Continued Pressures on Community Cancer Centers

November/December 2010, Vol 1, No 6

Consolidation and cost pressures remain key concerns for community cancer centers, according to Christian Downs, MHA, JD, the executive director of the Association of Community Cancer Centers (ACCC). Mr Downs presented additional results and analysis from the ACCC’s ongoing, 3-year member survey at the Managed Care Network Oncology Management Summit in Chicago, IL, on September 24. This survey traces the continued reaction of the community hospital cancer programs to legislative and economic changes that are reshaping community oncology practice.

The survey data, which were collected in late 2009, show that community cancer center revenue is still largely tied to providing drugs to patients. In comparison to the physician office setting, where phy sicians are on the hook for drug costs, “drugs mean less to hospitals,” Mr Downs pointed out.

Hospitals are also beginning to contract with multiple group purchasing organizations as a means of controlling costs, and a large percentage of respondents are using the 340B program, which can provide financial relief through cost-shifting. “There are programs around the country that you can’t imagine are 340B hospitals,” he emphasized. “That’s a big, big change.” Mr Downs said that a future ACCC survey will focus on that particular issue.

Traditional Approaches Changing
Among the biggest trends noted are programs employing more physicians, mainly medical oncologists, and demographics are playing a key role in this change. Older oncologists (generally aged 50 years), who have traditionally been entrepreneurial in setting up group practices, are being followed by a younger generation (35-40 years old) that seeks to be an employee rather than a partner. As a result, these older entrepreneurs seek relationships with community centers or other organizations in lieu of new, traditional partnerships.

In addition, the survey also notes consolidation among hospitals and a shift in thinking about community programs. There is renewed appreciation for not necessarily being part of an academic medical center that is conducting clinical trials, and a growth in philanthropic (or “named”) programs in the community setting.

Another change involves the cost of the drugs themselves. According to Mr Downs, physicians are all too aware that, “15 years ago, I had $1 million worth of inventory. Now, I have $10 million worth of inventory.”

In terms of overall finances, respondents reported cost-cutting, perceived their financial health asworse compared to the year before (78% vs 90%), and reported lessmoney being spent on new initiatives such as patient navigators.

What Is New at the Community Level
Patients are now paying more— according to Mr Downs, in some cases up to 400% more in the past 10 years. Concomitantly, the use of patient financial counselors has also increased rapidly, but the work of these individuals has shifted from setting up payment plans for patients to talkingmore about access to free or reduced-price drugs or receiving financial help from philanthropic foundations.

The use of patient navigators is increasing, but in Mr Down’s experience, their level of responsibilities can varywidely. Some simply take patients frompointAto point B,whereas others are advanced practice nurses who lay out treatment options and the toxicities associated with them. “We would like to see more of the latter” sort, he said.

Cancer care in hospitals is becoming “high tech rather than high touch,” he acknowledged, with institutions spending more money on the latest technology rather than on the person who would be delivering that technology. The attitude seems to be “get a gamma knife so we can put that up on the billboard on the highway, instead of getting additional patient navigators,” he quipped. Electronic health records are another high-tech tool expected to gain further use, but Mr Downs was shocked that some institutions are already using more than 1— perhaps as a result of consolidation among facilities.

Despite the financial stresses in the community setting, Mr Downs was hopeful. Hospitals, particularly cancer centers, are getting much better about looking at their profit and loss—where they’re going to or not going to make money—and they’re going to have better decision-making information available to them, he said

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