The 2013 Trends in Community Cancer Centers is year four of an ongoing survey of ACCC-member cancer programs designed to educate on nationwide developments in the business aspects of cancer care. The survey is also a tool to assist members in evaluating their own organization's performance relative to similar cancer programs.
As cancer programs strive to evaluate quality of care, they have found that data collection remains challenging and resource intensive.
Although most programs report that they measure quality care, many also report that they are only beginning the process.
High on the list of metrics used to measure quality are Commission on Cancer standards (94 percent of respondents) and patient satisfaction scores (91 percent of respondents). Thirty-six percent use the Quality Oncology Practice Initiative (QOPI) and 34 percent use the Physician Quality Reporting System (PQRS).
Ninety-one percent of programs said they would be interested in a peer network related to measuring the quality of cancer care delivery in hospitals for the purposes of sharing best practices.
"There is a lot to figure out regarding measuring quality appropriately, but unfortunately not a lot of experts in the area."
"My three tips for measuring quality cancer care: Make certain your program is integrated into the Quality and Safety Program of your health system. Develop quality indicators with physicians' input. Do not keep the successes internal to the program. Share them."
Cancer programs continue to see consolidations (acquisitions, affiliations, and mergers) in their marketplace.
Asked if their oncology program has merged, affiliated, or acquired another cancer program, 19 percent reported affiliations, 10 percent reported acquisitions, and 5 percent reported mergers.
Thirty percent report seeing consolidation of cancer programs in their primary market area over the last year. Forty-two percent said they've seen consolidation of physician practices in their primary market area.
Looking ahead, 40 percent reported that they expected consolidation of cancer programs over the next one to two years, and 46 percent expect consolidation of physician practices.
"I think the predominant centers treating cancer patients in a few years will be hospitals and very large community practices, because they will be the only organizations able to handle the risks and complexities given where cancer care is headed."
"We have counted 720 individual steps (and are still counting) that it takes to integrate a community practice into a hospital, which includes everything from people to processes for IT."
Cancer programs continue to seek paths toward cost containment and reduction without affecting quality and services.
Most respondents (80 percent) report their program's financial status as "good" to "very good" in Survey Year 4, a slight drop from the 84 percent who rated their program's financial health as "good" to "very good" in last year's survey.
Cost containment and cost reduction are key elements in maintaining financial stability within a cancer program. Respondents report reducing travel and conferences, renegotiating vendor contracts, and cutting administrative costs. Less than one-third reported hiring freezes (28 percent); fewer still reported salary freezes (18 percent).
"2012 looks a lot like 2011 because we have been trimming costs for some years now, and there is only so much that can be done without affecting revenues and retention."
"Cost reduction strategies usually start as a hospital-wide initiative, and every area gets the same directives. If oncology services are driving growth and profits, we need to fight for a different approach."
Affordability of care is a growing concern for patients. Cancer programs continue to see increases in numbers of underinsured and uninsured patients.
Cancer programs report seeing more patients needing help with prescription drug expenses (88 percent), more patients needing help with co-pays and co-insurance (87 percent), and more patients with no or inadequate insurance (81 percent).
Most cancer programs (88 percent) offer financial counseling to their patients.
The majority of respondents report that they are watching and
waiting while others experiment with Accountable Care Organizations (ACOs). Only 5 percent of respondents say they are currently participating in an ACO.
Almost half (47 percent) report that they plan to participate in an ACO, although details about cancer program participation remain to be determined.
Concerns center around the cost parameters in oncology and the practice of oncology, which are very different from primary care—the basis for the ACO model.
"We are still very much trying to figure ACOs out. It starts by looking at them from the hospital's perspective, and then from the cancer perspective, as appropriate."
"We want to understand the leading edge of ideas, but be cautious in what we implement. We don't want to be the first to invest money in ACOs."