State of Cancer Care in America

Dr. Blase Polite discusses the latest State of Cancer Care in America report, and the opportunities and challenges confronting the cancer care community.
Read the related article "The State of Oncology Practice in America, 2018: Results of the ASCO Practice Census Survey" on JOP

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Welcome back everyone to the ASCO Journal of Oncology Practice podcast. This is Dr. Nate Pennell, medical oncologist at the Cleveland Clinic and consulting editor for the JOP. It's that time of year again, when ASCO releases their annual report titled The State of Cancer Care in America, which has a goal of increasing awareness among policymakers and the larger cancer community about opportunities and challenges in the delivery of cancer care for the United States. The 2017 version is being released this month, and is always one of the most popular manuscripts and, to be honest, one of the most popular podcasts we do here at the JOP.
Joining me today is Dr. Blase Polite, associate professor of medicine and deputy section chief for clinical operations, as well as the executive medical director for cancer accountable care at the University of Chicago. Dr. Polite is a past chair of both the ASCO cost of cancer task force and the government relations committee, as well as being a fellow of ASCO. Today we'll be discussing the State of Oncology Practice in America, 2017, Results of the American Society of Clinical Oncology Practice Census Survey. Dr. Polite, thanks for joining me.
Nathan, good morning. It's great to be on with you again.
So why don't we start out just by talking a little bit about the background and the purpose of this annual State of Cancer Care in America report. How does ASCO get this data, and really what's the intended purpose?
So we're very excited this year. There's actually been a change to the way we do things. So in addition to the standard survey that we send out the practices, we've also been able through the work of our excellent team at ASCO to use something called the physician compare website and database from the Center for Medicare and Medicaid Services, CMS, that allows us for the first time to really get a sense of the true number of oncologists practicing across the United States, where they're located, how big their practices are, et cetera. So now we have two sets of data, one that gives us a nice sense of the geography of the total census of care of practices, and then our more detailed in-depth look of our survey practices.
And you know, this is really one of the most important things for those of us who work at the ASCO level, because this gives us a true pulse of what's going on out there, what are the market trends, and really, most importantly, what is it that is bothering practices on a day to day basis that we at ASCO then can try to figure out from a policy standpoint, can we work to make things better?
So one of the things that the State of Cancer Care in America always does is look at sort of the demographics and the makeup of the different practices. And have there been any significant changes this year? And is this something that is part of a trend, or anything that surprised you?
Well, the one thing that we continue to see, and we've gone back to 2013 and we've looked at the numbers of the-- using the physician compare, where we really get a sense of all of the oncology practices out there, is we're starting to see more and more consolidation. And specifically what I mean by that is we continue to see more oncologists every year, but a fewer number of total practices. So again, we're beginning to see more practices consolidate into larger groups. Not surprising, given the economic pressures and everything else that we see. But that that's probably a more consistent trend that we're seeing over the years.
Well, that certainly makes sense, I think, with the payer issues. And that kind of brings us to our next part here. One of the main purposes of this is for oncology practices to be able to list their top sources of pressure and concerns. So can you talk a little bit about what the concerns of the oncology practices were for 2017?
Yeah. So we were able to look at concerns within the census, both at an overall level, and then we're able to look at it specifically by how we break up the practices, which are academic, hospital, or health system owned, and physician owned. And what shop really to the top this year and wasn't really even a contest, was payer pressures. So this is the one thing that people are screaming from the rooftops, 70% of practices were physician owned, and really over half of other practices are saying that payer pressures are the biggest thing.
And then when we do payer pressures, we ask practices specifically what do they mean by payer pressures. And again here you look at the three things. They all kind of follow the same thing. The number one is prior authorization. Number two is coverage denials and having to do appeals, and number three is these peer to peer requests from medical directors. So these are the things that are bothering every single practice out there, and is really rising to the top.
In fact, we also then ask, well tell us about the resources you put forward in order to deal with the prior authorization. And we find on average practices have six full time equivalents dedicated just to doing prior authorizations. And we have one practice that has over 100 people dedicated to doing that. I know at the University of Chicago we have a dedicated group of about 30 to 35 whose only job is to deal with prior authorizations. So this is one of those things that I think we all feel. It frustrates everybody, and it's clearly something that will become a major focus for ASCO to figure out how can we find a better system.
I know that certainly resonates with me, and I'm sure all of our listeners. This is not going to be a surprise to them. We also have a, I'm sure, a fairly large group that does this at the Cleveland Clinic, but even the prior auths and peer to peer requests that make it through that layer are incredibly disruptive. I find it hard to imagine how individual practices that can't afford to hire people are dealing with this. And I guess that probably feeds into this consolidation that you are seeing.
Yeah, absolutely. I mean, I think that's a major part of it. And so one of the things I want to highlight is we are beginning this year with trying to turn the State of Cancer Care in America into a living sort of document, and what I mean by that is instead of just the once a year publication, within the Journal of Oncology Practice we are now going to have a state of oncology care series, and that will be both invited commentaries specifically addressing the things that our members are telling us are a problem, as well as looking for original research that we think answers and helps provide actual data to support some of the things that concern us.
And so it won't be a surprise to anybody that one of the first things coming out of the gate is going to be the issue of prior authorization. And what we've done there is we've invited Mike Colosia, who used to run the oncology business Aetna, and Lee Newcomer, who was recently retired from United Health, both very good friends of ASCO, both very, very thoughtful, as well as we're going to have a commentary on the physician side to really go at this question of why do they do it? What are some of the alternatives to it?
Because I think what you find when you get into these discussions is nobody likes prior authorizations. Insurance companies do it because they feel that there are times where we are doing things that are not supported by the evidence, and it clearly has some money saving to them. But if you really push them, they don't like the fact …