On September 29, 2016, a diverse, multidisciplinary panel of experts convened in Washington, DC, to discuss current challenges and potential solutions in oncology practice management. This summary represents an overview of the top 5 areas of discussion at the workshop.
Challenges and Solutions in Oncology Practice Management
This workshop opened with presentations by Dawn Holcombe, Steven Winkler, and April Christensen and was followed by a lively panel discussion. The discussion focused on 3 distinct areas—best practices in navigating state and federal regulations, including USP 797 and USP 800, both of which apply to hospital and private practice settings. This requires staff training, development of standard operating procedures, monitoring, testing, and continuous quality improvement. A second focus was on reforms in the 340B drug pricing program and the guidance provided by the Health Resources and Services Administration in implementing this program. A final focus was on the Medicare Sustainable Growth Rate and its impact on Medicare reimbursement. This discussion also included aspects of the Merit-Based Incentive Payment System (MIPS), which shifts the burden to physicians on a value-based payment model.
Managing an Oncology Practice
Kari Young’s presentation and discussion focused on practice staffing, working effectively with payers, the impact of ICD-10 on oncology practices, and taking advantage of patient assistance programs. Ms Young discussed how to effectively recruit and retain physicians and physician extenders, nurses, and patient navigation and administrative staff. She also spoke extensively on optimal ways an oncology practice can interface with payers. She discussed the impact of ICD-10 on oncology practices and their staffing, and shared details on a number of patient assistance programs for those who cannot afford healthcare.
Value-Added Systems in a Value-Based Payment Landscape
Roberta Buell, MBA, presented and led a discussion which focused on various aspects of value-based reimbursement options. She discussed reimbursements under MIPS/MACRA (Medicare Payment Reform Act), which links reimbursement to quality measures and clinical practice improvement activities. The Centers for Medicare & Medicaid Services (CMS) will link payments directly to Physician Quality Reporting System (PQRS) scores, providing positive or negative payment adjustments depending on the scores. Ms Buell also discussed the Oncology Care Model (OCM), a payment initiative that CMS is considering. To qualify for OCM, practices will need to develop quality measurement and reporting processes. Ms Buell provided examples of quality reporting that will resonate with OCM.
The Changing Landscape of Cancer Biology and Treatment
Barbara McAneny, MD, and Joshua Stoneking, PharmD, directed this discussion. The #1 source of revenue for oncology practices is drugs from infusion therapy, whereas, in comparison, revenue from evaluation and management is quite a bit lower. The impact of MIPS on oncology practices was discussed, including mandates for PQRS reporting, advancing care information, and clinical practice improvement activities. FDA guidelines on biosimilars development were discussed; physicians are concerned that biosimilar use will be mandated by payers, but the American Medical Association and other physician groups are developing policy statements that physicians should remain in control of whether to use biosimilars for specific patients. The evolving role of specialty pharmacy (SP) was also discussed, including how to find the right SP for a practice. The range of services that SPs provide was reviewed, including 24-hour access, adherence management, financial assistance, and other support services, such as patient counseling. However, in the ensuing discussion, several physicians in attendance were very concerned that an SP would interject between their practice and their patients regarding medication and adverse event counseling. This system may be acceptable to small practices that do not have the staffing to carry out patient assistance work, but this would not be acceptable to larger organizations. It was agreed that this is just one service an SP provides, and that partnerships between practices and SPs are customized to fit each practice’s needs. Limited distribution drugs and manufacturer/payer requirements that certain drugs be handled only through an SP were also part of a lively discussion.
Resources for Oncology Practice Managers
A panel discussion on this topic was led by April Christensen, Rose Gerber, Ted Okon, MBA, Barbara McAneny, MD, and Kari Young. This was a far-ranging discussion, touching on resources provided by the Community Oncology Alliance (COA), the Coalition of Hematology Oncology Practices of the Southwest (CHOP), and other web-based sources of information and practice support. COA resources include CPAN (COA Patient Advocacy Network), which provides advocacy resources for providers and patient education resources; and resources designed specifically for oncology practice managers, including websites or listserv electronic mailing list software applications that contain patient satisfaction surveys, pharmacy issues impacting community oncology practices, forums for nurse practitioners and physician assistants, and OCM collaborative information that facilitates implementation of OCM through peer-to-peer information exchange. CHOP resources were discussed, including forums for oncology practice managers on a range of topics such as reimbursement, practice changes, patient care, and networking. The ensuing panel discussion provided a snapshot of COA efforts to influence legislative changes that will impact practice management and healthcare delivery.