Amy Hanley Senior Workforce and Health Policy Specialist American Society of Clinical Oncology

Transcription

1 Workforce Issues and Impact on Providers Results of ASCO led Studies on the Oncology Workforce: New and existing data on workforce supply and practice trends Amy Hanley Senior Workforce and Health Policy Specialist American Society of Clinical Oncology

2 Summary of Presentation 1. Background data on physician workforce shortages 2. Presentation of recent ASCO workforce studies including the 2014 ASCO Census 3. How the ASCO Workforce Advisory Group (WAG) is using this information 4. Q & A regarding workforce

3 Mortality Good News Five-Year Survival Year of Death Source: National Cancer Institute Year of Diagnosis Cancer Deaths per 100,000 People % of Patients Surviving Five Years Source: National Cancer Institute

4 Survivorship Care Last Year - Cancer 5% Last Year - Other Cause 3% Initial Year 24% Continuing 68% By 2020, 81% increase in cancer survivorship Oncologists Survey: 68% of oncologist visits are for patients 1 or more years post-diagnosis

5 What s Ahead New Cancer Cases New Cancer Cases per 100,000 People Year of Diagnosis Source: National Cancer Institute

6 Cancer Care Challenges By 2025, new US cancer cases up by 42% ACA adds 25 million newly insured Cancer survivors increasing to 18 million

7 Projections Point to Likelihood of Significant Shortages by Total Annual Visits (in millions) Deman d Supply Demand Supply

8 Supply-Demand Perspective 300 New Patients/per year x 1,487 Oncologist Shortage 446,100 New Patients Face Challenges

9 13,400 U.S. Medical Oncologists

10 2014 Supply and Demand Study FTE Oncologists (Thousands) Total Oncology Demand (FTE) Total Oncology Supply (FTE)

11 More Oncologists Over 64 Than Under 40

12 Aging of the Oncologist Workforce Age Count % Count % < % 471 3% % % % % % % % % % 612 4% > 50% Note: 2007 data includes 4 oncology specialties & 2012 data includes 4 specialties and radiation oncology

13 Age Distribution of Oncologists (2013) 4% 16% % % Over 70 29%

14 Geographic Challenges Oncologists per 100,000 Population by State

15 Cancer Care in Rural America Oncologists per 100,000 Population by State 1 in 5 Americans live in rural areas 1 in 33 oncologists practice in rural areas

16 Oncologists by Age & Location

17 Oncologists in New Jersey 355 hematologists/oncologists billed from 141 practice locations in 2014 Source: Physician Compare, Centers for Medicare & Medicaid Services

18 State of Cancer Care in America 2014 ASCO National Oncology Census Results

19 The Big Picture

20 Participation 1253 respondents including 974 practices, representing over 10,000 oncologists 530 practices participated in 2013 representing nearly 8,000 oncologists Participation once again varied by geographic location & practice size Results being analyzed and will be published in March 2015

21 Total respondents (n=1253) Physician-owned practice Hospital/health system-owned practice Academic practice Industry International Locum Tenum/Retired Government # of respondents

22 Practices by census region and practice setting (n=971) # of practices Midwest Northeast South West Census Region Academic practice Hospital/health system-owned practice Physician-owned practice

23 Location of Oncologists from the 2014 Census

24 1,600 Number of APNs & PAs by practice setting 1,400 1,200 # of APNs & PAs 1, Academic practice Hospital/health system-owned practice Physician-owned practice # APN (n=2752) # PA (n=1136)

25 Reported use of electronic health records by oncology practices Have advanced EHR/EMR 61% 68% 67% Have basic EHR/EMR 16% 18% 22% Looking to implement in 15% 9% 6% next 6 months Do not use 8% 5% 5%

26 Services provided by practice setting Hematology (malignant) and Oncology Hematology (benign) Medical Oncology (without hematology) Radiation Oncology Gynecologic Oncology Surgical Oncology Internal Medicine Hospitalist Gynecology Other Pediatrics Pediatric Hematology/Oncology # of practices Academic practice Hospital/health system-owned practice Physician-owned practice

27 100.0% Payer mix by year 4.8% 7.3% 5.7% 90.0% 80.0% 70.0% 38.7% 36.1% 31.5% 60.0% 50.0% 9.2% 11.4% 12.4% 40.0% 30.0% 20.0% 47.4% 48.4% 50.4% 10.0% 0.0% Medicare (FFS & HMO) Medicaid Private/Commercial Uninsured/Self-pay

28 Is practice participating in ACO? (n=686) Academic practice 72.7% 27.3% Hospital/health system-owned practice 69.0% 31.0% No Yes (describe below) Physician-owned practice 78.7% 21.3% 0% 20% 40% 60% 80% 100%

29 Pressures cited by practices by practice setting in 2014 (select top two) Payer pressures Cost pressures Competitive pressures Drug pricing Staffing issues Clinical research issues Local economic pressures Other Drug shortages Access to genomic testing # of responses Academic practice Hospital/health system-owned practice Physician-owned practice

