Community cancer centers weather rough economy

ABSTRACT: Early survey results from the Association of Community Cancer Centers indicate that practices are scaling back in some areas but also that their overall financial outlook is healthy.

BALTIMORE-In spite of the continually slumping economy, the majority of U.S. cancer centers report that they are on firm financial ground, according to a survey by the Association of Community Cancer Centers.

The recent ACCC survey of member cancer programs provided insight into trends in ambulatory care, effects of the recession, and organizational strategies that may help the cancer care team adapt to changes in the healthcare marketplace, said Christian Downs, JD, ACCC executive director.

Lee Blansett, MBA, offered highlights from the survey results at the 2010 ACCC meeting. Mr. Blansett is a senior vice president at Kantar Health, a consulting firm based in Foster City, Calif. The survey was conducted from September to October 2009 and is designed to provide the association with information about its advocacy mission and to help member organizations understand national developments in the business of cancer care, Mr. Blansett said.

Of the 84 ACCC members that responded, either online or by telephone, to the survey, the majority classified themselves as not-for-profit institutions that provided both inpatient and outpatient services (see Table on page 14). The survey is a joint project between ACCC and Eli Lilly and will be conducted annually for three years. Final results of the 2009 survey will be released in July 2010.

Overall, Mr. Blansett reported that despite some hardships-some projects are being delayed and the financial needs of cancer patients are rising-things are not as gloomy as many in the industry had predicted.

The bad goods and the bad news

A recent report from the Medical Group Management Association showed that new physicians are giving up on private practices and taking salaried jobs at hospitals and healthcare networks. In cancer care, a growing number of oncologists are relocating to hospital-based practices and/or are referring Medicare and Medicaid patients to hospital practices. As a result, 52% of community oncologists saw a decrease in patient volume vs 14% in 2008.

The ACCC survey results showed that more programs are freezing or scaling back 2010 purchase plans for equipment, including linear accelerators, ultrasound machines, CT and MR scanners, and PET or PET/CT machines. Moreover, 60% of those responding said that they are delaying construction projects and have implemented a hiring freeze. Hospital-based cancer programs are experiencing the same belt tightening.

Finally, more cancer patients require financial assistance such as underwriting of the cost of medication and insurance copayments. Seventy-three percent of the survey respondents reported an increase in the number of uninsured or underinsured patients for whom they provide chemotherapy infusions.

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Nevertheless, 78% of the respondents characterized their cancer programs' financial status as good or very good, with only 7% deeming their financial health as poor. While this is a noteworthy drop since the 2008 survey results, when 90% reported good or very good financial status, respondents still reported that they felt they were competing successfully with other cancer care programs in their markets (community-, hospital-, and university-based), with an average market share of 43%.

Part of the reason for this sense of well-being is that community practices are consolidating, with 17% of respondents saying that they were considering a joint venture with a hospital, and almost half considering diversifying their practices by adding therapeutic radiation and other technology to increase revenue.

Mr. Blansett pointed out that the breakdown of ownership of hospital-affiliated programs is clear: Hospitals have the vast majority (92% on average) of square footage and number of chairs in infusion centers, although alternatives exist in most communities. But a downside for patients is that these infusion centers are open only during weekdays and standard business hours. As a result, Mr. Blansett encouraged providers to consider expanding the infusion center hours to offer chemotherapy services on weekends.

In terms of oral medications, 24% said that they dispensed oral agents at the infusion center, which is only a 3% increase from 2008 survey results. Mr. Blansett said that this figure will probably increase as more oral agents become available and as patients request them because of their greater convenience. However, he added that oral agents will most likely be dispensed by hospital pharmacies. Because most nonhospital infusion centers don't have retail pharmacies, it remains to be seen how community cancer centers will devise a way to provide access to oral chemotherapy, he said.

Finally, in terms of technology, the use of electronic medical records (EMR) has gone up, although they are universally available in community cancer centers. Of the programs with EMR, 54% reported using more than one type of software.