Elaine L. Towle

Results of the ASCO Study of Collaborative Practice Arrangements.

PURPOSE ASCO projects a shortfall of oncologists in the next decade. The study was designed to address the workforce shortage by exploring collaborative oncology practice models that include nonphysician practitioners (NPPs). METHODS ASCO contracted with Oncology Metrics, a division of Altos Solutions, to conduct a national survey of NPP integration and identify collaborative practice models and services provided by NPPs, as the first phase of the ASCO Study of Collaborative Practice Arrangements. Results of the national survey were used to identify practices for the next phase, in which selected practices participated in a more detailed data survey and satisfaction surveys. Focus groups or interviews were conducted with NPPs to collect additional subjective information to inform the project. RESULTS The incident-to practice model was the predominant model. Satisfaction was universally high for patients and generally high for physicians and NPPs. In virtually all cases (98%), patients recognized they were seeing an NPP rather than a physician. Practices in which the NPP worked with all practice physicians showed significantly higher productivity than those practices in which the NPP worked exclusively with a specific physician or group of physicians. CONCLUSION The use of NPPs in oncology practices increases productivity for the practice and provides high physician and NPP satisfaction. Patients were aware when care was provided by an NPP and were very satisfied with all aspects of the collaborative care that they received. The integration of nonphysician practitioners into oncology practice offers a reliable means to address increased demand for oncology services without adding physicians.

Benchmarking Practice Operations: Results From a Survey of Office-Based Oncology Practices

The Medicare Modernization Act of 20031 brought with it sweeping changes to community-based oncology practices. As Medicare payment for both drugs and drug administration services have changed, oncology practices have become more aware of their business practices and have responded by closely evaluating and monitoring operations. In a January 2006 report to the Centers for Medicare & Medicaid Services and Congress, titled “The Effects of Medicare Payment Changes on Oncology Services,”2 the Medicare Payment Advisory Commission stated that “oncologists responded by cutting costs and increasing efficiency.” As oncology practices continue to strive to further improve practice efficiency, they will need to develop metrics to measure current performance and trend improvements. They also will need to benchmark key practice business indicators specific to oncology. The Medical Group Management Association (MGMA), a professional association that includes medical practice managers and administrators throughout the United States, conducts a comprehensive annual cost survey that reports key practice business indicators and related benchmarks. However, the resulting benchmarks lack specificity for the oncology specialty. In the late 1990s, the Assembly of Oncology and Hematology Administrators, an MGMA specialty assembly, developed additional survey questions to report benchmarks specifically for oncology. MGMA published an oncology-hematology survey for several years. However, because of low participation and high administrative burden, the collection of oncology-specific data was discontinued. The last MGMA oncology-specific report was published in 2003 and was based on 2002 data. More recently, MGMA published its Cost Survey for Single Specialty Practices 2006 Report, which was based on 2005 data. The survey contained 138 questions and had participation from only 12 oncology practices nationwide.3 To meet the growing demand for oncology-specific business benchmarks, Onmark created a user-friendly survey tool to collect data on business operations from its member practices. Onmark Inc, an OTN company in South San Francisco, California, is one of the largest group purchasing organizations in the community-based treatment setting, with more than 2,100 members representing more than 3,600 physicians and more than

National Oncology Practice Benchmark, 2012 Report on 2011 Data

4 billion in annual drug purchases. To ensure confidentiality, Oncology Metrics LP, was commissioned to conduct the survey and report the results. The goal was to develop a number of key practice business indicators, or benchmarks, by which to measure and trend changes in oncology practice efficiency. To simplify the survey process, the 34-question survey was offered as a Web-based survey tool. A total of 178 oncology practices participated in this First Annual Onmark Office-Based Oncology Business Benchmarking Survey.

Key Practice Indicators in Office-Based Oncology Practices: 2007 Report on 2006 Data

In this, the seventh iteration of the National Practice Benchmark, the authors made significant changes in the approach and analysis of the survey, including restructuring and shortening the survey instrument to facilitate the participation of hospital and academic oncology practices, in recognition of the ongoing changes in the oncology industry.

