Oncologists’ Perceptions of the ACA’s Impact and Expectations for 2015

Oncologists’ Perceptions of the ACA’s Impact and Expectations for 2015

Fielded November 3-5, 2014

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Microsyndicated Report:

© 2014 InCrowd Inc.NOT FOR EXTERNAL DISTRIBUTION

Methodology – Five Question Microsurvey

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Objective:

– To better understand oncologists’ perceptions of the impact of the Affordable Care Act (ACA) on their practice and investigate expectations regarding new cancer treatments, pathways, and reimbursements for 2015.

Primary Takeaway:

– Early results show oncologists are generally concerned with the implementation of the ACA adversely effecting their patients and practice, however the full implications have yet to be realized.

Methodology:– Data collected via InCrowd’s microresearch application from November 3rd to 5th 2014

– Sample of 100 oncologists from across the US that:

• Are board certified and licensed in the US, treating between 100 and 500 patients per month, and have been practicing medicine for between 3 and 25 years

• Are primarily treating breast, lung, prostate, or colon cancer patients

• Reported their practice has already been or will be impacted by the ACA in 2015


Key Findings

ACA Impact: Nearly two-thirds (64%) of oncologists who entered the survey have already been impacted by the ACA, while one-fifth (21%) expect it will impact their practice in 2015; 15% report that their practice has not been impacted by the ACA and don’t expect the law to impact their practice over the next year.

Over one-fifth (22%) of oncologists cite decreasing income and reimbursements as the most prevalent effect of the ACA on their practice so far.

While 19% of oncologists also mention a general shift among patients into insurance plans with narrower networks, limited coverage, or Medicaid.

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2015 Pipeline Expectations: New immunotherapies and targeted biologics, including PD-1/PD-L1 inhibitors, are their most anticipated treatment developments for 2015.

2015 Oncology Pathways Expectations: Oncologists are generally apprehensive about treatment pathways, with about a quarter expressing concern that pathways will ultimately limit their treatment autonomy to the detriment of their patients’.

Some oncologists also worry that pathways may have a negative impact on personalized or precision medicine and will pressure cancer patients to pursue less expensive and less effective treatments.


Key Findings - Continued

2015 Reimbursement Challenges: About 4 out of 10 oncologists believe reimbursements and income will (continue to) decline over 2015.

While nearly a fifth of oncologists anticipate no new major challenges regarding reimbursements in 2015.

Concerns over pathway-related penalties and smaller margins on chemotherapy (and other drugs) are other reimbursement-related concerns.

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ACA-Related Effects: Approximately 7 out of 10 oncologists agree that the ACA has resulted in more paperwork and a greater regulatory burden for their practice, has caused concern about the end of the 2014 enhanced Medicaid reimbursement rates, and has driven more cancer patients to avoid or defer needed treatment due to increases in patient cost burdens.

Oncologists are largely divided on the effectiveness of bundled payments, or episode-based payments, as a means of improving the quality of healthcare delivered, controlling costs by incentivizing coordinated care, and making their practice more financially viable.

Oncologists operating within a private practice are less likely than those operating within health systems to agree that their patient load has increased or that bundled payments or covered clinical trials are beneficial to their practices and patients.


Nearly two-thirds of all oncologists who entered the survey have already been impacted by the ACA, while one-fifth expect it will impact their practice in 2015

S1: In your opinion, how much of an impact has the Affordable Care Act (ACA) had on your practice, if any at all? 5n=118

Impact of the ACA on Oncologists

14%

22%

28%

21%

15%

A great deal of impact

Somewhat of an impact

A little bit of an impact

No impact yet, butexpected in 2015

No impact at all and noneexpected (screened out)

Over one-third of oncologists report the ACA has had

moderate to high impact on their practices


Breast Cancer 67

Lung Cancer 35

Prostate Cancer 73

Colon Cancer 34

The majority of oncologists interviewed operate within an independent private practice setting and almost half work primarily with breast cancer patients

S2: Which of the following best describes your current practice setting / arrangement?S3: For which of the following cancers do you see/treat the most patients in a typical month as a medical oncologist? 6n=100

PCP Practice Arrangement / Autonomy

60%24%

14%2%

Independent private practice (standalone, group single-, or groupmulti-specialty)

Affiliated with or part of a loosely controlled health system (i.e.,central or controlling board makes recommendations, butdecisions are largely left to practices)

Owned by a tightly controlled health system (i.e., central orcontrolling board dictates formulary, pathway, and proceduraldecisions that must be adhered to)

Other

Primary Oncology Focus

47%

24%

18%

11%

MeanPts/Month


Oncologists operating in tightly controlled health systems are significantly more likely to have already been impacted by the ACA, with half reporting mod to high impact

A/B/C - indicates group result is significantly higher than designated group at a 90% confidence intervalS1: In your opinion, how much of an impact has the Affordable Care Act (ACA) had on your practice, if any at all?S2: Which of the following best describes your current practice setting / arrangement? 7

Overall n=100; Private Practice n=60Loose System n=24; Tight System n=14

Impact of the ACA by Oncology Practice Arrangement(Among Those Currently or Expecting Impact)

