Genentech Survey: Many Practices Unprepared for USP

In 2016, just a quarter of oncology practices considered themselves prepared for upcoming US Pharmacopeia (USP) <800> standards on hazardous drug management, according to the 2017 Genentech Oncology Trend Report, which surveyed 201 oncology practice managers (OPMs) from community, hospital, and academic settings.

The survey said many other practices were taking a wait-and-see stance or working with consultants to design and implement the costly changes in building layout and air-flow technology that would make their practices safer for clinical staff and patients.

The report also said medical scribe use to help with electronic health record (EHR) maintenance and other administrative tasks had reached 40% of practices and was helping to improve oncologist job satisfaction. EHR tasks have been blamed for high stress levels and burnout among oncologists and are considered a factor in the difficulty of getting young medical school graduates interested in a career in oncology.

In tandem with this finding, the report said use of advanced practice providers is spreading, although recruitment of these professionals is difficult and competitive.

Many practices are increasing their daily and weekly hours to improve convenience for patients, the report added.

Half of OPMs surveyed by Genentech said they are considering changes in collection policies because of the high number of patients with high-deductible policies. OPMs said drug copayments are successfully collected from only 25% of patients. They identified patient out-of-pocket costs as one of the most pressing cancer care challenges in 2016.

Genentech conducted the survey of OPMs as part of a broader examination of perspectives in oncology that included responses from managed care organizations, specialty pharmacies, oncologists, and employers. The results shed light on the impact of current trends on oncology practice and illustrate the stresses that practices are facing as well as the methods they are employing to cope.

In the study, conducted from late July to mid-October 2016, Genentech said 40% of OPMs reported using medical scribes to assist with data collection and recording efforts. OPMs’ use of medical scribes to assume a portion of practice burden contributed to improvements in oncologists’ job satisfaction (55%) and overall productivity (53%) during clinic days. Respondents to these questions included 30 OPMs from community-based practices. Genentech reported that 10% of OPMs across all practice settings said they had tried medical scribes in the past and abandoned the idea.

The pharmaceutical company reported that 127 OPMs surveyed (63%) employed advanced practice providers (APPs) in 2016, and one-third of OPMs reported having difficulty recruiting or retaining APPs. The report said that hiring nurses, APPs, and staff to process prior authorizations was a foremost objective for many OPMs who are planning to expand staff in 2017.

APPs were being used for in-person patient encounters, care coordination, EHR maintenance, telephone triage with patients on clinical issues, and e-mail with patients on clinical issues.

One half of OPMs anticipated that staff time for processing precertifications and prior authorizations would increase by the end of 2016 compared with 2015.

In responses to questions about efforts to improve patient access and patient-centered care, 21% of OPMs said they worked at practices that offered weekday hours after 6 PM, whereas 19% of practices were open 6 or 7 days weekly. Thirty-nine percent of OPMs expanded weekly hours in 2016. The report said 50% of OPMs surveyed had undertaken to hire or assign staff for proactive patient contact at different points of care to avoid complications, emergency department visits, and hospitalizations in 2016 or planned to in 2017.

Most of the OPMs (84%) said they had electronic health record systems and offered patient portals. Many integrated secure e-mails, text messaging, tablet devices, and smartphones into operations in 2016 or planned to in 2017.

At the time the survey was conducted, revenue growth expectations for 2016 were strongest among hospital-based practices (90%), followed by academic/medical center based practices (72%), and lastly community based practices (53%).

The report said practices found it challenging to participate in the Oncology Care Model (OCM), CMS’ experiment with value-based care. Among the OPMs surveyed, 62 (31%) said their practices were participating in the OCM, but 42 said their practices had applied and either were not accepted or withdrew because of the requirements.

The degree of understanding of CMS’ new reform initiatives under the Medicare Access and CHIP Reauthorization Act (MACRA) was apparent from the responses given by practice managers. Asked to rate the quality of their understanding of performance incentive and advance payment model components of the program, 35% said they had a good understanding, 22% rated their understanding very good, and 5% defined their understanding as excellent. The other responses were unsure, 10%; fair, 21%; and poor, 7%.

In preparation for the performance incentive program, called the Merit-based Incentive Payment System, the OPMs said they were participating in EHR use (48%); participating in CMS’s Physician Quality Reporting System, a healthcare quality improvement program (34%); attending seminars (28%); and working with consultants to understand the financial impact (23%).

The survey said 159 OPMs or (79%) said their practices were implementing or considering reorganizational strategies to improve financial performance. Care coordination improvement was identified as a key driver of reorganization efforts. The survey said 54% of respondents from community based practices (n = 91) were working to join other practices or considering it, 44% were eyeing hospital integration, 29% were considering selling their b to a hospital, and 54% and 42% were on track to participate in an accountable care organization or oncology medical home, respectively.

Among 91 respondents from community practices, 41% said they employed care navigators and 27% used hospital-employed navigators.

Noting that community based practices are more likely to experience declining drug payment margins compared with other settings, Genentech said the survey found that OMPs were trying to offset those reductions by reducing drug waste, increasing group purchasing organization contracts, using specialty pharmacy for drugs with lower margins, negotiating higher drug reimbursement and administration fees with private payers, and dispensing oral drugs in-house and expanding in-practice dispensing to include injectable and infused drugs.

Whereas only a quarter of respondents to the survey said their practices already were compliant with pending USP <800> standards for hazardous drug handling, the remainder were doing nothing to prepare, waiting to see how their local state boards would rule on the guidelines, learning about the pending standards, or working with consultants to calculate costs of compliance and renovate their facilities.

Genentech. The 2017 genentech oncology trend report. genentech-forum.com/content/dam/gene/managedcare/forum/pdfs/Oncology-Trends/2017_Genentech_Oncology_Trend_Report.pdf. Published July 2017. Accessed July 10, 2017.