, from Lancaster General Hospital in Lancaster, Pa., and Debra Ishihara-Wong, APRN, MN, who came all the way from The Queen’s Medical Center in Honolulu, Hawaii.
Major Site of Care Shift
Whereas 65 percent of chemotherapy currently takes place in physician offices, over the next five years the numbers will shift in favor of hospitals, said Lee Blansett, senior vice president, MattsonJack DaVinci. That’s because financial declines in community private practices are rapid under average sales price (ASP) contracts. Although patient volumes in practices rose from 2005 to 2007, profitability margins plunged a whopping 90 percent over the period. “There is futility in oncology practices adding low-margin procedures to replace the chemotherapy margin,” said Blansett. “That delivers incremental but declining gains.” As community oncologists reduce infusions, hospital cancer program patient volumes will likely increase.
Blansett went on to provide glimpses of a soon-to-be released ACCC benchmarking survey, “Cancer Care Trends in the Community Hospital Cancer Center – 2008.” Look for survey results to come in early January 2009.
“Hospitals are doing very well,” he said. Most respondents characterize their programs’ financial status as good or very good. And volumes are up. “This bodes well for the future.”
Quality Care and Metrics
Meaningful pay for performance is still years away, according to presenterAmy Siegler, MBA, managing director, The Advisory Board Company. “Oncology is stuck at the starting gate regarding value-based purchasing because the cancer community is just beginning to get consensus around a very preliminary set of quality indicators, and data collection challenges remain.”
Although quality and transparency are rising to the top of the hospital agenda, cancer programs often do not have a method for consistently and accurately measuring the quality of the care they provide. The dearth of robust data and ongoing nature of treatment make gathering information on performance a significant challenge. Even with great information on hand, cancer programs may not have the resources and incentives needed to execute on the data and drive real change, according to Siegler.
That said, meaningful opportunities exist for hospitals to better understand their current performance and use data to drive quality improvement, according to Siegler. Metric selection, performance tracking, and quality improvement initiatives should continue to be pursued for the dual purpose of preparing for pay for performance, while at the same time elevating program quality. Early metrics are potentially more about building a reporting infrastructure than understanding the most pressing quality deficiencies, said Siegler. While moving in the right direction, it is unclear whether the initial set of indicators will reveal true areas in need of quality improvement for most cancer programs. CMS pay-for-reporting efforts in other service lines, mainly cardiac, show the vast majority of hospitals meeting the bar on core measures.
New Partnerships, Some May Threaten Cancer Programs
Some medical oncology private practices are at the crossroads, said Richard Emery, vice president and executive director, Trinitas Comprehensive Cancer Center. “Something has to change. Either they move to the hospital setting or they merge with other physicians.” Hospitals need to be pro-active and talk to their medical oncologists in the community. “Understand the political landscape of the local market,” said Emery.
One new model in particular threatens cancer programs. “Urologists are getting involved in radiation therapy. The urologists treat in a free-standing center, cutting off the hospitals entirely--their revenue is gone.” In one scenario known as a block lease, a urology group may lease space at a radiation therapy facility, pay a fixed fee, and bill for services. "Urologists can get into the radiation therapy game without buying a linear accelerator," said Emery.
He explored options for hospitals, as well as potential legislation and regulations that might counter or make illegal such arrangements.
Lu Anne Bankert, Senior Director, Programs and MeetingsPhone 301.984.9496, ext. 219, Email labankert@accc-cancer.org