30 Pressures cited by practices by year Access to genomic testing Drug shortages Other Local economic pressures Clinical research issues Staffing issues Drug pricing Competitive pressures Cost pressures Payer pressures 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

31 Pressures cited by practices by year % 17.2% 16.0% 14.8% 2.6% 9.0% 7.4% 6.4% 4.0% 0.7% Payer pressures Cost pressures Competitive pressures % 24.2% 18.4% 12.1% 0.9% 10.8% 7.2% 5.1% Drug pricing Staffing issues Clinical research issues Local economic pressures Other Drug shortages Access to genomic testing % 24.3% 14.7% 8.6% 5.4% 6.5% 9.4% 5.0% 0% 20% 40% 60% 80% 100%

32 Biggest Pressures in NJ Other Access to genomic testing Clinical research issues Staffing issues Payer pressures Local economic pressures Drug shortages Drug pricing Inc Expenses Comp pressures

33 Potential for staff layoffs by year Administrative staff 8.1% 17.9% 18.0% Other clinical staff 5.1% 12.9% 15.5% LPN/LVNs 3.8% 6.2% 8.1% Certified oncology nurses 3.1% 5.6% 7.6% 2012 Physician assistants 1.6% 1.9% 4.3% Nurse practitioners 2.9% 2.6% 5.4% Non-oncology physicians Oncology physicians 1.8% 1.9% 2.6% 4.1% 4.9% 6.4% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0%

34 100% Likelihood of changing patient volume in next 12 months (n=647) 90% 80% 32.6% 29.0% 19.4% 70% 60% 50% 38.4% 42.0% 24.2% Very likely to increase patient volume Somewhat likely to increase patient volume Unlikely to change patient volume 40% 30% 20% 19.8% 18.6% 34.5% 10.6% Very likely to decrease patient volume Somewhat likely to decrease patient volume 10% 0% 5.8% 5.6% 3.5% 4.8% Academic practice Hospital/health system-owned practice 11.2% Physician-owned practice

35 Administrative staff Other clinical staff LPNs/LVNs Certified oncology nurses Physician assistants Nurse practitioners Non-oncology physicians Oncology physicians Likelihood of reducing salaries in next 12 months (response range ) # of practices N/A Very Unlikely Somewhat Unlikely Neither Likely or Unlikely Somewhat Likely Very Likely

36 Likelihood of raising salaries in next 12 months (response range ) Administrative staff Other clinical staff LPNs/LVNs Certified oncology nurses Physician assistants Nurse practitioners Non-oncology physicians Oncology physicians # of practices N/A Very Unlikely Somewhat Unlikely Neither Likely or Unlikely Somewhat Likely Very Likely

37 Likelihood of change in level of clinical trials participation in next 12 months Increase number of open trials (n=526) 16% 7% 19% 25% 32% Decrease number of open trials (n=509) 47% 17% 19% 9% 8% Begin conducting private clinical trials (n=459) 31% 8% 22% 19% 20% Very Unlikely Eliminate private clinical trials (n=480) 68% 12% 15% 3% 2% Somewhat Unlikely Neither Likely or Unlikely Begin conducting federal clinical trials (n=435) 38% 8% 26% 12% 15% Somewhat Likely Very Likely Eliminate federal clinical trials (n=467) 68% 9% 13% 4% 6% Eliminate all clinical trials (n=517) 75% 8% 11% 3% 0% 20% 40% 60% 80% 100%

38 Community Practices At Risk In the next 12 months, how likely is your practice to Physician-owned practice Close the practice (n=377) Sell the practice (n=381) Merge with another practice (n=382) Purchase another practice (n=380) # of practices Very Likely Somewhat Likely Neither Likely or Unlikely Somewhat Unlikely Very Unlikely

39 In the next 12 months, how likely is your practice to Close the practice (n=827) 82% Sell the practice (n=834) Merge with another practice (n=840) 63% 77% Very Unlikely Somewhat Unlikely Neither Likely or Unlikely Somewhat Likely Very Likely Purchase another practice (n=833) 73% 0% 20% 40% 60% 80% 100%

40 In the next 12 months in NJ, how likely is your practice to Close the practice Sell the practice Merge with another practice Very Likely Somewhat Likely Neither Likely or Unlikely Somewhat Unlikely Very Unlikely Purchase another practice

41 Rough Waters for Practices Economic pressures Political turbulence General disruption across medicine Sequestration ICD-10 PQRS, Meaningful Use Health Reform ACOs, shifts in practice environment Performance based payment Wave of newly insured Uncertainty

42 How is ASCO using this information?

43 How the Census feeds into other ASCO Programs: ASCO s efforts on Capitol Hill and in the states ASCO s efforts in the Patient Centered Medical Home for Oncology Payment Reform Cost of Cancer Care and Value CancerLinq ASCO University

44 Questions??

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