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Proactively Addressing the Future of Community Oncology

Sandra M. Swain, MD, FACP

15 Oct 2012 12:54 PM

I recently had the honor of representing the Society at the ASCO co-hosted 2012 Cancer Center Business Summit, titled “Transitioning to Value Based Oncology: Strategies to Survive and Thrive.” This unique meeting brought together multiple stakeholders to share perspectives on the current state and future direction of oncology. Appropriately, the agenda reflected the diversity of topics and models of major interest to the oncology community, including presentations on a benchmarking study of oncology practices, payer and provider initiative panels on innovative payment models, organizational strategies for future success, and building the patient-centered medical home. We also listened to a great presentation on end-of-life care, advanced-care planning, living life well, and the “journey of life” (which I will address in a future blog post).

What we learned at the summit emphasized the significant challenges we face, but also left room for hope. Practices are feeling the squeeze, but they are adapting. The future of community cancer care remains in flux, but like others present at the meeting, I left the meeting feeling excited about our field and the future of oncology. Issues such as fragmentation, cost, and efficiency are being recognized and addressed. During our discussions, I heard many terms related to practice models—blending, surviving, collaborating, thriving, dynamic, pathways, volatile, disruptive, care management, trust, and urgency. But the most important term I heard was “proactive,” which captured the essence of the meeting and why we carved out time to attend.

All of the speakers emphasized what we all know and live with every day—it’s all about the patient. We want to continue building those relationships with our patients as they enter the most important journey of their life and make that journey as good as it can possibly be. In order for that to happen, we as physicians need to be leaders in deciding our own fate and, in the process, the fate of our patients.

Patients want community oncology practices to thrive because their satisfaction is higher when they can stay close to home in a user-friendly environment; payers want community practices to survive because costs are less; and community physicians want to survive in some form because it provides control, autonomy, and more personal satisfaction. In order to achieve these, we discussed many different solutions, including different forms of Accountable Care Organization involvement, multispecialty groups, oncology medical homes, oncology “supergroups,” state-wide oncology programs, innovation grants for oncology initiatives, and hospital employment or practices directing cancer-service lines for a hospital.

In order for patients to continue to have access to high-quality care close to their homes and families, it is critical that community oncology not only survive, but thrive. We all love medicine and look back on the idealistic goals we had when we entered the field. We want to preserve those goals for our future and continue with the cognitive and humanistic part of what we do.

Comments

Number of Comments: 2
Anupama Kurup

Monday, October 15, 2012 1:45 PM

Thank you Dr. Swain.  I would echo your comments. 

There is a great deal of discussion about the alternative payment models that better compensate oncologists for the work that they do, including the use of treatment pathways.  It is now more important than ever for practicing oncologists to get involved and add their voices in these discussions.  Practicing oncologists are on the front-lines delivering much needed care in their communities, and they are best suited to provide "real world" expertise on how best to deliver quality care.

Anupama Kurup, MD ASCO Clinical Practice Committee Chair-elect

Robin Zon

Wednesday, October 24, 2012 3:21 PM

I had the honor of representing my independent, private practice group to this same meeting, and thank Dr. Swain for her excellent summary of the meeting themes. In addition to what was noted above, I was impressed by the willingness of many private practice groups voluntarily participating in pilot programs such as episode/bundled payment programs and development of oncology medical homes, as well as the many strategies publically shared by other practice leaders. I found it reassuring that despite the uncertainties facing community practices, there remains the shared common goal of serving the patient. In addition to Dr. Kurup’s admonition for community practices to increase involvement in these discussions, ultimately strategic plans addressing the many challenges we face need to be communicated well and understood by stakeholders of various backgrounds and motivations in order to be successfully implemented.

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Sandra M. Swain, MD, FACP