Cost of Treatments Tops Survey of Oncologists' Concerns

Jennie Crews, MD

Concern over the cost of cancer drugs nearly doubled among oncology professionals from 2015 to 2016, jumping from 45% to 83%, according to the annual Trends in Cancer Programs survey administered by the Association of Community Cancer Centers (ACCC). The annual survey, taken by practice administrators (48%), nurses (29%), medical directors (6%), and pharmacists (17%), focuses on challenges and trends in oncology practice. Representatives of 166 cancer programs responded, or 24% of ACCC membership.

Although they have concerns about the cost of cancer care drugs, oncology professionals said other major issues include obtaining reimbursement for nonrevenue producing services that improve patient care (66%). They said they want more transparency in commercial policies so patients know exactly what plans do and do not cover (65%), and they said there is a need for physicians and midlevel providers to be able to focus more on direct patient care and less on paperwork (55%). They said they would also like to see increased funding for cancer research and clinical trials (53%).

One practice administrator quoted anonymously in the survey results said that his clinic had gone so far as to create a “cost transparency group” to help provide education and assistance to patients who have been prescribed high-cost chemotherapies or immunotherapies. Other comments attached to the survey indicated that respondents feel that payers should improve provider access to decision makers (officials who can give clearance for payment) so that drug approval red tape can be reduced.

Commenting on the rising concern about drug costs, ACCC president Jennie Crews, MD, said that several coping initiatives can be identified within the practice community. “One of the ways practices are responding is by hiring and training social workers or financial advocates to meet with patients and try to help with co-pay assistance and insurance coverage assessment. Additionally, there’s a lot of time spent, whether that’s through nurses or authorization experts, to try to make sure that the desired treatment is going to be covered for the patient.”

Crews also said that physicians are having to think more carefully about the costs of drugs they prescribe. Practices are also trying to become better educated about the cost of medication because this is not something many of the providers—physicians, in particular—have really been exposed to in the past.” When it comes to reimbursement for supportive care services, professionals would like to see more funding for patient navigation, survivorship care planning, and financial counseling. These are key to the success of patient-centered care and can significantly ease many of the difficulties of the cancer treatment process, Crews said. Without these programs, the quality of care is lower. “This is a huge challenge,” Crews said.

“While ACCC member cancer programs have made great strides in advancing patient-centered care, it’s clear that payer policies are lagging behind,” Crews said. “Reimbursement for these services is especially critical as we transition to new models of cancer care delivery, such as the Oncology Care Model (OCM) and the Merit-based Incentive Payment System.”

Whereas practices often struggle to provide funds for these services, many of the ACCC’s members have enrolled in the OCM from CMS, which includes supplementary per-patient payments that are intended to cover extras such as improved patient navigation, Crews said. “When you see an eligible patient, you have this payment to help cover coordination of care and some of these other services.”

Despite these initiatives to put the patient at the center of care, only 39% of respondents said financial advocates meet with all patients to discuss insurance options and cost of care, making this an issue that still needs to be addressed. Survey respondents said other types of financial assistance were being offered more broadly, such as access to pharmaceutical drug replacement programs (77%), social workers who render some financial assistance services (73%), and financial advocates or counselors (64%). Practices also offer assistance with transportation costs and gas cards (59%) and connect patients with philanthropic foundations that offer patient assistance (49%).

Although clinics would like to give their patients more attention, physicians are spending more time entering data in the electronic health record, which prevents them from connecting with their patients and providing the best care, according to the survey. “The current environment that we live in has a lot of electronic paperwork,” Crews said. “Much of it is focused on either meeting governmental requirements or meeting a proof of coding level. Some of it is not really pertinent to direct patient care. Some practices have done work with scribes or others who can off load some of that busy work that providers have to do, leaving more time for higher-level decision making by the physician.” By shedding light on important issues in cancer care nationwide, the annual ACCC Trends in Cancer Programs survey gives oncology- related services an opportunity to improve their systems. “I think it’s a great benchmark to see where your practice is compared to other practices,” Crews said. “I think it can be an indicator where resources need to be deployed. It’s somewhat of a tool that reassures people and lets them know they’re not alone. There are a lot of other folks struggling with the same issues. It also can be a great tool to identify where the practice needs are and to dive deeper into resources that the ACCC has available to help.” Survey respondents said they participate broadly in ACCC Member Cancer Programs, which provide multiple methods to reduce cost while maintaining quality care, such as initiatives to streamline processes and improve quality of care (62%), programs to decrease unnecessary hospitalizations (60%), and services such as oncology rehabilitation, nurse call centers for symptom management, and nurse practitioner-based survivorship care (57%).

Members also participate in a program to track the frequency and use of high-cost medications (56%).

The ACCC said it will use the survey results to inform discussion at its CANCERSCAPE annual meeting in Washington, DC, March 29 to 31. “I think there are some pieces of this survey that will be incorporated into some of the discussion that happens,” Crews said. “Part of what we’re going to hear about at Cancerscape is what might the change in [White House] administration mean for oncology care in the future. We’re going to have experts come in to address that. A lot of the concerns brought up in the Trends survey could be inf luenced by the new administration and by Congress and whatever actions they take regarding the Affordable Care Act. I think this survey will be beneficial in identifying concerns that individuals can take to their legislators.” Crews said she is a believer that the trend toward value-based care will solve some of the problems that practitioners are encountering; whereas, others may take longer to resolve. “I think there is going to be a slow fix to some of these problems, but I do feel confident that we’re going to see some improvement if not complete resolution with some of these issues, especially through the efforts of our members who have gone into value-based practice,” Crews said. “They can share their knowledge with us. I feel positive about the future. None of these things are insurmountable.”

Association of Community Cancer Centers. Trends in Cancer Programs 2016. https://accc-cancer.org/surveys/pdf/Trends-in-Cancer- Programs-2016.pdf. Published January 5, 2016. Accessed January 5, 2016.