From MACRA to Burnout: How Oncologists Really Feel

Implementation of the Medicare Access and CHIP Reauthorization Act is shifting physician reimbursement-oncologists included-from a volume- to a value-based model.

New research from Cardinal Health Specialty Solutions found that more oncologists feel confident in their ability to meet the requirements of the Medicare Access & CHIP Reauthorization Act (MACRA) than in 2017. The new findings show 77% reported some level of confidence versus 53% in 2017. In addition, compared to 2017, more oncologists report having the resources and staff needed to manage MACRA (24% compared to 10%).

While confidence about meeting MACRA requirements has improved, less than 15% of respondents are confident that MACRA will improve patient outcomes or lower the total cost of care, according to the report. The number of oncologists who say their practice is exploring a merger with another entity as a strategy for meeting MACRA requirements has dropped from 16% in 2017 to 3% today.

In addition, the report provides insights into key issues that are impacting oncology practices including perspectives about the growing incidence of physician burnout and factors that trigger stress for oncologists; and the increasing reliance on nurse practitioners and physician assistants-also known as advanced practice providers (APPs)-to drive efficiency in the practice. The research was fielded in advance of three live summit events, hosted by Cardinal Health Specialty Solutions, in September, October, and November 2018, using written surveys. More than 160 oncologists from a mix of community and hospital-based practices participated in the research.

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Other key findings include:

• Nearly half of participating oncologists report experiencing significant amounts of stress at work (46%) and more than a third (35%) would need seven or more hours of extra time each week to complete their work responsibilities.

• The top factors contributing significant or excessive stress for oncologists were electronic health records (36%); changing reimbursement and payment models (33%); and interactions with payers (31%).

• Hiring APPs was the most common strategy for making workloads more manageable (46%)

• Three-quarters of oncologists (74%) already use APPs in their practices and 57% predict the number of employed APPs will increase over the next three years.

• When asked about the value of APPs, 65% of operations stated that APPs allow their workload to be more manageable and enable their overall practice operations to become more efficient.

“As the number of patients seeking cancer treatment continues to grow annually, health systems are increasingly focused on having a robust network of oncologists to meet the growing demand.  However, the industry is already experiencing a reduction in the number of new oncologists entering the field, and our research shows that one in five oncologists may consider retiring early due to stress at work,” says Chadi Nabhan, MD, MBA, FACP, vice president, chief medical officer, Cardinal Health Specialty Solutions. “Combined, these factors could lead to a significant shortage in oncology providers. For health system executives, understanding the challenges facing oncologists-and the steps they are taking to mitigate those challenges-may be key to building a sustainable network of oncology providers.”

Based on the report, Nabhan has four recommendations for healthcare execs:

• Create open dialogue with oncologists to better understand the challenges they face in their practices and how they view their future. “Stress triggers may vary by region and setting, so understanding the unique factors that contribute to stress in each organization-and identifying the early warning signs-will be key to helping oncologists mitigate the risk of burnout,” says Nabhan.

• Develop succession plans and expand the bench. “With a documented shortage of oncologists and more likely to retire early, healthcare executives should plan ahead and invest in ongoing recruitment efforts to assure patients continue to receive the care they need,” says Nabhan.

• Continue to support physicians with MACRA reporting and managing administrative burdens.  “While our research shows oncologists are more confident in their ability to meet MACRA requirements, changing reimbursement models are still one of the top factors causing stress for them,” says Nabhan. Health system executives should work closely with oncologists in their networks to establish best practices for MACRA reporting and to assure that the associated administrative tasks are not stealing time from patient care.

• Establish a work environment that is attractive to APPs. As physicians rely more heavily on APPs, the hiring market will become more competitive. “Practices that integrate APPs within the team and provide opportunities for APPs to take on challenging work will have an advantage when it comes to hiring. Health system executives can play a key role in establishing a culture where both oncologists and APPs can thrive,” says Nabhan.