ASCO Prepares for the Future of Oncology Practice

Anticipating major changes in how oncology practices could be structured over the next several decades, the American Society of Clinical Oncology (ASCO) has undertaken a full-scale study of how oncology practices are structured today and how they are preparing for the future in response to increasing economic pressures and new developments in cancer care. The preliminary results of the ASCO National Census of Oncology Practices, which were released in January 2013 (Forte GJ, et al. J Oncol Pract. 2013;9:9-19), will provide the foundation for the full scope of the 3 major research projects that comprise the ASCO initiative. Ultimately, the results of this project will help to inform policymaking in oncology for the next 2 decades.

According to Sandra M. Swain, MD, FACP, President of ASCO, the primary goal of these studies is to gain an understanding of “how practices are responding to environmental stressors as they continue to provide cancer care to their patients. Absent this information, policy and practice solutions will inadequately respond to the needs of the community or may inadvertently address the wrong issues. The oncology community has a responsibility to prepare for the future, which starts with gaining clarity about the present.”

Launched in June 2012, the intent of this census is to systematically gather demographic information—including practice size and organization model, staffing characteristics, affiliations with hospitals and other healthcare providers, and patient characteristics—on every oncology practice in the United States on an annual basis to help practices make informed business and clinical decisions.

Preparing for the Future

The questions were designed to be broad enough to elicit in-depth responses from oncology practices on how they are adapting to the ever-growing economic, demographic, and political changes that are affecting the daily operation of oncology practices while their administrators and clinicians simultaneously remain focused on providing patients with the highest-quality cancer care. The areas that will be examined each year include:

  • Rising costs of cancer care
  • Drug shortages
  • Competitive forces
  • Payer restrictions
  • Staffing • Mergers
  • Technology implementation— electronic health records (EHRs) or electronic medical records (EMRs)
  • Patient volume

More than 630 US oncology practices participated in the first census, and of these practices, 542 provided full-data replies. It became apparent that, for many practice administrators, compiling all of the requested information on several questions was labor intensive and time consuming, with some of the questions either requiring input from other practice staff members or necessitating a review of the previous year’s records. Therefore, the initial findings will be built upon in subsequent surveys. ASCO plans to significantly expand participation in the next census, which will reopen in the spring, to ensure that the data collected is representative of the entire oncology community.

Use of EHR/EMR Systems

More than 60% of the responding practices use an advanced EHR/EMR system, 16.2% use a basic EHR/EMR system, 15% plan to implement an EHR/EMR system within the next 6 months, and 8% of the practices reported no current or planned use of an EHR/EMR system in the next 12 months.

Organizational and Staffing Structures

Another series of questions focused on changes to a practice’s organizational structure during the previous 12 months, including practice purchases, mergers, and new affiliations with other healthcare entities; additions and/or reductions to staff; as well as salary increases and/or decreases.

Larger practices (N = 159) were defined as having ?7 physicians, and smaller practices (N = 189), 1 to 2 physicians. The responses clearly indicated that in the 12 months before the census, larger practices were more likely than smaller practices to:

  • Merge practices (8.9% vs 3%)
  • Hire new staff (70.7% vs 41.4%)
  • Increase salaries (61.2% vs 40.7%)

Likewise, larger practices were slightly less likely to lay off staff than smaller practices (15.3% vs 16.9%).

Among smaller practices, 4.5% are likely to lay off oncologists and 2.4% are likely to lay off oncology nurses sometime in the next 12 months, compared with larger practices that plan to lay off oncologists (0.8%) or oncology nurses (1.6%). Smaller practices also face an increased likelihood of closing the practice entirely sometime in the next 12 months compared with larger practices (6.5% vs 1.5%).

Among larger practices, 33.6% indicated that they are likely to hire additional oncologists and 14.2% are likely to hire more oncology nurses; those proportions were 8.9% and 5.2%, respectively, in smaller practices. Large practices are also more likely than smaller practices to purchase additional practices (3.8% vs 2.4%) sometime in the next 12 months.

Additional Findings

Other preliminary findings from the 630 responding oncology practices include:

  • Participating practices treat an average of 1268 new patients each year
  • The mean number of oncology physicians in a practice is 9.0. The mean number of full-time equivalent oncology nurses is 6.7
  • The majority of the practices (71%) provide hematology/oncology, 23.4% provide medical oncology, and 20.9% provide radiation oncology services to their patients
  • Less than half (48.3%) of the practices provide chemotherapy services to their patients
  • Other services provided by some practices include social work (28.2%), clinical trial participation (26.7%), laboratory services (25.8%), and nutritional counseling (22.9%)
  • The majority (55.9%) of the practices are private community practices; 9.8% are private practices that are integrated with large healthcare systems
  • The remaining practices are academic practices (9.5%), academic community-based practices (1.8%), institutional but nonacademic practices that employ physicians (12.4%) or contract physicians (3.5%), and government-based practices, such as military, Veterans Affairs, and federal and state departments of health (1.8%)
  • Overall, 57% practices are affiliated with a community hospital, 28% are affiliated with an academic medical center, and 28% are affiliated with another type of medical center
  • Nearly half (47.4%) of the pa­tients managed by these practices are covered by Medicare, 9.2% are covered by Medicaid, 38.6% have private insurance, and 4.8% are uninsured.

Conclusion

ASCO’s attempt to survey every oncology practice in the United States is an unprecedented and substantial undertaking, and not without some limitations in generalizing the information. Practices vary widely throughout the country, and the low response rate on the initial census makes it difficult to extract the data in ways that can inform policymaking at this time. The census, however, will be an ongoing initiative that when combined with 2 other major research projects (the ASCO Workforce Information System and the ASCO Geographic Access to Oncology Care) should provide the data needed to inform advocacy and policy for oncology over the next several decades.

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