Andrew L. Pecora, MD
Editor-in-Chief of Oncology Business Management
Chief Innovations Officer, Professor, and Vice President of Cancer Services
John Theurer Cancer Center at Hackensack University Medical Center
President, Regional Cancer Care Associates, LLC
It is always fun to try to predict the future. Invariably you will be wrong. Nonetheless, the current issue will attempt to outline future states of oncologic care delivery and reimbursement. What will oncology care look like in 2020?
Will oncologists all be working in an employed model, an extension of the current trend that was emphasized in a recent New York Times article: “The private practice oncologist is becoming a vanishing breed, driven away by the changing economics of cancer medicine.1” The article cites the Community Oncology Alliance statistic that says since 2008 of the 1447 independent oncology practices in the US, 544 were purchased by or entered into contractual relationships with hospitals, another 313 closed, and 395 reported that they were experiencing difficult financial situations.
Or, will there be a reverse in course to the private practice setting because of the increased expense of oncology care delivery in the employed, hospital-based setting? I guess only time will tell.
What is clear is that the science of oncology, cost of oncology care, and methods of therapy will likely be vastly different by 2020. Immune-based therapies alone are likely to substantively change the economics of oncology and oncology care delivery. Will their cost be additive or supplant existing total cost? Only time will tell. Add to this the personalized genomic revolution. Will we have a test by 2020 that will allow patients and their doctors to avoid therapies with no chance of working? Will this reduce total cost or increase them? I do not know.
Regardless of our inability to predict the future, policy makers and markets are affecting change in oncology care delivery. Various methodologies of reimbursement including bundles, episodes of care and capitation, all with and without shared savings, are in trial or development.
Early results indicate that bundles/episodes of care can reduce total cost of care in controlled settings. Is this universally applicable? Only time will tell. How will advancement in technology and information exchange affect all of this? You got me.
There is a great expression I once heard that seems appropriate to share here—never let the truth get in the way of a good story. It will be wonderful if we can save on total cost while improving outcomes for all patients suffering with cancer. I have written about the Goldilocks formula before—do just the right amount of care…not too much and not too little. Previously we have addressed the promise of big data and how big data may enable the Goldilocks formula.
Our population is aging and cancer prevalence is increasing in large part because of our collective good work. Prevention and early detection remain key. However, as outcomes improve with new and more expensive agents for advanced disease, the math may not work on total cost of care savings because the expensive therapy is the best therapy. It would be nice if we could have 20/20 vision when it comes to the future, but I guess only time will tell.
Kolata G. Private oncologists being forced out, leaving patients to face higher bills. New York Times. November 23, 2014. Accessed on November 26, 2014. http://nyti.ms/1vlB32v.