Data Drive Change: Identifying Trends and Shifts in Oncology
Chicago, IL—Information is king in this day and age, and while collecting it is difficult, possessing it could lead to change. In oncology, collecting data on trends and pressures may influence policymakers, suggested Allen S. Lichter, MD, FASCO, Chief Executive Officer, American Society of Clinical Oncology (ASCO) and Conquer Cancer Foundation in opening remarks at the 2013 Cancer Center Business Summit.
Physician Compare Data Analysis
Dr Lichter began his discussion with preliminary findings of an analysis of data from Physician Compare (www.medicare.gov/phy siciancompare/), a website provided by the Centers for Medicare & Medicaid Services (CMS) that allows consumers to find and choose physicians and other healthcare professionals enrolled in Medicare. The website includes information on clinical practices, such as specialty, location, and will eventually include performance information.
Data from Physician Compare were used to determine the number of practicing oncologists in the United States. According to the database, there are 11,343 physicians with the primary specialty of oncology or hematology; 2584 practices have ?1 oncologists and more than 7600 billing addresses.
The data include some inaccuracies: a practice whose billing address may be spelled out, but is abbreviated in another location, would be counted twice. A practice with 2 entrances would be counted twice as well.
Not surprising, when taking a closer look at the number of oncologists by state, data from Physician Compare indicate that highly populated states, such as New York, California, Texas, and Florida, also have the most oncologists. Similarly, the presence of an oncologist in a practice coincides with the number of oncologists and population in that state.
However, some of the most populous states, such as California, have a per capita number of oncologists that actually tends to be low compared with states such as North Dakota that have a per capita number of oncologists that tends to be high.
The Iowa Project
Using data from Physician Com-pare, the state of Iowa was selected to further assess the extent of the differences in the data. Iowa was considered a good candidate, because it has a very well-developed physician registry through the Iowa Medical Society, Dr Lichter explained.
Four data sets were triangulated and a detailed analysis of each physician record was performed. According to the Iowa Physician Information System (IPIS), 88 oncologists live in the state. However, based on 3 other databases—the National Provider Index, the American Medical Association (AMA) and the ASCO membership database—the actual number is between 88 and 90 oncologists. Arguably, if the aim was to find the approximate number of oncologists in the state, these data would be it, Dr Lichter noted. However, more information is needed to better understand the trends and shifts in oncology.
Looking back to Physician Compare, 105 oncologists are listed in Iowa, but this difference with IPIS data could be explained by several factors. First, Physician Compare data include information from oncologists whose primary practice is outside of Iowa. For instance, if the practice is located on a road that crosses state borders, it may be counted twice. Second, the data from IPIS date back to 2011, whereas Physician Compare is updated every 6 months (2013). Finally, the listing of primary and secondary specialty could also account for the differences in the number of oncologists.
Patient access was also evaluated as part of the analysis. If a patient lives in Des Moines, Dr Lichter explained, where there are 15 oncologists, and 1 of the practices close, then patients are able to go to another oncologist in the area. However, if the area only has 1 oncologist, and that practice closes, then that area is not covered.
“The general surgeons have done a great job of understanding these data in their specialty, and have coined the expression ‘surgical islands,’ big swaths of geographic data where there is no access to a general surgeon,” Dr Lichter added. “Having that information has helped inform policymakers, and has helped lead to decisions that are impacting general surgery in a positive way.”
Collecting these data is difficult, because practices have satellite locations that cover areas beyond the primary practice.
Results of the Community Oncology Census
To start collecting the data themselves, ASCO undertook a census of oncology practices. In 2012 the first census included 632 practices and 5018 physicians; in 2013, it included 530 practices and 8011 physicians. The census is open from May 30 to August 30 and is promoted through many ASCO channels. The results are reported at the annual meeting of the Association of Community Cancer Centers.
“Not only are we trying to count everybody, and where they are, what they are affiliated with,” Dr Lichter stated. “We are trying to understand the pressures on the field.”
Overall, data from the 2012 and the 2013 census indicate that the pressures to close and sell oncology practices are stable, although there are efforts to merge with or purchase another practice. Consolidation is another area of flux. Furthermore, many oncology practices are likely to affiliate with another practice, community hospital, or academic medical center.
In terms of the workforce, the number of oncologists who are older than 64 years surpassed the number of those younger than 40 years in 2008. In addition, the number of oncology trainees who are international medical graduates is also trending up (44%-45%). Whether these trainees stay in the United States or return to their home countries is also being tracked. Furthermore, the data indicate that African American oncologists are underrepresented compared with other internal medicine
Physician Payment Reform in Oncology
There are currently 2 schools of thought when it comes to formulating payment reform: one is focused on the current fee-for-service (FFS) approach, but has payment modifiers based on quality and value metrics. The other breaks from the FFS system to offer new ways of reimbursement based entirely on quality and value metrics.
The proposal being set forth by ASCO’s volunteer committees involves a new style of reimbursement based on monthly fees for patient evaluation, treatment management, transitions and care, and follow-up. More important, this proposal includes a plan to test a modified FFS system and to test alternatives.
Other projects being developed by ASCO include precision medicine in oncology, defining value in oncology, Risk Evaluation and Mitigation Strategies and drug safety, a better understanding of the 340B drug pricing program, and oncology patient-centered medical homes.
“Policymakers are influenced by data,” Dr Lichter concluded. “They nod when you have an opinion. They are influenced to do things when you have data.”