Oncology Practice Trends From the National Practice Benchmark

As community-based oncology practices continue to adjust to changes made by payers, both government and private, the metrics needed to assess business changes become increasingly more important. A January 2007 Report to Congress by the Medicare Payment Advisory Commission (MedPAC) stated that “physicians reorganized their practices to become more efficient and control costs by obtaining lower prices on drugs,” and “all practices made at least some changes to lower their expenses, particularly their drug and staffing costs.”1 In 2006, Onmark, an Oncology Therapeutics Network (OTN) company, conducted the Office-Based Oncology Business Benchmarking Survey, and reported highlights of the results in the Journal of Oncology Practice.2 Recognizing that community-based oncology has a strong desire to monitor and trend the key practice indicators (KPIs) that were established last year, the company conducted the second annual Business Benchmarking Survey in Spring 2007. The oncology-specific business benchmarks contained in this article update these KPIs and also compare the 2007 survey results with those from 2006. Onmark is one of the largest group purchasing organizations in the community-based treatment setting, with more than 2,400 members representing more than 4,000 physicians and more than

Oncology Practice Trends From the National Practice Benchmark, 2005 through 2010

6 billion in annual drug purchases. As with the 2006 survey, Oncology Metrics LLC was commissioned to conduct the survey and report the results to ensure that the identity of the participating oncology practices was kept confidential. To provide comparative results, the operational and financial benchmarks remained essentially the same as last year. One specific addition to this years report is the metric of established patient visits per full-time equivalent (FTE) medical oncologist per year. This was included to help validate physician workload as it relates to new patients per FTE medical oncologist per year. An optional section was also added to the 2007 survey that included questions about staffing and staff compensation. This years report in the Journal of Oncology Practice includes both business operational and financial benchmarks.

National Oncology Practice Benchmark: An Annual Assessment of Financial and Operational Parameters—2010 Report on 2009 Data

In 2011, we made predictions on the basis of data from the National Practice Benchmark (NPB) reports from 2005 through 2010. With the new 2011 data in hand, we have revised last years predictions and projected for the next 3 years. In addition, we make some new predictions that will be tracked in future benchmarking surveys. We also outline a conceptual framework for contemplating these data based on an ecological model of the oncology delivery system. The 2011 NPB data are consistent with last years prediction of a decrease in the operating margins necessary to sustain a community oncology practice. With the new data in, we now predict these reductions to occur more slowly than previously forecast. We note an ease to the squeeze observed in last years trend analysis, which will allow more time for practices to adapt their business models for survival and offer the best of these practices an opportunity to invest earnings into operations to prepare for the inevitable shift away from historic payment methodology for clinical service. This year, survey respondents reported changes in business structure, first measured in the 2010 data, indicating an increase in the percentage of respondents who believe that change is coming soon, but the majority still have confidence in the viability of their existing business structure. Although oncology practices are in for a bumpy ride, things are looking less dire this year for practices participating in our survey.

Essentials of Staff Development and Why You Should Care

Oncology Metrics, a division of Altos Solutions, has been conducting organized surveys of practicing oncologists since 2005. In this article, we present data that represent trends in community oncology practice over a 6-year period, 2005 to 2010, and make projections on the basis of these data. Over the next 3 years, operating margins will continue to decrease, gains in business and clinical operating efficiencies will slow, and labor costs will rise. The cost of drugs provided to patients is also increasing while the amount above cost that is being reimbursed continues a slow decline. The gap between practice costs and practice revenue will continue to narrow, and as this occurs, community oncology practices will find it difficult to maintain their current business models.

The 2007 National Practice Benchmark: Results of a National Survey of Oncology Practices

Amid increases in costs and numbers of patients combined with decreasing or stagnant reimbursements from payers, many oncology practices are improving efficiency and decreasing costs. The National Oncology Practice Benchmark, a national survey of community practices, provides data to help practices improve and monitor progress as they adapt to the changing practice environment.

The National Practice Benchmark for Oncology: 2015 Report for 2014 Data

Physicians may reason that their energy, education, and training should be focused on patient care and research, whereas staff education should be the responsibility of practice managers. But physicians have an important role in staff development.