Trends in Oncology: Preparing for Seismic Change. ASCO s Clinical Affairs Department

Transcription

1 Trends in Oncology: Preparing for Seismic Change Association of Northern California Oncologists May 20, 2015 Thomas R. Barr, MBA Director, Business Metrics and Analysis Clinical Affairs Department ASCO s Clinical Affairs Department Helping practices survive and thrive today AND in the future Led by a practicing oncologist priorities and programs to be driven by you Hands on help for practices Practice efficiency; staffing models, workflow; quality reporting/qi projects; learning networks Information and analysis Practice trends; economic analysis; performance measurement; payment reform 1

2 Dr. Stephen Grubbs Senior Director, Clinical Affairs The new clinical affairs department of the American Society of Clinical Oncology is dedicated to providing services, education and other resources to support oncology practices in all settings. Dr. Grubbs will begin his new role in June. Grubbs, 62, is a community oncologist and managing partner at Medical Oncology Hematology Consultants in Newark, Del. He is also a principal investigator with the Delaware/ Christiana Care National Cancer Institute Community Oncology Research Program. A collaborative learning network for oncology practice knowledge Focus on administrative, operational, financial and quality improvement activities Valuable tool for practice improvement Enrollment is open now! Contact PracticeNet@asco.org for more information 2

3 Learning Objectives for today Understand the trends seen in the 2014 National Practice Benchmark Reports Predict the continuity of these trends as fee for service health care is replaced by risk payment models Oncology Practice Trends From the National Practice Benchmark Thomas R. Barr, and Elaine L. Towle JOP 2014;10: Survey participants are exemplary not average The data we report in the NPB are drawn from practices working in specific markets, oncology delivery ecosystems. These markets, though likely competitive, do afford practices enough latitude to maximize revenue while mitigating costs. This is not an ASCO survey but it does play on 3

4 2003 The Big One The Medicare Prescription Drug, Improvement, and Modernization Act is now most widely recalled as the Medicare Modernization Act or MMA Remember that prescription drugs were the focus This was the largest overhaul of Medicare in the public health program's 38-year history Within 2 years, it produced a fundamentally different business environment for medical oncology Within 6 years, practices and industry adapted Oncology Metrics trends, 2005 to

5 Oncology Metrics trends, 2005 to Oncology Metrics trend tracking by year per FTE HemOnc 1991 to

6 Net drug revenue as a percentage of drug revenue (margin) Net drug revenue and total revenue less cost of goods paid for (COGPF) 6

7 Figure 6: Operating expense and revenue per established patient visit Figure 7: Operating margin per established patient visit 7

8 Figure 8: Established patient visits per FTE HemOnc Figure 9: FTE staff per FTE HemOnc. 8

9 Figure 10: Established patient visits per FTE staff Figure 11: Operating expense and total collections per FTE staff 9

10 SGR Repeal: We got it now what? Providers Must Choose Increasing Enhanced Financial Fee for Risk Service and Reward or Accountable Care Options 2015:H2 2019: 0.5% annual update Merit-Based Incentive Payment System : Frozen payment rates 2026 and on: 0.25% annual update 2018: Last year of separate MU, PQRS, and VBM penalties 2020: -5% to +15% 1 at risk 2022 and on: -9% to +27% 1 at risk 2019: Combine PQRS, MU, & VBM programs: -4% to +12% 1 at risk 2021: -7% to +21% 1 at risk Advanced Alternative Payment Models :H2 2019: 0.5% annual update : Frozen payment rates 2026 and on: 0.75% annual update : 5% participation bonus : 25% Medicare revenue requirement. 1. Positive adjustments for professionals with scores above the benchmark may be scaled by a factor of up to 3 times the negative adjustment limit to ensure budget neutrality. In addition, top performers may earn additional adjustments of up to 10 percent. 2. APM participants who are close to but fall short of APM bonus requirements will not qualify for bonus but can report MIPS measures and receive incentives or can decline to participate in MIPS and on: Ramped up Medicare or all-payer revenue requirements Source: The Medicare Access and CHIP Reauthorization Act of 2015; Advisory Board analysis. 6 universal payment reform basic requirements 1. 24/7 patient access to clinician with real-time access to patient s medical records 2. Robust clinical measurement and management 3. Continuous quality improvement based on clinical and financial information 4. Patient navigation 5. Documented care plan containing all 13 IOM components 6. Treatments consistent with nationally recognized clinical guidelines 10

11 Conclusions Fee for service payment system is on shakey ground The timetable for quake damage is proscribed by law and will be felt by 2020 Electronic medical record automated clinical measurement and reporting is essential All payment reform flavors require the same basics Prepare now drive data density in your EMR Leapfrog solution to oncology innovation Dynamic real time Clinical and financial measurement Patient Focused Big lots and lots of patients. Big lots and lots of payers. 11

12 Questions? Medicare Oncology Payment Model Resources Thomas R. Barr, MBA Director, Business Metrics and Analysis Clinical Affairs Department 12