23%38%

7%

37%21%

43%

27%21%

29%

13%21% 21%

(A)Independent

Private Practice

(B)Part of a Loosely

Controlled Health System

(C)Owned by a Tightly

Controlled Health System

High Impact

Moderate Impact

Low Impact

Impact Expected in2015

40%42% 50%

CC


Decreased income/reimbursements

Patient loss due to and general shift to narrower networks, limited coverage, and Medicaid expansion

Anticipating major changes/impact, but currently unaffected

Increased patient volume / More insured individuals

Less time for patient care / Patient care limited indirectly by ACA requirements

Increases to patient cost share(e.g., high deductibles, out-of-pocket, drug costs, etc.)

More insurance hassles(e.g., more denials, prior authorization issues, referral issues, etc.)

Increased confusion or uncertainty due to insurance changes

Increases to paperwork, bureaucracy, admin, and practice overhead

Other

Unsure of when or what impact will be

Decreasing income/reimbursements and more patients shifting to plans with narrower networks, more limited coverage, or Medicaid are among the most mentioned prevalent effects of the ACA according to

oncologists

S1: In the comment box below, please describe what you believe has been or will be the ACA’s most prevalent effect on your practice. 8n=100

Most Current or Expected Prevalent Effect of the ACA on Oncology Practices(Number of Mentions)

22

19

17

15

11

9

9

9

8

8

7

Other mentions:• Patients are dissatisfied• Increased income/reimbursements• Hospital consolidation / Shift to

hospital employment


PD-L1/PD-1 inhibitors

New immunotherapies

New targeted biologic or biosimilar therapies / Molecular profiling

Not sure / None / Nothing in particular

Specific products

Histone deacetylase inhibitors

Better cancer-specific treatments

Better or new alternative therapies

Other

Better testing and preventative care

New immunotherapies and targeted biologics, including PD-L1/PD-1 inhibitors, are by far the most anticipated oncology treatment developments for 2015

Q1a: What new cancer treatment options, drugs or other oncology products are you most looking forward to in 2015? 9n=100

Most Anticipated Oncology Treatments or Products for 2015(Number of Mentions)

33

15

14

12

8

5

5

3

3

2

Alternative therapies mentioned:• Thermal / photon oncology• New radiation therapies• Improved androgen therapies• Other non-traditional therapies

Specific treatments mentioned:• Palbociclib• LHRH & taxotere combo treatments• Tasquinimod in mCRPC• Keytruda• Bevacizumab• Nivolumab• Kadcyla


Restricts ability to do my job / Limits treatment autonomy

None / No impact

Less personalized or precision medicine

Patients will pursue more inexpensive, but less effective treatments

Other

Pathways already in place / No new effects

Small, largely negative impact

Will be forced on us and mandated by penalties

Not Sure / Unclear

Patients will avoid or be denied needed treatment

Will become the new norm in oncology treatment

Great, largely negative impact

More paperwork & bureaucratic hassle

General diminishing returns / Less income or reimbursement

Oncologists are generally apprehensive about treatment pathways, with concerns about their potentially negative impacts on oncologists’ treatment autonomy, personalized or precision medicine, and their

patients’ cancer treatment decisions

Q1b: How, if at all, do you anticipate oncology treatment pathways will affect your practice in 2015? 10n=100

Anticipated Effects of Oncology Treatment Pathways in 2015(Number of Mentions)

24

12

11

11

11

9

8

8

8

5

5

4

4

3

Other pathway-related comments:• Will not adopt pathways in 2015• Should adopt NCCN guidelines• Will encourage targeted agent

development• Open to pathways/generally positive• Will encourage molecular profiling• Will improve treatment efficiency• Will decrease use of biologics


Declining reimbursements/income

No major impact/new challenges expected

Inadequate chemotherapy coverage / Smaller margins on chemotherapy

Will be increasingly restricted to specific pathways due to penalties or prior authorization issues / Less freedom to choose best treatments

Not sure

Increases to patient cost share(e.g., high deductibles, out-of-pocket, drug costs)

More patients with limited coverage seeking to pay less(e.g., fewer visits, avoiding/deferring treatment)

Pressure to sell practice (due to cost shift) or become hospital employee

Other

Substantial increase to challenges, paperwork, and burden related to insurance companies

Inadequate reimbursement due to Medicare sequestration

More bundled payments and other alternative reimbursement models

The most prominent reimbursement challenge anticipated by oncologists for 2015 is the continuing decline of reimbursements themselves, typically cited as “indirectly” related to the ACA and its impact on the industry as a whole; however, about one-fifth anticipate no new or major reimbursement challenges

Q1c: Please explain any significant reimbursement challenges you anticipate in 2015 and whether or not they relate to the ACA? 11n=100

Anticipated Reimbursement Challenges and Changes for 2015(Number of Mentions)

39

19

13

10

9

7

7

6

5

4

3

3

Other reimbursement-related comments:• Arbitrary quality-based reimbursements

and incentives• Timelier payments• Less coverage for PET scans


The ACA has resulted in considerably more paperwork and a greater regulatory burden for my practice

