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.
The Medicare Modernization Act of 2003 1 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.
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.
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 year's 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 year's 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 year's 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.
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