Trends in Oncology: Preparing for Seismic Change
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5/19/15
Trends in Oncology:
Preparing for Seismic Change
Association of Northern California Oncologists
May 20, 2015
Thomas R. Barr, MBA
Director, Business Metrics and Analysis
Clinical Affairs Department
ASCO’s Clinical Affairs Department
Helping practices survive and thrive…today AND in the future
• Led by a practicing oncologist—priorities and
programs to be driven by you
• Hands on help for practices
– Practice efficiency; staffing models, workflow; quality
reporting/QI projects; learning networks
• Information and analysis
– Practice trends; economic analysis; performance
measurement; payment reform
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Dr. Stephen Grubbs
Senior Director, Clinical Affairs
The new clinical affairs department of the
American Society of Clinical Oncology is
dedicated to providing services, education and
other resources to support oncology practices
in all settings. Dr. Grubbs will begin his new
role in June.
Grubbs, 62, is a community oncologist and
managing partner at Medical Oncology
Hematology Consultants in Newark, Del. He is
also a principal investigator with the Delaware/
Christiana Care National Cancer Institute
Community Oncology Research Program.
• A collaborative learning network for oncology
practice knowledge
– Focus on administrative, operational, financial and
quality improvement activities
– Valuable tool for practice improvement
• Enrollment is open now!
• Contact PracticeNet@asco.org for more
information
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Learning Objectives for today
• Understand the trends seen in the 2014
National Practice Benchmark Reports
• Predict the continuity of these trends as fee
for service health care is replaced by risk
payment models
Oncology Practice Trends From the National Practice
Benchmark
Thomas R. Barr, and Elaine L. Towle JOP 2014;10:407-410
• Survey participants are exemplary – not average
• The data we report in the NPB are drawn from
practices working in specific markets, oncology
delivery ecosystems.
• These markets, though likely competitive, do afford
practices enough latitude to maximize revenue
while mitigating costs.
• This is not an ASCO survey but it does play on
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2003 – The Big One
• The Medicare Prescription Drug, Improvement,
and Modernization Act is now most widely recalled
as the Medicare Modernization Act or MMA
• Remember that prescription drugs were the focus
• This was the largest overhaul of Medicare in the
public health program's 38-year history
• Within 2 years, it produced a fundamentally
different business environment for medical
oncology
• Within 6 years, practices and industry adapted
Oncology Metrics trends, 2005 to 2010.
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Oncology Metrics trends, 2005 to 2013.
Oncology Metrics trend tracking by year per FTE HemOnc 1991 to 2013.
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Net drug revenue as a percentage of drug revenue (margin)
Net drug revenue and total revenue less cost of goods paid for (COGPF)
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Figure 6: Operating expense and revenue per established patient visit
Figure 7: Operating margin per established patient visit
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Figure 8: Established patient visits per FTE HemOnc
Figure 9: FTE staff per FTE HemOnc.
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Figure 10: Established patient visits per FTE staff
Figure 11: Operating expense and total collections per FTE staff
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SGR Repeal: We got it – now what?
Increasing
Providers Must Choose Financial
Enhanced Risk
Fee for and Reward
Service or Accountable Care Options
Merit-Based Incentive Payment System
2020 – 2025: Frozen 2026 and on: 0.25%
2015:H2 – 2019: 0.5% annual update
payment rates annual update
2018: Last year of separate MU, 2020: -5% to 2022 and on: -9%
PQRS, and VBM penalties +15%1 at risk to +27%1 at risk
2019: Combine PQRS, MU, & VBM 2021: -7% to
programs: -4% to +12%1 at risk +21%1 at risk
Advanced Alternative Payment Models2
2015:H2 – 2019: 0.5% annual update 2020 – 2025: Frozen 2026 and on: 0.75%
payment rates annual update
2019 - 2024: 5% participation bonus
2019 - 2020: 25% Medicare 2021 and on: Ramped up Medicare
revenue requirement or all-payer revenue requirements
.
1. Positive adjustments for professionals with scores above the benchmark may be scaled by a factor of up to 3 times the negative
adjustment limit to ensure budget neutrality. In addition, top performers may earn additional adjustments of up to 10 percent.
2. APM participants who are close to but fall short of APM bonus requirements will not qualify for bonus but can report MIPS Source: The Medicare Access and CHIP Reauthorization Act of 2015;
measures and receive incentives or can decline to participate in MIPS. Advisory Board analysis.
6 universal payment reform basic
requirements
1. 24/7 patient access to clinician with real-time access to
patient’s medical records
2. Robust clinical measurement and management
3. Continuous quality improvement based on clinical and
financial information
4. Patient navigation
5. Documented care plan containing all 13 IOM
components
6. Treatments consistent with nationally recognized
clinical guidelines
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Conclusions
• Fee for service payment system is on shakey
ground
• The timetable for quake damage is proscribed by
law and will be felt by 2020
• Electronic medical record automated clinical
measurement and reporting is essential
• All payment reform flavors require the same basics
• Prepare now – drive data density in your EMR
Leapfrog solution to oncology innovation
• Dynamic “real time”
• Clinical and financial measurement
• Patient Focused
• Big – lots and lots of patients.
• Big – lots and lots of payers.
115/19/15
Questions?
Medicare Oncology Payment Model Resources
www.asco.org/medicaremodel
PracticeNet@asco.org
Thomas R. Barr, MBA
Director, Business Metrics and Analysis
Clinical Affairs Department
Thomas.Barr@asco.org
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