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From the Editor

In 1971, President Nixon declared the war on cancer. Millions of dollars flooded into research facilities, and by the early 1990s, we reaped the benefits of those investments as new anticancer agents and supportive care drugs arrived to help us better manage the disease and its side effects.
Politics makes extreme messes. While Congress and the administration continue their political lunging and feinting (not to mention grandstanding), cancer care providers are hunkering down, buying drugs, and caring for patients with cancer.
We have survived yet another bout with the Medicare Sustainable Growth Rate, the “fiscal cliff” deductions, as well as significant cuts from Medicare, and the year has only started.
As practice administrators, we try to prepare for emergencies, but the unexpected always happens. Hurricane Sandy blew onto the East Coast and hit hard with rain, wind, and blizzard conditions.

To many people, the question above may seem simple. But, there are many different answers, depending on the speaker’s perspective, and these are often contradictory. Some people say that physicians are best suited for interpreting and managing the care of patients with cancer. Others say that physicians do not have time to stay on top of new evidence and drug information, so oversight by external agencies and specialty pharmacies is necessary to ensure that appropriate decisions are made across the country.

The media and political pundits were having a field day with predictions and countdowns. No matter what your politics were, opinions resonated all around you: What would the Supreme Court do? What would it mean?

The majority of cancer care is well known to be delivered in the community setting. We also are starting to learn that there may be cost differences based on site of service. What does that really mean to a patient with cancer, a physician, a practice administrator, and a payer or employer? The real answer is…it depends.

Oncology as a medical specialty is, and always has been, rapidly evolving. The world in which we provide care for patients is also rapidly evolving, and not always in sync with our changes. Doctors will be needed to diagnose and treat patients, but where and how that happens may look dramatically different in only 10 years. We still have the ability to shape that future, but what we do today, and every day from now on, will help to define our role. More external forces than internal forces have already shaped our evolution to 2012 from the 1970s, as described below.

The scope of oncology practice management is undergoing seismic changes. Groups that formerly focused on the survival of their patients, now have to wonder about their own operational survival, but under what evolving model? Administrators are being asked to oversee the operation of the practice, as well as scores of reporting measures and new contractual relationships, and perhaps even new institutional relationships.

On October 6, 2011, the Medicare Payment Advisory Commission (MedPAC) proposed a way that Congress, if it wanted to eliminate the sustainable growth rate (SGR) formula without raising the federal deficit and within the confines of Medicare, could approach an SGR fix. Since that proposal, the opposition has been deafening. The MedPAC proposal would change the ratio between primary care and specialists for good.

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  • American Health and Drug Benefits
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