- In response to the growing trend of hospital consolidation, including questions about cancer care decision-making, cost impacts, and delivery of care, the Association of Community Cancer Centers (ACCC) Institute for the Future of Oncology has released, “Opportunities and New Realities in Cancer Care: A White Paper on Oncologist/Hospital Integration in the ACA Era.” The white paper provides perspectives on how these alignments are affecting cancer care providers, cancer programs, and the patients they serve.
To examine this and other issues, ACCC recently convened the inaugural meeting of the Institute for the Future of Oncology, bringing together more than 40 oncologists and cancer care program executives from across the country. Participants offered insight on the impact of consolidation trends in communities and various cancer care settings. Additionally, participants offered perspectives on some of the upcoming opportunities and challenges oncology care providers will face as they manage changes in patient care, functionality, and costs.
Among the paper’s main findings:
Consolidation is on the rise. Participants reported a substantial increase in consolidation and expect the trend to continue, considering the large and growing demand for cancer services.
Consolidation and integration of oncologists within hospitals has not impacted physicians’ clinical decision-making as yet, however, oncologists expressed concerns that their ability to tailor care could erode over time.
To preserve quality and promote cost-effective care, oncologists will need to become advocates within the hospital and/or healthcare system, engaging with hospital leadership through open communication.
One size does not fit all. While the forces driving consolidation are often similar across settings, integration models vary across the country and from market to market.
Patient access to cutting-edge clinical trials may fall short. Increased consolidation may open new doors, increasing clinical trial access for more patients, or it may result in less support for community-based clinical programs.
"The forum discussion makes it clear that it’s no longer ‘business as usual,’ especially with changes from the ACA underway,” said Virginia T. Vaitones, MSW, OSW-C, ACCC President and oncology social worker at Pen Bay Medical Center in Rockport, Maine. “Health reform and the evolution of different care delivery models and reimbursement mean that the landscape around community cancer centers is shifting rapidly. It will take collaboration from all providers and stakeholders to make sure patients continue to receive quality care."
The white paper notes that despite continued consolidation, communities are well-served by a variety of cancer program models, including – in some markets – strong, independent practices. “There is no one model that will work in every community,” said Jennie R. Crews, MD, FACP, ACCC Treasurer and Medical Director, PeaceHealth St. Joseph Medical Center, St. Joseph Cancer Center. “We have members who are doing quite well as independent practices, while others have seen new opportunities under consolidation models. But, there is no question that some smaller practices will have to consider the possibility of partnering with larger groups or health systems. It’s a natural by-product of the push for more coordinated patient care and shifting reimbursement models.”
In addition to consolidation, forum participants discussed key issues around patient access to clinical trials. “There are key issues to address, such as shrinking funding for research and funding questions under the ACA, so we’re not certain that patients will see the full potential of consolidation to expand clinical trial access,” says Steven L. D’Amato, BSPharm, BCOP, ACCC Secretary and Executive Director, Maine Center for Cancer Medicine.” Given the importance of clinical trials in cancer care, however, it’s an issue that we need to tackle.”
As community cancer centers continue to navigate their way through these issues, ACCC will release a second white paper that discusses the promise of health information exchanges (HIE) as well as the challenges that may arise with adoption and implementation. HIE has been identified as a major driver behind consolidation and has subsequent impacts on cancer care.
“This meeting was the first of what will be ongoing gatherings convened by ACCC among cancer care experts. It’s critical that community cancer providers are able to navigate not only the environment they face today, but also anticipate and adapt to the environment they will face in the years to come,” said Becky L. DeKay, MBA, ACCC President-Elect and Director of Oncology Services, LSU Health Shreveport, Feist-Weiller Cancer Center.
To learn more about these findings or to learn more about ACCC, visit www.accc-cancer.org