Dr Barbara McAneny: It Is Crucial Community Oncology Practices Be Allowed to Thrive

With the low cost and high quality of community oncology practices and 40% of Americans living in rural areas, the country needs to preserve and allow community practices to thrive, said Barbara L. McAneny, MD, president of the American Medical Association and CEO of the New Mexico Cancer Center.

Transcript

How can community practices adapt to survive in this changing healthcare environment?

I highly value community oncology. I think it is the low-cost, high-quality alternative to hospital-based systems, because under the hospital outpatient perspective payment system that automatically costs the system twice as much. We’re the most expensive healthcare system on the planet, we cannot afford to pay twice as much for the same service. So, to me it is crucial for our system to maintain community oncology.

In addition, 40% of Americans live in rural areas. There are not going to be large, integrated systems in rural areas. So, for those reasons I think it’s very important that we conserve, and allow to thrive, community oncology practices.

In order to do that, first of all we have to have a system that does not penalize physicians for doing the right thing for the right patient. The Oncology Care Model has a practice adjuster that tries to look for how efficient they were before, and also has an early adopter factor that they put in for people who are using the new biologic agents, which are much better than standard chemotherapy, much less toxic, better outcomes, so ethically we absolutely have to use those drugs. But they are also very expensive. Which means that under the Oncology Care Model, and actually under the [Medicare Access and CHIP Reauthorization Act], oncologists are penalized for using these expensive drugs, even though it’s the right thing for that patient with that disease. So, the first thing we have to do, if we’re going to preserve community oncology, is to reward physicians, not penalize them for doing the right thing for patients.

The second thing that we need to look at is the site of service changes that I have to hire the same level of oncology-trained nurses as a hospital, I now need data analytics, which I never needed in my practice 10 years ago, I now need technical people who can keep the [electronic health record] running, and be able to work with. So, the expense of practices has gone up significantly, but the payment from Medicare has not. So, we are penalized for trying to adapt. If they want practices to evolve, from fee-for-service into some sort of alternative payment model, CMS and the payers have to recognize that that evolution takes resources. Everybody has to have a margin if they’re going to be able to stop and think about: how can I do this better? What do I need to invest in to be able to do a better job for my patients? Do I need to hire another nurse? Do I need to do other things? So, we really need a system that will allow physician practices to have that margin so that we can invest in the future.

And the other thing that I think will help physician practices is to band together with other physician practices. A group of practices, of which we’re one, created an organization we call National Cancer Care Alliance, which is a group of practices across the country, coast to coast, and that allows us to share what I would call bandwidth. There are so many things that you have to think about and be good at to run a practice. You have to know how to do [information technology] HIPAA security, you have to know how to get the most out of your electronic medical record, you have to think about how you’re structuring your practice to be able to offer those same-day visits to patients and to do that care coordination that’s so important. If we band together, then we can delegate thinking about one of those problems to one of the people in the practice and then share the outcomes. So, that will really help us. And I think that’s going to be a good model for the future.