MACRA looms large in community oncologists’ practice perspectives


New Cardinal Health survey sees the profession adjusting to value-based care

A second annual “Oncology Insights” report from Cardinal Health Specialty Solutions includes a survey of some top-of-mind issues among community oncologists, who remain a vital part of how oncology is managed in the US health system. The key takeaways are: a continuing adjustment to the requirements of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), which included a shift from fee-for-service reimbursement to a version of value-based care; and an expanded reliance on so-called Advanced Practice Providers (APPs), primarily nurse practitioners and physician assistants. This, in turn, highlights something that pharma marketers to oncology practices should already know: that NPs and PAs can be a critical part of how their products are perceived and administered.

For MACRA, Cardinal Health notes that 24% of practices now have “the resources and staffing in place to manage this change,” compared to 10% in 2017, although 24% (a slight reduction from 2017) also say “we are unsure of how we will manage our strategy.” A notable change from 2017 is that only 3% say that their practice is “seeking a merger with a larger entity;” that figure was 16% in 2017 (and presumably some of those have subsequently merged their practice). From other survey results, notes Bruce Feinberg, Cardinal chief medical officer, “We know changing reimbursement and payment models continue to be one of the top stress factors for many participating oncologists.”

For APPs, the survey finds that 74% of oncologists already employ APPs, usually nurse practitioners, and that 57% of respondents expect to hire more over the next 3 years. (A related statistic cited in the report is that the patient load of oncologists has grown from 235 in 2003 to 358 in 2015). APP duties are evolving: while 62% of oncologists say their APPs only see returning patients, 36% say the APPs see both new and returning patients. As much as 83% of APPs are involved in patient education, and 61% make supportive care decisions.

The Cardinal survey is available for download here.

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