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An Emerging Breed of Super Administrator

February 2012, Vol 2, No 1
Dawn Holcombe, MBA, FACMPE, ACHE
President, DGH Consulting, South Windsor, CT

The scope of oncology practice management is undergoing seismic changes. Groups that formerly focused on the survival of their patients, now have to wonder about their own operational survival, but under what evolving model? Administrators are being asked to oversee the operation of the practice, as well as scores of reporting measures and new contractual relationships, and perhaps even new institutional relationships.

The practice administrators’ “to do” list looks dramatically different from the way it did just 4 years ago. How does one stay prepared? No matter what the practice size, the challenges are rapid and unrelenting. The topics remain consistent with medical practice administration elements, but for 2012 and beyond, the magnitude of demands and sophistication of management that is needed to deal with those elements will challenge even the most experienced administrator. If you are not faced with the following issues yet, you are likely soon to be:

1. Ownership In cities and towns across the country, private oncology practices and hospital cancer centers echo the same refrain, “what will we look like next year?” Some of the variables that will shape those answers include:

  • Drugs: source more than price (Will practices continue to acquire drugs from their source of choice, or will buy and bill continue? Will a delivered model evolve?)
  • Site of service: will care be delivered in a physician office, hos-pital, freestanding center, or through home infusion?

2. Data analytics New analytics will be needed to prove the value of your care to others, and to validate internal quality and efficiency measures

3. Contracting No longer limited to rates and fee schedules, payer contracting could soon become a complex process of episode of care bundling, performance measures and payments, and coordination with other oncology management tools external to your practice. Con­tracting or negotiations with other entities, such as hospitals seeking affiliations or ownership, will only increase in 2012

4. Finance Watching the bottom line is now the bottom line for any healthcare model—practice or hospital. Not only understanding the internal finances of your group, but also looking outside to oversee how treatment decisions can affect the total cancer spend, is becoming critical for your position in the medical community

5. Regulations Federal and state regulations will continue to become more onerous. Miss one, and there will usually be an auditor waiting to catch you, with increasingly severe penalties. Practice administrators who delegate responsibility for regulatory oversight and compliance are ultimately still responsible

6. Staffing Creative staffing, be­yond the traditional oncology model, will be a staple for 2012 and beyond. Oncology pharmacists are emerging as a complement to the shrinking pool of oncology physicians. Will you be collaborating with or employing oncology pharmacists?

Staying (or Becoming) a “Super Administrator”

Each administrator of an oncology practice today has already developed his or her own unique strengths. There is no one “right” profile for an administrator, and it may not matter what your background is. It is clear that successful administrators for future oncology practices will share new universal strengths:

1. Perspective The ability to listen to the needs and interests of other key players along the healthcare continuum and to adjust your message in terms of their needs and interests

2. Technology acumen Our billing systems and electronic medical records are not equipped out of the box to answer the quality and utili-zation questions we now need answered, at least not without constant modification. It will be essential not only to understand the technology in the practice, but also to look beyond the traditional functions and direct the strategic adaptations that will produce the data you need for operations and quality

3. Vision Vision not just for the details but also for the bigger picture for your practice and beyond the walls of the practice. Practices have traditionally focused very well on processes to treat individuals. They will now be required to integrate processes not just for the patients who are individuals, but also to streamline population and disease groupings of large numbers of patients. Practices will be required to improve communications and information sharing bridges between their operations and other aspects of healthcare (eg, primary care and other specialty physicians, patient navigators, case managers, pharmacy managers, hospitals and possibly other sites of care, hospices, and home infusion). Whether the integration is virtual or driven by an acquisition or merger, practice administrators will need to lead their groups through this new territory

4. Creativity There is great impetus for new leadership for quality and effectiveness in healthcare. We are in a period of transition, where many solutions are tried and we may hit obstacles as they evolve. Practice administrators who stay informed during the transition, and contribute to the body of knowledge, and lead their groups through what could be a myriad of new opportunities will be well positioned to be the leaders in demand for the future, whatever shape it takes

5. Business common sense Oncol­ogy is a specialty that draws compassionate individuals, whether they provide clinical support or business support to cancer patients and those who serve them. The old adage “there is no mission without a margin” is very true. The practice administrator is now asked to help the physician serve several perspectives of financial responsibility: what is affordable and appropriate for the patient, the practice, the health plan, the employer, and society.

Leveraging Professional Resources
So, how does a practice administrator stay equipped to lead his/her group into the future? It will only happen through information, communication, and education. The need to stay connected and informed is growing stronger. You can leverage and manage the information flow by subscribing to specific news lists and discussion groups. HealthLeaders, the American Society of Clinical Oncology (ASCO), the Association of Community Cancer Centers (ACCC), Community Oncology Alliance (COA), and Oncology Business Review all offer good summaries and overviews.

The professional networking website LinkedIn offers a wealth of interesting discussion groups from each of these organizations, as well as topic-driven groups. You may also choose to subscribe to the discussion boards hosted by your own state association groups, or groups such as ASCO, ACCC, COA, and ACOA (Am­erican College of Oncology Ad­ministrators).

Conferences and webinars remain one of the primary opportunities to network outside of your own market and learn about trends and inno-vations, even opportunities and threats. State associations for oncologists and administrators offer strong networking and update opportunities. Publications such as Oncology Practice Management, Value-Based Cancer Care, and others bring the outside world to your door or computer.

Human nature is to hunker down when the weather gets fierce. The storms of change swirling around oncology practice administrators today demand a strong leader, one who will stand tall in that wind and set a new course for the group. It will not be easy, but it will happen.

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