This year has been more hectic for practice administrators than I have seen in decades. Practice administrators keep telling me they feel they are working harder and harder, and have so many more demands on the practice involving reporting, chasing reimbursement, securing access for their patients, and helping their physicians navigate the increasing demands on them, that it is just too hard to keep up.
While attending the June 2017 American Society of Clinical Oncology (ASCO) meeting in Chicago, I noted the meeting had more sessions than ever on topics such as the Oncology Care Model (OCM), value-based care, and surviving the new Medicare Access and CHIP Reauthorization Act of 2015, including the Merit-Based Incentive Payment System (MIPS).
These sessions were attended more by physicians than by practice administrators, but the messages were the same. There were scores of analytics presented, suggestions of data collection to help manage the new demands, new dashboards, and companies offering to help make sense of this all, for the data or a price or both.
This is all going to come down to one point: there is only one pot of money—for society, for commercial payers, even for providers. Everyone is looking to accomplish more while simultaneously expecting to spend less and be paid more.
This is not a sustainable merry-go-round for providers, payers, or especially for patients.
Summer is here, and often the pace of life naturally slows down. People force themselves to walk away from the daily grind and take vacation and time with their family. Let’s take advantage of that slight reduction in self-imposed pressure to stop and evaluate our work.
The ultimate goal of oncology practices is the delivery of cost-effective, efficient care that provides best outcomes for patients. Some practices are making the discussion about value-based care choices an integral part of every written and verbal communication within their care team and with the patient. This strategy has provided oncology practices a new perspective, as well as the realization that many of the previously “pressing” issues are no longer so important. Their care teams have a context and a framework for every decision, and that clears the way to simplifying processes and relieving unnecessary worries.
At the Spring 2017 Managed Care Forum, I. Steven Udvarhelyi, MD, President and CEO, Blue Cross and Blue Shield of Louisiana, delivered the keynote address, saying that providers were asking how to engage in value-based contracting. His recommendation to providers was: “If you are still practicing today as you did 12 months ago, or 24 months ago, we are not likely to contract with you. I want to work with others who understand that transformation is the key to value, and if you can show me that you truly have reinvented your model and culture and focus to provide cost-effective, efficient care with good outcomes, we can talk.”
Start a Conversation
Many oncology practices are wondering what they are going to do in response to the many demands of the OCM or MIPS to be considered high performers.
My suggestion is that you take the time this summer to change the conversations within your group toward a conversation about value and patients, by questioning the current standard of delivering care, which will yield significant results.
Ask questions such as:
- Will these changes in the care delivery standards influence the patient’s quality of life?
- Will a referral or a test result in a change of treatment choices, and at what cost?
- Are we paying attention to the patient as a whole, including the patient’s other medical conditions, work situation, support system, and psychosocial issues?
- Do we recognize the effect that those aspects could have on the cost-effectiveness and efficacy of the treatment choices the patient makes and the outcomes?
- Are we listening to each other and to our patients?
- Are we communicating upstream and downstream with each other and with other care providers, to ensure that significant issues (eg, emergency visits, readmissions, comorbidities, medication adherence) are not causing needless complications and costs?
- Are we functioning as a team or in distinct silos of focus?
- Are we stopping to take a breath and think about how we are moving forward, rather than just moving?
Realignment of Focus
Try to take advantage of the natural summer relaxation of tension, and take a few moments to consider how a simple change of focus may make much of the “craziness” fall into place. Realignment of focus and culture is not easy, and does require strong leadership.
You could start with one meeting of your practice leadership. Discuss the obligations that your practice is feeling, the scrutiny everyone is under, and the opportunities open to oncology practices for transformation by listening attentively and communicating more openly.
Pick 1 or 2 changes that will lead to reduction of significant concerns for your patients. Look at what a new perspective and improved communication will be needed to refocus your team, and witness the transformations slowly beginning to happen.
Soon you will find your group turning the corner toward transformation to value-based care, and your performance measures will adjust accordingly.
Communication
The cornerstones of all the discussions at ASCO 2017 were communication, listening, and learning. Some of that is being forced on practices, such as increased reporting and monitoring, but the more you look at information, the more you question and the more you learn.
Oncology care has evolved from inpatient care with little management to outpatient care, to community-based care, and now, to new collaborations and merged delivery models. Oncology practices will continue to evolve, and my guess is that even just 3 years from now, the care model will evolve again.
Maybe it will involve technology for better 24 hours a day, 7 days a week communications with patients when they are not in your offices. Maybe it will evolve into more centralized care, or decentralized, patient-specific care—in terms of treatment choices and delivery models. Maybe the acute care oncology infusion practice model will evolve to some other, less resource-intensive model.
The one thing we can trust is that hospitals and medical offices will respond to the limitations on the healthcare costs increases and retool into different models over the next 10 years. We may look back on this summer, the first full year of the OCM and MIPS, as the time we took a collective breath, sat back, and talked and listened, and the change in cancer care began.