Practices Hammered by Rising Uncertainty

OncLive Chairman,

Mike Hennessy

The rise of high-deductible health plans (HDHP) has been accelerated by the Affordable Care Act, yet for many oncology practices this trend adds to the administrative workload and creates deep uncertainty on the accounts receivable side. Our cover story this month takes a look at how HDHPs make it difficult for patients to utilize their insurance plans and how this makes it tougher for doctors to get paid. Practices now spend more time working with patients whose deductibles cost thousands of dollars and who must pay those up front before treatment can begin.

“We have more people working in our office now— not that we’re getting paid to pay them—to counsel patients, saying this is what it’s going to cost to get this treatment, this is what your coinsurance is going to be, you have to meet this deductible,” Kenneth Adler, MD, vice chair of the American Society of Hematology’s Committee on Practice, told Oncology Business Management in an interview.

The rising administrative burden is also addressed in a story this month on ASCO’s State of Cancer Care in America 2015. ASCO has highlighted many positive and negative trends in oncology care and suggested a host of potential solutions, but it emphasizes the heavy workload all practices are facing, and sounds a note of concern about the high incidence of burnout among physicians. Roughly 50% of oncologists report having experienced overload syndrome.

The good news, ASCO Chief Medical Officer Richard Schilsky, MD, said in an interview, is that over 80% of oncologists surveyed said they would choose this profession all over again, despite the headaches, the long hours, and the growing complexity. There is something highly rewarding about this branch of medicine that keeps them involved and enthusiastic.

Other interesting factoids from this year’s ASCO report include the rising number of women oncologists: Women now number more than 30% of oncologists, with a median age of 46. In fact, in oncology fellowship programs women amount to 48%, which surpasses the 46% figure for women in medical training programs overall. Statistics like these show the changing face of oncology practice in the US, which also has more doctors over the age of 64—and heading for retirement— than under 40.

The need to recruit younger doctors to join the profession also is a strong theme in the ASCO report, which indicates that rural areas are especially in need of staff as physicians tend to prefer working in urban environments.

Professional employment is looked at through a different lens in an Oncology Business Management feature this month on hematologists and their desire to gain more recognition and influence in the increasingly corporatized world of oncology and hematology. A diminished emphasis on nonmalignant hematology in academic training programs and a trend toward more bloodwork being done by non-hematology specialists has contributed to an “undervaluing” of the expertise hematologists have to offer, the American Society of Hematology says in a report issued last month.

ASH is calling for creation of “systems-based” hematology positions that would allow them greater roles in targeted medicine, for example, or have them do early troubleshooting for diseases like thrombotic thrombocytopenic purpura (TTP), which can constitute a huge drain on plasma supplies if not managed well, ASH says in the report.

This month’s issue includes new elements that will appear on a regular basis. A legal column by New Jersey- New York law firm Moses & Singer offers guidance on what the courts will require you to disclose in the event you conduct an internal investigation into the handling of Medicare and Medicaid funds; and in a column on practice management, Marcus Neubauer, MD, writes about making the most of precision medicine, from ordering the appropriate tests to using the results of those tests effectively.

Lastly, in a section on Capitol Hill developments, we look at the status of the Sustainable Growth Rate formula and an early holiday present ASCO would like to see in the next US fiscal budget: more money for the National Institutes of Health and the National Cancer Institute to spend on clinical research.

It’s all here, in this month’s Oncology Business Management!