Hollywood, FL—Oncology practices need to transform the way they deliver cancer care, said John D. Sprandio, MD, FACP, Chief of Oncology at Delaware County Memorial Hospital in Drexel Hill, PA, and Medical Director of ION Solutions.
“According to Darwin, it’s not the strongest of a species that survives; the species that survives is the one that is adaptable to change,” Dr Sprandio said. “Practices and programs need to plan their response.”
Dr Sprandio, who is also an oncology management consultant, shared his viewpoints at the Third Annual Conference of the Association for Value-Based Cancer Care.
“The fundamental question not being adequately addressed,” he pointed out, “is, ‘How is care best delivered? What are the best settings, best processes, and plan of care? The challenge is how to consistently deliver care.”
Dr Sprandio pointed to 6 oncology- practice–related categories in which money is wasted: delivery, coordination, overutilization, pricing, administrative burden, and fraud. Half of these are areas in which physicians can have an impact. The magnitude of the cost issue has created a “market demand for better value,” with legislative pressures now being felt as well, he noted.
The Doctor–Patient Relationship Is Central Dr Sprandio’s practice “got on the path” 10 years ago, he said, based on a 2007 white paper advocating physician engagement as an essential means of driving quality. That paper highlighted the centrality of the doctor–patient relationship by emphasizing:
Physicians face numerous barriers to quality that are essentially “time stealers,” he said. But these can be tackled when the work environment is designed in a way that is standardized, simplified, clinically relevant, and engaging for patients, and that fixes accountability at the locus of control.
“We followed the paper’s advice and started streamlining processes of care, making everything our physicians touched clinically relevant. We tackled this with full implementation of the oncology-specific electronic medical record that contained a software overlay that gave us real-time information,” Dr Sprandio said.
Oncology in the Era of Healthcare Reform “The era of healthcare reform followed this, and now it’s all about quality and cost,” Dr Sprandio said. “But where does cancer care fit into healthcare reform?” The foundation of the patient-centered medical home (PC- MH) and accountable care organizations (ACOs) is primary care. There is virtually no mention of cancer care in ACO discussions, he pointed out. “Complex care outside the scope of primary care requires delegation to specialists. How does the primary PCMH or ACO manage the rising cost of cancer care if management is transferred to oncology? They need to rely on those delivering the care.”
Provider Accountability “The government can write legislation to encourage behavior, but it cannot mandate it,” he said. “The people delivering the care must step up and change it.”
Failure to control cancer costs (by reducing waste) will result in further funding cuts and will have unintended clinical consequences for the most vulnerable: reduced access, increased copays, and reduced compliance, Dr Sprandio predicted.
“Improving delivery and reducing utilization are different sides of the same coin,” he said. “Physicians need help in these.” To this end, chemotherapy guidelines and pathways are partially helpful; anything that standardizes care is good, Dr Sprandio said. But the oncology PCMH pertains to delivery beyond chemotherapy drug selection, and requires practice transformation.
“We delivered an oncology PCMH model focusing on the delivery of care beyond chemotherapy,” Dr Sprandio remarked. “We made a business case for quality by focus on controlling cost and improving value.”
The “intertwined” components of his oncology PCMH include pretreatment services, active treatment, survivorship, palliative care, and end-of-life care. His group is prepared for future payment models and for the need to interact with other systems that adopt new organizational structures, such as ACOs, and hospital system and payer hybrids.
The PCMH embraces processes that drive patient- and payer-centered outcome measures (Table 1), which are measured in real time and are presented to the physicians in his practice.
“Our internal data show that we reduced emergency room use by 68% since 2007, and reduced hospital admission rates from 1.1 per year to 0.5 per chemotherapy patient,” he reported.
Dr Sprandio’s practice has taken a “scalable approach” and has created a self-instructional guide for practices and cancer programs (Table 2).
The PCMH’s components pertain to building payer value, building practice value, and to enhancing patient value. Users can select only the modules they need. It provides “consulting expertise at a fraction of the cost” and is “the most efficient way to build practice quality and value,” Dr Sprandio maintained.
