annual cancer center business summit industry survey 2010ccbdgroup.com/survey2010.pdf · summit...
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Annual Cancer Center Business Summit Industry Survey 2010
Ron Barkley, M.S., J.D. US Oncology
Teri U. Guidi, MBA, FAAMA The Oncology Business Institute
With special thanks to Jodi Brunner, Eric Howe
and Chuck Morales of Meetings and Incentives for their survey instrument design and compilations
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Annual Cancer Center Business Summit Industry Survey 2010
Hypothesis: health reform is leading to increased activity among cancer care providers to affiliate, consolidate, integrate. 2010 Survey explored:
• Employment and professional service contracts;
• Sites of service (physician practice or hospital-based);
• Facilities and equipment relationships;
• Staffing & management relationships;
• Information technology (IT) and EMR relationships;
• Forms of clinical integration and associated compensation.
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Respondent Profile
Collaborate Go it Alone
Practices 16 16
Community Hospitals 35 9
Academics 1 2
Other 3 4
SubTotal 55 31
Grand Total 86
64% 36%
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Does Size Matter?
1
9
13
9
0
2
4
6
8
10
12
14
>25 Physicians 13-25
Physicians
2-5 Physicians 6-12
Physicians
Practice Size
3 3
7
18
0
2
4
6
8
10
12
14
16
18
<100 beds >400 beds 100-250 beds 251-400 beds
Hospital Size
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Going it Alone
• A substantially larger proportion of practices intend to “go it alone”
Going it Alone
Practices
52%Hospitals
29%
AMCs
6%
Other
13%
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Reasons to Go it Alone
9
3
8
11
0
2
4
6
8
10
12
Already
Dominate
Bigger is not
Better
No Partners Other
Reasons
Reasons to Go it Alone
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Collaborators Collaborators
Practices
29%
Hospitals
64%
AMCs
2%
Other
5%
• A larger proportion of hospitals report seeking collaborations than practices
9
Oncologists Seeking Management and Physician Affiliations
Oncologists seek management company
Actively Pursuing
11%
Exploring
28%
Current Status
6%
Not Exploring/NA
55%
Oncologists seek affiliation with other physiciansCurrent Status
11%Actively Pursuing
11%
Exploring
21%
Not Exploring/NA
57%
• Over half are not considering affiliation with management companies or with other physicians
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Oncologists Seeking Hospital Affiliations
• Over 70% are currently or actively pursuing affiliation but more than half are not considering employment
Oncologists seek affiliation with hospital/AMC
Current Status
26%
Exploring
16%
Not Exploring/NA
16%
Actively Pursuing
42%
Oncologists seek employment by hospital/AMCCurrent Status
12%
Exploring
24%
Actively Pursuing
12%
Not Exploring/NA
52%
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Who is Billing Infusions?
• Over 2/3 report infusion services in the hospital (with or without the Professional Services) while fewer than half now provide infusion in the office.
Chemo in HOPD +/- in Office
Exploring
15%
Not Exploring/NA
19%
Actively Pursuing
2%Current Status
64%
Chemo in Office
Actively Pursuing
0%
Current Status
44%
Exploring
2%
Not Exploring/NA
54%
12
Who is Billing for Radiation?
• Radiation therapy is provided as a hospital service nearly 3 times as often as it is in a free-standing center
RT in HOPD +/- Professional Fees
Exploring
2%
Not Exploring/NA
25%
Current Status
71%
Actively Pursuing
2%
RT Freestanding, not HOPD
Exploring
6%
Not Exploring/NA
67%
Current Status
27%Actively Pursuing
0%
13
Space and Equipment
• Few joint investments yet but larger proportions lease space or equipment
16%
8%4%
15%
6%
31%
43%
9% 8%
0%
10%
20%
30%
40%
50%
Practice leases
equipment to/from
hospital
Shared ownership/equity
joint venture
Practice leases space
to/from hospital
Space/Equipment Structure Current Status
Actively Pursuing
Exploring
14
Staffing and Management
• Hospitals provide staff to or manage practices in larger proportions than the inverse
37%
6%
13%15%
6%8%
35%
6%
12%
20%
2%
18%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Hospital provides
staff to practice
Practice provides
staff to hospital
Hospital manages
practice
Practice manages
HOPD
Staffing and Management Current Status
Actively Pursuing
Exploring
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Professional Services Agreements
• Many have oncology medical directorships while employment and PSAs exist in nearly identical numbers
69%
2%
13%
31%
6%
16%
29%
10%
20%
0%
10%
20%
30%
40%
50%
60%
70%
Oncologists serve as
medical director
Hospital employs
oncologists
Oncologists provide
professional services
(PSA)
Physician and Professional Services Current Status
Actively Pursuing
Exploring
16
Information Technology
• Scheduling, PACS, etc.
47%
6%8%
42%
8%4%
48%
2% 2%
0%
10%
20%
30%
40%
50%
Mix of practice and hospital's
other IT
Using hospital's other IT Using practice's other IT
Other IT Systems UseCurrent Status
Actively Pursuing
Exploring
17
Electronic Medical Records
• Oncology-specific EMRs are clearly becoming the norm
20%
0%
6%
31%
2%
8%
30%
17%
8%
36%
14%
2%0%
10%
20%
30%
40%
Using hospital's non-
oncology EMR
Mix of practice and
hospital EMR
Using hospital's
oncology EMR
Using practice's
oncology EMR
EMR UseCurrent Status
Actively Pursuing
Exploring
18
Multidisciplinary Clinics • Over 80% have or are exploring multi-disciplinary clinics
• Only 44% compensate or are exploring compensation
22%
8%
12%
8%
39%
27% 27%
57%
0%
10%
20%
30%
40%
50%
60%
Current Status Actively Pursuing Exploring Not Exploring/NA
Multidisciplinary Clinics
Multi-disciplinary Clinics in Use
Compensation for Participation
19
Pathways and Guidelines
• Pathways/Guidelines and measuring adherence are of high interest
• Compensation is however rarely on the radar screen
46%
33%
4%
18%22%
14%
24%24%20%
12%
22%
63%
0%
10%
20%
30%
40%
50%
60%
70%
Current Status Actively Pursuing Exploring Not Exploring/NA
Pathways
Oncology Clinical Pathways in Use
Oncology Pathways Measured/Enforced
Compensation for Adherence
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Measuring Results
• Outcomes and satisfaction measurement is high while compensation is rarely under consideration
54%
71%
10% 10%
4%6%
18%14%
29%
18%
12%
55%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Current Status Actively Pursuing Exploring Not Exploring/NA
Outcome Measures
Clinical Outcomes Measured
Patient Satisfaction Outcomes Measured
Compensation for Outcomes
2010 Summit Survey Observations
• 2/3 of respondents were seeking collaboration versus 1/3 intending to “go it alone;”
• Going it alone because: already dominant; bigger not better; no available partners; reason unspecified;
• Larger proportion of hospitals than physicians seeking collaboration;
• Decline in physician office as site of infusion services;
• Representative sampling of business relationships involving facilities, equipment, staff, IT/EMR;
• Clinical integration (mult-D; pathways; outcomes measures). But little in way of compensation.
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Thank You