Oncology, more than most areas of medicine, relies on the trial-and-error method of experimentation to develop treatments. There isnt one regimen, procedure or drug that will solve the host of problems that cancer creates. In a similar way, the trial-and-error process seems to be an effective approach for healthcare providers looking for ways to maintain strong cancer-center programs, with outsourcing these services as one option.
As Norfolk, Va.-based medical oncologist Edward George explains, there are two countercurrents in the oncology-services segment today. The first is the exciting surge of new technologies and therapies that have helped boost cancer survival rates by nearly 25% in the past 20 years, according to figures from the American Cancer Society. Just last week, the society reported that the U.S. cancer death rate, which has been dropping slowly since 1993, has fallen more significantly in recent years. While previous studies showed cancer death rates decreasing by an average of 1.1% a year from 1993 to 2002, that figure nearly doubled to 2.1% for the years 2002 through 2004. The cancer society credited prevention efforts, new screening methods and wider use of early detection for the drop.
At the same time, working against the stream of advancements to battle cancer is pressurefrom Medicare and private payers aliketo constrict application of the new treatments to contain costs, George says. For 2006, the National Institutes of Health estimated the nations total cost related to cancer to be $263.3 billion. And much of these services are provided in outpatient settings, as there were some 2.5 million hospital outpatient visits for cancer services in 2004, according to the federal National Center for Health Statistics.
Consequently, cancer programs, in whatever form they take, will have to adapt to the latest trends in oncology care if they hope to remain viable, says Kathleen McCarthy, a principal in the Clifton Park, N.Y., office of Health Strategies & Solutions, a Philadelphia-based healthcare management consulting firm. The firm assists in medical staff development and planning in the areas of business and finance, clinical programs, ambulatory care and facilities/space programming.
As McCarthy explains, first generation cancer programs 10 to 15 years ago brought together a variety of services that included chemotherapy and radiation therapy. Today, McCarthy says these centers have evolved into second generation programs that now face increased competition in an environment that has continued pressure on reimbursement rates in the face of increased costs related to, among other things, labor and acquiring new technology.
Earlier this year, McCarthy wrote an article in her firms monthly newsletter that identified the following four growth strategies for cancer-center programs: a disciplined approach to investing in technology; tumor-site-specific disease management; convenient, accessible, one-stop shopping for cancer services; and physician-hospital alignment.
The last two areas already exist in a variety of oncology-service models, including free-standing cancer centers by for-profit companies, hospitals that lease space to renowned institutions such as New Yorks Memorial Sloan-Kettering Cancer Center, and joint ventures that align medical oncologists with both hospitals and larger companies such as Houston-based US Oncology or smaller ones, such as Aptium Oncology in Los Angeles.
It depends on what your goal is as the party looking to outsource, McCarthy says. One benefit could be the ability to provide access to specialized care. The other main driver is to increase efficiency. To the extent that you have a core competency in a particular clinical area, you can be more efficient.
But outsourcing services doesnt mean outsourcing accountability, according to Leonard Lamkin, executive director of the Chicago Patient Safety Forum, a group that works to improve patient safety in the Chicago metropolitan area.
If I go to a hospital, the hospital is ultimately responsible, Lamkin says. Its still the question of: If something happens, and the patient or family wants questions answered, where do they go to? for their patient safety and quality concerns.