Tomorrow’s oncologists are likely to be far busier, rely more heavily on information technology, and face greater scrutiny of the quality of their care than they do today, according to a panel convened at the conference. The panelists, who represented four leading US oncology professional associations, discussed the intense period of change the profession is going through, the driving forces behind that change, and what it all means for today’s oncologists.
Main challenges
The panelists identified uncertainty (specific and general), the changing healthcare environment, and an aging population as the specialty’s main challenges.
For Allen S. Lichter, MD, chief executive officer of the American Society of Clinical Oncology (ASCO) in Alexandria, Virginia, the uncertain future of single-specialty community-based practices topped his list of challenges. He expressed concern that current decisions about issues such as accountable care organizations and physician payment reform could stack the deck against such practices and drive physicians into multispecialty groups and hospital-based settings.
It’s important that the profession articulate the compelling reasons for preserving these practices, he said. “The argument for preservation will have to be a bit more substantial than ‘physicians have always practiced this way and enjoy practicing this way.’ It’s not that that’s not true, but it’s not compelling enough,” he said.
Matthew Farber, director of Provider Economics and Public Policy with the Association of Community Cancer Centers in Rockville, Maryland, cited the changing healthcare environment as another challenge. This includes not only how and where care is being given as a result of consolidation and cooperation of practices and hospitals, but the nature of that care—for example, with the trend away from infusional therapy and toward oral therapy.
In addition, the old model (buy-and-bill, fee for service) is being replaced by pathways, benchmarks, bundling of care, and episodic care. “If you are not already experiencing them in your own practices, get ready,” Mr. Farber said. He encouraged oncologists to be preemptive in negotiating changes that protect their interests, to get involved, and to stay abreast of the changes.
Another panelist, Matthew E. Brow, vice president of Corporate Communications, Government Relations & Public Policy with US Oncology in Washington, DC, believes an aging population and the entry of the Baby Boomers into Medicare will present a key hurdle for the specialty. Between now and 2020, the number of Medicare beneficiaries will increase by nearly 35%, and the impact of that increase will be “significant and far reaching.” Oncologists will be expected to see more patients, which will put intense pressure on the reimbursement rate, he noted. The combination of a larger Medicare patient population and declining reimbursement could make it increasingly difficult for practices to remain financially viable.
Ted A. Okon, MBA, executive director of the Washington, DC-based Community Oncology Alliance, sees overall uncertainty as a consuming challenge, whether it’s about near-term concerns, such as the sustainable growth rate (SGR), or longer-term concerns, such as whether or not there will be healthcare reform. “It’s very difficult because the economic laws still pertain,” he observed. “You have to operate a practice as a business, and it is next to impossible to do so in an uncertain environment.”
Impact of the new healthcare law
On the positive side, the Patient Protection and Affordable Care Act (PPACA) eliminates lifetime caps and copays on screening and preventive services and gradually will close the infamous doughnut hole, Dr. Lichter said. But its physician payment reform is worrisome.
“I have not spoken to anyone in healthcare who has said that physician payment, basically a fee-for-service reimbursement, will persist untouched,” he said. “There will be new models of physician payment reform. We have to work on understanding them and making sure the changes work, and if they are not to our benefit, we must at least ensure we don’t go backwards.”
Mr. Brow added that another benefit of the PPACA for community oncology will be the creation of a large new population of individuals with private health insurance. Private payers “are almost certainly paying better than Medicare is paying today and will likely pay in 2014 and 2015. This will help offset the impact on practice revenue of growth in the Medicare segment,” he said. The legislation will also substantially expand the Medicaid population, but since Medicaid patients make up only 3%–5% of community oncologists’ patients, and given the swelling Medicare ranks, it will not have much impact on these oncologists unless they see a largely pediatric population.