Finding Efficiencies in the Oncology Practice


The business of better care.

Oncology providers are all too familiar with the challenge of balancing patient care with practice efficiency. For these physicians and their practices, a number of market conditions have created financial pressures that heighten the impact of this critical, yet complex balancing act. Medicare rate setting has spurred site-of-care shifts, as evidenced by the trend toward higher reimbursement rates for - and greater utilization of - chemotherapy administration in hospital outpatient departments compared to physicians' offices. And though the vast majority of patients are still treated in the community practice setting, more than 11 percent of overall chemotherapy claims volume between 2008 and 2012 shifted from physician offices to hospitals.1 In addition, the Medicare Modernization Act (MMA) effectively resulted in an increased administrative burden for practices in the form of requirements for pre-authorization paperwork and complex coding for reimbursements. And with private payers often following Medicare's lead in setting payments, practices will surely experience tighter margins across the board.031_Practice _Efficiencies _FB_r1

As Accountable Care Organizations (ACOs) and other value-based payment models emerge and scrutiny over standards of care increases, pressure to prove quality care via outcomes grows. It may be said that pay for performance is the new reality when it comes to both Medicare and private payers. Still, the healthcare industry cannot afford to trade quality care for cost efficiency. Focusing on one or the other sacrifices the success of the practice, which means more and more providers are looking at ways to balance the two. And there are three important areas where practices can strike a balance and find efficiency benefits that still allow them to do what they do best - care for their patients.

Staffing considerations
Cost control efforts are leading a number of practices to closely evaluate staffing. And those who do look into appropriate staffing levels may find that slashing headcount is not the answer. In fact, investing in the right non-clinical support - and putting those individuals in the right roles - can improve profitability. When it comes to ensuring effective staffing that helps the practice gain efficiencies without compromising face-to-face patient service, practice leaders should consider a few key questions:

  • Who should be on the team? Does the practice size or volume demand separate roles for human resources, facilities management, payer relations or strategic planning? Practices with more than four physicians on staff may invest in a practice administrator to provide high-level planning and leadership, while smaller practices may only require an office manager to lead day-to-day operations. As complex therapies for treating cancer emerge, oncology practices may also want to consider adding a pharmacist to the staff. As far back as 2006, studies revealed an upward trend in oncology practices hiring both pharmacists and technicians that can order drugs, prepare infusions and make clinical recommendations.2 
  • What duties will non-clinical staff perform? A critical part of determining staffing needs and ensuring efficiency is knowing what functions are business-critical and where the administrative burden can be reduced for physicians. According to a 2009 article in the Association of Community Cancer Centers' Oncology Issues journal, "grouping tasks that do not require face-to-face contact with patients, such as insurance verification and registration, with all back-end functions can improve productivity without compromising the patient experience."3 Depending on the model of centralization, clearly identifying needs and roles can be an effective way for both large and small practices to gain staffing efficiencies. And in such an assessment, practices should also clearly define the processes (verifying insurance, collecting co-pays, etc.) in order to reduce risk and mitigate loss.
  • What functions will be outsourced? Practices have many options when it comes to vendors that can handle billing, coding and other administrative functions. From revenue cycle and practice management to genomic profiling and lab work, vendor partnerships are available and easy to integrate across a number of administrative and clinical areas. These types of partnerships can make financial sense in markets where talent shortages exist and when lack of infrastructure is a challenge.

Better business through data
As oncologists think about who they'll hire, it will be equally essential to consider the needs of the individual roles for access to data and how those needs can be met in more efficient ways. For example, financial counselors within the practice need visibility into treatment economics, while practice administrators require a robust set of data that informs better decision-making and strategic planning. In-house pharmacists and physicians need insight to streamline inventory management and control drug spending. And as new ways of harnessing data emerge, providing the right visibility to the right people is getting easier. Practices should consider integrated technology offerings that help them connect and manage all facets of the treatment workflow. Solutions can range from inventory cabinets to software suites, and GPO contracting has long offered cost efficiencies. Ultimately, leveraging the tools and information available can make for more efficient decision-making and, as a result, more time for patient care.

Patient and administrative support programs
When thinking of the needs of both patients and the practice, oncologists should also consider ways to reach across the healthcare continuum to improve efficiencies and care. This will be particularly critical when it comes to ensuring treatment effectiveness and enhancing the level of care provided to patients. The support programs offered by most drug manufacturers provide education and assistance that make the provider's treatment decisions more effective while improving speed to therapy and medication adherence. While these types of programs vary, they can include co-pay assistance for patients and even reimbursement support to help staff overcome coding and billing challenges that impact revenue and outcomes.

Better care through better business
More efficient business practices can certainly mean better care. Improving the health of practice operations allows physicians to focus on improving the health of patients. And as stakeholders within practices - and external influencers on the manufacturer side -continue to recognize each other's needs, the solutions available for operating more efficiently continually improve. Simply put, the way practices operate is as influential on patient lives as ever.


1 Vandervelde, A., Miller, H., & Younts, J. (2014, June). Impact on Medicare Payments of Shift in Site of Care for Chemotherapy Administration. Retrieved February 12, 2015, from
2 Thompson, C. A. (2006, October 1). Oncology Practices Recruit Pharmacists for Efficiency, Savings. Retrieved February 12, 2015, from
3 Pilley, K. P., & Mathis, T. (2009). Staffing an Oncology Practice: Art or Science? Oncology Issues, (November/December 2009), 31-33. Retrieved February 12, 2015, from

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