How does the business of oncology practice fare today? The National Comprehensive Cancer Care Network (NCCN), which allies 21 of the world’s leading cancer care and research centers in developing state-of-the-art practice guidelines, decided to ask that question in a survey it conducted among several hundred oncology specialists earlier this year. The results, a sobering portrait of professionals under pressure, were presented at NCCN’s annual Leadership conference in Philadelphia last month.
Confounding perceptions that oncologists are a pampered group able to set the terms of their engagement with patients—and to command high fees from compliant insurers—the survey tells a different story. Most cancer practices are working at full capacity, with a growing “triage” problem leading to variations in the quality of care for some patients, while grappling simultaneously with a troubled bottom line as payers ratchet down on costs. Significantly, that bottom line still depends heavily on reimbursement for medications—anywhere from 60 percent to 75 percent of revenues is the average per practice. Thus, the impact of health reform on the in-office specialty drugs used widely in treatment is a major uncertainty on the financial health of cancer practices going forward.
“Demand for oncology services is overwhelming the health care system and many of the professionals we surveyed see the future of cancer care as a low-margin, high-volume business in which active management of the practice will be critical to survival,” said NCCN spokesman Patricia Goldsmith. The contrast between commitment and compensation is increasingly stark. While the average working time for oncology specialists engaged in private practice is now 60 hours per week, it has been accompanied by a pronounced decline in per-patient revenues. Coping trends under way include relying more heavily on mid-level professionals to monitor care and limiting the range of non-essential services available to Medicare patients who do not have supplemental private insurance cover.
So what are the key issues that keep cancer care professionals up at night? Fears of forcing patients out of treatment due to cost and insurers who impose diminishing returns; Medicare reimbursement cuts for infusion drugs and other mainstays of treatment; alignment of private payers with Medicare around low Medicare fee-for-service rates; vanishing professional and personal time; and difficulty in attracting qualified professionals to the cancer space.
Overall, manpower shortages are an increasing reality, with the survey posting findings that indicate a 50 percent gap in surgical specialists versus current need, and more than 60 percent for specialists in gynecological cancers. The shortages are destined to grow as health reform expands the insured population. Unless this is redressed through new incentives to fix a deteriorating financial picture, it will impact everything from the quality of care available to patients to the ability of the drug industry to interact with cancer professionals.