Since 2009, the Associated of Community of Cancer Centers (ACCC) and Lilly Oncology have conducted an annual survey to gauge the climate of oncology care in the United States. As 2015 draws to a close, the organizations report on the latest trends and concerns felt by the oncology community. Participants of the study included independent oncology programs, university-based cancer programs, university-affiliated cancer programs, hospital-employed physician oncology practice programs, shared operations, and—the largest participant group, comprising 66% of respondents—hospital-based outpatient cancer programs.
In gauging what practitioners felt were the biggest challenges facing cancer programs, results revealed that a majority are concerned about the lack of reimbursement for supportive care services (65%) and budget restrictions (61%). The high cost of cancer medications, a popular topic in today’s media, was cited as a concern by 45% of respondents, with 44% expressing concern about the increased number of patients unable to pay for treatment.
Further data has revealed a significant drop-off in programs’ participation in the 340B drug program—a program that requires drug manufactures to provide outpatient drugs to eligible health care organizations at significantly reduced prices. Only about half of the programs surveyed said they participate in the program, compared to 59% that were involved in 2014. Additionally, only 49% said they planned to participate in the future, versus more than 60% that gave the same response in 2014. However, most programs (53%) are now offering quality and compliance programs to help educate patients on issues related to their medication; this is a sharp increase from last year, when only 34% of programs offered such initiatives.
In another shift consistent with current market trends, programs now all seem to be using metrics to measure and track the quality of care they offer. The most popular measures were the Commission on Cancer (CoC) standards and accreditation (94%) and patent satisfaction scores (90%). Most programs (87%) also reported using CoC accreditation to communicate their value to payers. These high percentages suggest that these measures represent a new standard in the industry.
Patient-centered services seem to be another area in which programs are intent on improving. Although only about half the programs (51%) worry about meeting the new standard for survivorship care that went into effect in 2015, most have plans to enhance the offerings of their patient-centered services. Nearly all of programs plan to expand their patient navigation (89%), psychological counseling (88%), survivorship care (87%), and genetic counseling (81%) services. Palliative care also showed a sharp increase: today, 92% of programs are offering palliative services, versus only 78% last year. However, despite numerous studies indicating that patients want to know the cost of their cancer treatment, the majority of programs (53%) do not provide an estimate of total treatment costs.
Since the determination by the Centers for Medicare and Medicaid Services to cover low-dose computed tomography screening for lung cancer went into effect on February 5, 2015, programs are continuing to grow their lung cancer screening services. Whereas last year only 51% of programs offered this screening, this number has risen to over 77% in 2015. Molecular testing has also become a standard among programs; more than two-thirds now offer it for breast, lung, and colon cancers. However, many still worry about the challenges associated with diagnostic testing, such as reimbursement difficulties, resource allocation, and lack of patient awareness.
Still, even with the increased number of options offered by oncology programs, the bottom lines of most cancer programs continue to improve. Half of the surveyed programs reported that they exceeded their budget expectations for the 2014 fiscal year; only 33% could say the same for the fiscal year of 2013. In part, this may be due to an increasing role of cancer program administrators in purchasing decisions: administrators were involved in 90% of the purchasing decisions made by programs thus far in 2015, an increase of ~20% from 2014.
The trends revealed in the ACCC’s 2015 Cancer Programs Survey demonstrate an increased focus on improving value in cancer care. The complete survey results can be found here.
