By Christine MacCracken, MSHEd, BSN, Senior Director, Business Insights
On July 10-11, 2012, the National Comprehensive Cancer Network® (NCCN®) convened a group of stakeholders in Philadelphia for its biannual NCCN Academy for Excellence & Leadership in Oncology™. Attending the conference were representatives from the Pharmaceutical and Biotech industries, policy experts, and payors, as well as patient advocacy organizations. These key stakeholders gathered for a one-and-a-half day session to learn about and discuss key issues impacting oncology. Participants gained knowledge about the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) panel processes, emerging payor initiatives, and innovative collaborations among various stakeholders, as well as some unanticipated but likely impacts on innovation in oncology as a result of the Accountable Care Act (ACA) and its Sunshine Act component.
Day One of the program began with an expert roundtable, “On the Cusp of Healthcare Reform,” moderated by Scott Gottlieb, MD, of the American Enterprise Institute and included Mara G. Bloom, JD, MS, of Massachusetts General Hospital Cancer Center; Jennifer Carlson from The Ohio State University Comprehensive Cancer Center; Alice G. Gosfield, Esq., of Alice G. Gosfield and Associates, P.C.; and Kavita Patel, MD, MSHS, of the Brookings Institution Engelberg Center for Healthcare Reform.
Interpretations of potential risk
Dr. Gottlieb opened the discussion by asking the panel their thoughts on the June 28th US Supreme Court decision to uphold the ACA and the perceived implications. Simply stated—it’s complicated.
Dr. Patel noted that, while the majority of the ACA was upheld, interpretations of the ruling vary. Perhaps the most significant interpretation being the healthcare tax and how states would—or would not—respond to Medicaid expansion.
Depending on the lens through which a state looks, states may be incentivized or de-incentivized to participate in Medicaid expansion, according to analysts. In either case, the path forward for hospitals providing cancer care is paved with uncertainty. This ambiguity is soliciting varied responses from healthcare systems and private practices. In order to maintain revenue streams, these groups are continuing the trend of consolidating their resources and expertise, but the price of doing so is not only fiscal.
Productivity, Ms. Bloom reflected as part of Massachusetts General’s experience, can be impacted, even if temporarily, due to the changes in processes and the new control by the parent hospital. Private practices not accustomed to standard operating procedures associated with large health systems require time to acclimate, said Ms. Bloom. She also cautioned that the process of standard operation is labor intensive and demands constant attention, not only to quality and cost control, but also a mutual commitment to collaboration between the parent hospital and practices.
Vertical integration presents a cadre of concerns, not the least of which is sustaining quality healthcare for patients. All panel members acknowledged that consolidation does not necessarily equate to cost savings, and cost containment may be a zero-sum game said Dr. Patel. The panel members discussed how the fundamentals of the way clinicians practice must change, and that, even after reform, the model remains basically a fee-for-service model driven largely by payors responding to employers’ need to reduce costs. Inevitably, hospitals will be pressured to make reductions in resources, including salary for specialty clinicians, said Ms. Bloom, possibly contributing to a decreasing number of oncologists.
An additional concern discussed by the panel was the challenge of obtaining core grants, which are a pillar of academic medicine and allow for scientific discovery. Notably, research is not addressed by the ACA; however, this does not preclude institutions from uncertainty about how they will continue this important aspect of their missions. If the government fails to invest in academic research, academic medicine and, subsequently, patients will be impacted negatively, said Ms. Carlson.
The Sunshine Act
Financial and research concerns relate not only to how these items will be paid for, but also how they will be reported. “The Sunshine Act: will it cause the perfect storm?” co-presented by Xcenda, was the second panel. Dr. Gottlieb moderated this panel and was joined by John Deno, JD, from Bristol-Myers Squibb; Christian Downs, MHA, JD, of the Association of Community Cancer Centers; Kristine Flemister, PharmD, of Xcenda, LLC; Jerald P. Radich, MD, of the Fred Hutchinson Cancer Research Center; and Kavita Patel, MD, MSHS, of the Brookings Institution Engelberg Center for Healthcare Reform.
Similar to the health insurance mandate, the Sunshine Act portion of the ACA has been intensely debated among industry and the clinical community. It is feared that this Act, which was created to increase transparency to the public, may ultimately stifle innovation. And the lack of clarity may be to blame.
Mr. Downs noted that because the provisions of the Act are unclear, some physicians are taking a highly conservative approach by refusing to participate in activities sponsored by industry, including continuing medical education (CME).
The impact on continuing education for clinicians is not the only concern. Research to advance oncology care is also at risk, especially for rare tumor types; Drs. Radich and Patel reflected on the potential consequences of not participating in such activities noting that, with fewer experts, advances for rare or orphan diseases could be vulnerable due to not only the public misperceptions of why they are receiving funding, but also the administrative burden of reporting.
Note: The remaining panel discussions will be summarized in the August 20th edition of eBulletin.
About NCCN Academy: NCCN Academy for Excellence & Leadership in Oncology™ School of Pharmaceutical & Biotech Business provides pharmaceutical and biotechnology professionals with the significant opportunity to view the oncology space, its future, and its current operational issues from the provider and payor perspectives.
Through this interactive program, attendees learn from key stakeholders what they view to be the most pressing issues in oncology today and how to apply this knowledge to create mutually successful working relationships.