2.04

I am worried about the end of the enhanced 2014 Medicaid reimbursement rate

2.07

An increase in patient cost sharing, such as higher deductibles or out-of-pocket costs, have caused more cancer patients to defer or

avoid needed treatments2.20

Incentivizing reimbursements for treatment regimens that follow specific pathways identified by insurers ultimately reduces the

quality of patient care2.45

Bundled payments help to improve the quality of healthcare delivered, while controlling costs by financially incentivizing

coordinated care3.15

Increased access to primary care and preventative services will go a long way to reducing the incidence of many cancers

2.95

The ACA’s required coverage for clinical trials of cancer treatments have been a significant boon for some of my patients

2.93

Due to the ACA, our patient volume has increased significantly since the beginning of 2014

3.06

Bundled payments, or episode-based payments, (can) make my practice more financially viable or secure

3.27

Around 7 out of 10 oncologists agree that the ACA has resulted in more paperwork and a greater regulatory burden for their practice, has left them concerned about Medicaid reimbursement rates, and has driven

more cancer patients to avoid or defer needed treatment due to an increased cost burden

Q2: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the following statements. (5-point scale) 12n=92-100

ACA Impact Statement Agreement

35%

32%

28%

20%

10%

10%

8%

7%

4%

37%

40%

39%

37%

22%

32%

25%

28%

24%

16%

16%

19%

25%

24%

20%

39%

30%

29%

12%

12%

15%

16%

28%

27%

20%

22%

27%

2%

15%

10%

7%

13%

16%

1 - Strongly Agree 2 - Somewhat Agree 3 - Neither Agree nor Disagree 4 - Somewhat Disagree 5 - Strongly Disagree

Mean


Though most oncologists recognize ACA-related increases to paperwork, regulatory burdens, and patient cost sharing regardless of their practice type, independents are less likely to agree that their patient load has

increased or that bundled payments or covered clinical trials are beneficial to their practices and patients

A/B/C - indicates group result is significantly higher than designated group at a 90% confidence intervalQ2: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the

following statements. (5-pt scale, 1=Strongly Agree to 5=Strongly Disagree) 13

Overall n=92-100; Private Practice n=56-60;Loose System n=19-24; Tight System n=12-14

ACA Impact Statement Agreement by Practice Arrangement

OverallMean

Independent Private Practice

(A)

Loosely Controlled Health System

(B)

Tightly Controlled Health System

(C)


2.04 2.02 1.82 2.50


2.07 2.04 2.13 2.23

An increase in patient cost sharing, such as higher deductibles or out-of-pocket costs, have caused more cancer patients to defer or avoid needed

treatments2.20 2.05 2.48 2.38

Incentivizing reimbursements for treatment regimens that follow specific pathways identified by insurers ultimately reduces the quality of patient care

2.45 2.41 2.16 2.85


2.93 3.09 C 2.86 2.31


2.95 3.03 2.71 2.92


3.06 3.28 BC 2.75 2.64

Bundled payments, or episode-based payments, help to improve the quality of healthcare delivered, while controlling costs through financially

incentivizing coordinated care3.15 3.35 C 2.96 2.58


3.27 3.38 3.25 2.79

Relatively More Agreement Relatively Less Agreement


Moderately and highly impacted oncologists seem more likely to agree that the ACA has resulted in more paperwork and a greater regulatory burden for their practices and that they are concerned about the end of

the enhanced 2014 Medicaid reimbursement rate

Q2: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the following statements. (5-pt scale, 1=Strongly Agree to 5=Strongly Disagree) 14

Overall n=92-100; Low n=30-33;Mod n=24-26; High n=14-16; In 2015 n=22-25

ACA Impact Statement Agreement by Degree of Impact

OverallMean

Low ImpactModerate

ImpactHigh Impact

Impact in2015


2.04 2.19 1.84 1.80 2.22


2.07 2.23 1.96 1.79 2.16

An increase in patient cost sharing, such as higher deductibles or out-of-pocket costs, have caused more cancer patients to defer or avoid needed

treatments2.20 2.31 2.00 2.12 2.32

Incentivizing reimbursements for treatment regimens that follow specific pathways identified by insurers ultimately reduces the quality of patient care

2.45 2.68 2.46 2.47 2.09


2.93 3.03 3.20 2.53 2.76


2.95 2.97 3.08 2.81 2.88


3.06 3.15 3.04 3.00 3.00

Bundled payments, or episode-based payments, help to improve the quality of healthcare delivered, while controlling costs through financially

incentivizing coordinated care3.15 3.33 3.17 3.00 3.00


3.27 3.24 3.19 3.50 3.24

Relatively More Agreement Relatively Less Agreement


Mark Antonacci

InCrowd, Inc.

[email protected]

973.432.6381 | www.incrowdnow.com

mailto:[email protected]

http://www.incrowdnow.com

Oncologists’ Perceptions of the ACA’s Impact and Expectations for 2015

Healthcare

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