Apr 26, 2015
Growing patient demand and administrative burden fueling the challenges
The U.S. cancer care system faces tremendous turbulence while dealing with growing numbers of cancer patients and survivors, mounting pressures to control rising health care costs, and widespread oncology practice transformation, according to the new ASCO report The State of Cancer Care in America: 2015.
The report, first published in the Journal of Oncology Practice (Epub 2015 Mar 17) and presented at a Congressional briefing, chronicles the current realities of the cancer care system and examines trends in the oncology workforce and practice environment that are affecting patient care and access.
“This year’s report clarifies multiple stresses in our nation’s cancer care system, but there is reason to be hopeful,” said ASCO President Peter Paul Yu, MD, FACP, FASCO. “With this knowledge and insight, we can identify ways to ensure that all patients with cancer receive high-quality care—and help oncology practices adapt, survive, and succeed in today’s demanding health care environment.”
Report highlights key progress against cancer
According to the ASCO report, there is a wider array of treatment options now available for many cancers. As a result of these and other advances, patients with cancer are living longer than ever before. Today, more than two-thirds (68.5%) of patients with cancer live beyond five years after their diagnosis, compared to 49% in 1975.
This positive trend is contributing to an increasing number of cancer survivors: In 2014, more than 1.6 million cancers were diagnosed, bringing the total number of Americans alive today who have received a cancer diagnosis in their lifetime to 14.5 million. These cancer survivors will need follow-up care for late complications or side effects of treatment, and future cancer screening.
The challenges to high-quality care delivery
In addition to acknowledging the many successes in the field, the report also provides much-needed documentation of the growing pressures facing cancer care professionals, including the following:
- Growing cancer care demand. Due largely to an aging population, a dramatic 45% increase in cancer incidence is expected by 2030. At the same time, obesity is also on the rise and is expected to contribute an additional 500,000 cancer cases over the same time period.
- Disparities in access to cancer care persist. The benefits of cancer screening and treatment advances have not been experienced consistently across racial and ethnic groups.
- Oncology workforce size remains constant, but may soon be outpaced by growing demand. The report finds that with approximately 11,700 oncologists currently providing direct patient care (up slightly from last year), the following worrisome trends may adversely impact patients’ ability to obtain specialty cancer care: an aging oncology workforce; gaps in racial and ethnic workforce diversity; poor coverage in rural America; and growing professional burnout.
Oncology practice transformation
Oncology practices continue to experience extreme volatility, with changes occurring in virtually every facet of the cancer care delivery system:
Financial instability and changing payment models. In 2014, cost and payer pressures persisted as the most pressing oncology practice concern. Escalating drug prices were also a major concern. Nearly 72% of practices report continuing to work in a fee-for-service payment system; other payment models (including capitation and bundled payment) are being used to a lesser degree—but are on the rise. About 36% of oncology practices report either implementing, or considering implementing, a pathways program, and 30% were considering medical home programs that emphasize care coordination. At the same time, Medicare recently announced plans to dramatically change 85% of its fee-for-service payment system to a value or quality-based model by 2016 and 90% by 2018.
Practice consolidation continues. One quarter of all community-based oncology practices report the likelihood of becoming affiliated with a hospital over the next year.
Pre-authorization a major concern. Oncology practices report that the administrative burden imposed by insurance companies and time spent dealing with patient insurance issues are reducing the time available for patient care.
“Patients need us to find better ways to pay for and incentivize high-quality, value-based care,” said Dr. Yu. “ASCO is currently developing and testing an alternative payment approach [asco.org/advocacy/physician-payment-reform] that reflects the current realities of oncology practices and ensures that patients receive the full range of services that are integral to their care.”
Moving forward: ASCO recommendations
The State of Cancer Care in America: 2015 sets forth a series of recommendations to quell the disruption occurring in the national cancer care system and ensure that all patients with cancer have access to high-quality care. ASCO calls on each stakeholder in the cancer care delivery system to implement changes, including the following recommendations directed to Congress:
- Immediately repeal the Sustainable Growth Rate (SGR) formula* and replace it with a sustainable structure that incentivizes the delivery of high-quality cancer care.
- As the 21st Century Cures initiative moves forward in the House— and the “Innovation for Healthier Americans” legislation in the Senate—ensure interoperability of medical records and provide the resources to enable practices to track and report quality measures, while serving patients in an environment of widespread change in care delivery and payment systems.
- Prevent further erosion of the national research infrastructure and support continued breakthroughs in cancer therapies by increasing the budgets of the National Institutes of Health and the National Cancer Institute.
For more information on ASCO recommendations and additional findings reported in The State of Cancer Care in America: 2015, including a downloadable PDF and a webcast recording of the ASCO Congressional briefing, please visit asco.org/stateofcancercare. The report can also be accessed and downloaded at jop.ascopubs.org.
*At the time of publishing, the U.S. House of Representatives voted to repeal the SGR; the Senate has delayed its vote until after the Spring recess.