Drug Costs -- The No. 1 Challenge in Cancer Care

Roxanne Nelson, BSN, RN

January 11, 2017

The cost of drugs is the most pressing concern for cancer care practices, according to a new survey from the Association of Community Cancer Centers (ACCC).

In this year's survey, 83% of respondents identified drug costs as their primary concern, which was nearly twice that (45%) from last year's survey.

"While the cost of cancer drugs is a top challenge for healthcare providers, more than half the survey respondents said they are helping patients reduce costs by tracking the use and frequency of high-cost medications (56%), and almost half (48%) are developing best practices related to using lower-cost medications," ACCC President Jennie R. Crews, MD, MMM, FACP, told Medscape Medical News.

There were also a number of other changes from the 2015 survey, including what respondents considered to be the top five challenges and concerns.

Both this year and last, two thirds of respondents reported that the reimbursement of non-revenue-producing services that improve patient care is a critical issue. These services include patient navigation, survivorship care planning, and financial counseling and are key elements of patient-centered care, the ACCC comments.

"The lack of reimbursement for supportive care services remains a top challenge to cancer programs, but it has not deterred providers from incurring costs, such as nonreimbursable positions," Dr Crews said. "Eighty percent of survey respondents said they incur these costs to ensure quality, patient-centered care."

The third top concern for this year was the need for increased transparency in commercial insurance policies so that patients can readily understand what service plans do and do not cover (65%).

The last two top challenges identified this year were the need for physicians and midlevel providers to focus on direct patient care and not paperwork (55%). Roughly the same percentage (53%) felt there was a need for increased funding for cancer research and clinical trials.

In the 2015 survey, respondents reported that their top five challenges were the lack of reimbursement for supportive care services (65%), budget restrictions (61%), marketplace competition (49%), ability to meet multiple accreditation requirements (46%), and the cost of drugs (45%).

Multidisciplinary Cancer Care Team

The ACCC is an advocacy and education organization for the multidisciplinary cancer care team. It is affiliated with more than 23,000 cancer care professionals from more than 2500 hospitals and practices nationwide. Members include medical and radiation oncologists, surgeons, cancer program administrators and medical directors, senior hospital executives, practice managers, pharmacists, oncology nurses, radiation therapists, social workers, and cancer program data managers.

The 166 respondents of the survey represent a range of individuals from different disciplines: 48% were administrators, 29% were nurses, 17% were pharmacists, and 6% were medical directors.

Impact of New Programs

When administrators were asked about the potential impact of Medicare's site-neutral payment policy, 61% felt that "the negative impact on our hospital-based program's bottom line will make it even more challenging to meet burdensome regulations, reporting, and accreditation requirements."

In addition, 44% believed that "if this policy were to affect the 340B Drug Pricing Program, it would have a negative impact on the hospital," and 42% said that the negative impact could result in cuts to supportive care services and other low- or nonreimbursed services.

As for the impact by new care delivery models, more than half of the administrators and medical directors said that they are partnering with primary care providers on outreach, screening, and prevention efforts, as well as working with primary care providers to streamline referral processes.

Financial Assistance

As cancer care becomes increasingly costly, and despite studies that have found that patients would like to know the cost of their treatment, only 39% of respondents reported that financial advocates meet with all patients to discuss insurance options and cost of care. A quarter of programs reported that financial advocates provide all patients with an estimate of care costs.

In the 2015 survey, more than half of programs (53%) did not provide an estimate of total treatment costs, including the patient's responsibility, before beginning therapy.

"Last year's survey found that many providers did not offer the financial education patients want to make fully informed treatment decisions," said Dr Crews. "A positive trend we found from the 2016 survey is that more than half the respondents have added or plan to add financial advocacy services."

She added that through its Financial Advocacy Network, the ACCC is doing its part to help expand the knowledge and capabilities of providers by offering tools and resources, such as the 2016 Patient Assistance and Reimbursement Guide and the new Patient Assistance App. "This mobile device app gives financial advocates easy access to payment assistance and reimbursement programs," said Dr Crews.

IT Challenges

Although technology in healthcare is ever increasing, many cancer programs continue to report challenges to implementation.

The number one challenge cited by 75% of respondents was that prior authorizations remain labor and time intensive. Second, cited by more than two thirds (68%), was getting electronic health records (EHRs) to "talk to each other" and integrate data.

The third challenge reported (58%) was in accessing data to monitor quality metrics, support market share analysis, and meet regulatory and accreditation requirements.

"I am surprised by how little support we get from EHR companies.... None of the EHRs talk to each other," commented one medical oncologist.

Reducing Costs

The cancer care programs surveyed are actively taking steps to reduce costs. Administrators and medical directors who responded to this issue reported that they are engaging in LEAN initiatives focused on streamlining processes and improving quality of care (62%), as well as working with physicians to reduce unnecessary hospitalizations (60%).

More than half (57%) said that they were adding services, such as oncology rehabilitation, nurse call centers for symptom management, and nurse practitioner–based survivorship care, and that they were tracking the frequency and use of high-cost medications (56%).

One respondent noted that they "stay on formulary as much as possible. Keep less effective drugs off formulary. Use our financial counselors and pharmacists to help reduce patient cost."

Oral Oncolytics

As oral drugs become more common in cancer care, there is a need to effectively monitor patient adherence and adverse events, as well as educate patients about their use.

Last year's survey found that only half of cancer programs (53%) had compliance programs related to oral oncolytics, but that was up from 34% in the 2014 survey.

This year, 86% reported that patients are monitored for adherence and toxicity through scheduled follow-up visits, 59% reported that patients are asked targeted questions at each visit, and 52% schedule outbound telephone calls.

In addition, two thirds reported that patients receive printed education materials, which include safe handling procedures and information on the importance of adherence, and 58% said that a nurse provides education.

About half of cancer care programs track when a prescription for an oral medication is first filled — and 42% track refills.

The ACCC has used the data drawn from its 2016 survey to help shape the agenda for its upcoming 43rd annual meeting, CANCERSCAPE, which will be held in March.

ACCC. 2016 Trends in Cancer Programs. Full text


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