Oncology practices are challenged by day-to-day operational functions, which are often related to payment, reimbursement, and competition, according to the new survey titled “The State of Oncology Practice in America” from the American Society of Clinical Oncology (ASCO) on the oncology practice landscape in the United States.
“The State of Oncology Practice in America” was published in the Journal of Oncology Practice in July 2018,1 and is part of the ASCO State of Cancer Care in America series.
The survey highlights key trends in oncology practice management and practice concerns, as well as information on the size, geographic distribution, use of electronic health records (EHRs), and number of oncology practices.
“Time spent by providers dealing with EHRs, prior authorizations, and other reporting requirements competes with resources to deliver high-quality patient care,” stated M. Kelsey Kirkwood, MPH, Research and Analyst Specialist at ASCO, and colleagues.
Response Rate and Type of Practices
For this survey, ASCO used Medicare Physician Compare data to identify oncology practices in the United States. The survey examined trends in the number and sizes of practices from 2013 to 2017.
More than 2200 hematology/oncology practices provided care to adults in 2017. Of those practices, 394 (18%) completed the survey and accounted for 58% of the hematologist/medical oncologist US workforce (N = 7203).
The majority of the practices were physician owned (42%), followed by hospital health system owned (37%) and academic (21%); the distribution was nearly identical to that of the 2016 census cohort. The following are the key findings of the report.
Key Concerns for Oncology Practices
Interactions with payers was cited as a key challenge in 2017 by the majority of practices.
Overall, 58% of responding oncology practices reported payer pressures as the top concern. This was a significant increase over concerns reported in 2016, when payer pressures ranked as the fourth concern. Among these practices, prior authorizations (75%) and coverage denials and appeals (62%) were the biggest payer stressors that they face.
Other top concerns included competitive pressures, staffing issues, and increasing expenses.
EHRs remained a burden on practices, with only 15% reporting full interoperability.
Of the responding practices, 57% could use their EHR to send data to a clinical registry, and 60% could send electronic copies of EHR data to patients.
“With much energy spent at the practice and provider levels, it is unfortunate to find within our Census cohort that EHRs are still largely unable to transfer data seamlessly and consistently to one another, let alone to patients and to cancer registries,” noted Ms Kirkwood and colleagues.1
The majority of practices are prepared to comply with the Medicare Merit-Based Incentive Payment System (MIPS).
Of the responding practices, 58% reported that they were ready to comply with MIPS; preparedness was especially high (74%) among physician-owned practices. However, more than 33% of practices are still unsure if they are ready, leaving 8% of practices unprepared for the 2019 deadline.
Consolidation continues, but more than 50% of practices remain small.
As of 2017, there were 2248 oncology practices in the United States and 12,423 US-based hematologists, hematologists/oncologists, and medical oncologists.
From an extraction of 2016 Physician Compare data, the researchers identified 2427 oncology practices, representing a 2.6% decrease in the number of oncology practices from 2016 to 2017. Annual declines in the number of practices were observed dating back to 2013 (range, 0.3%-5.1%).
Despite this consolidation, 76% of practices employ 1 to 5 oncologists, and 72% report only 1 site. Of the practices, 21% employ 6 to 40 oncologists and 3% employ ≥41 oncologists. In total, 25% of practices have 2 to 5 sites and 3% have 5 to 10 sites.
The oncology practice landscape continues to evolve.
Many of the practices reported changes in organization structure, with 34% citing closures, openings, mergers, and/or sales, which represents a more than 2-fold increase compared with 16% in 2016.
Of the practices that reported changes in 2017, 53% opened new sites, 27% merged with others, 25% purchased other sites, 21% closed sites, and 6% sold sites.
Access to cancer care is low in rural areas, high in the South.
A total of 19% of the US population resides in rural areas; however, only 7% of oncologists practice in rural areas. The South had the largest (33%) share of practices and the highest cancer burden, with 38% of new cancer cases diagnosed in 2017.
The researchers noted that these “findings likely represent conservative estimates of such burdens because they are driven by responses from midsized to large-sized organizations, which tend to have lower relative administrative burden and greater market influence than small practices and therefore may be able to adapt more readily to changes in the health care environment.”1
ASCO intends to increase its outreach among small practices in the future to better capture their practice experiences.
- Kirkwood MK, Hanley A, Bruinooge SS, et al. The state of oncology practice in America, 2018: results of the ASCO Practice Census survey. J Oncol Pract. 2018;14:e412-e420.