Which types of healthcare centers will be caring for these patients in the future? Patients prefer to be seen by their oncologists even after five years, but just one in eight patients are seen at academic centers; most are treated at community hospitals, Dr. Nathan said.
Explore this issue:March 2018
With numbers showing that the higher the volume of surgical cancer treatment a center has, the better the survival rates, the National Cancer Institute has instituted a pilot program designed to bring more U.S. patients into a system of high-quality care centers, with the hope of reducing healthcare disparities and improving information sharing among community care centers. When they were followed, standards developed by the Leapfrog Group, a coalition of 130 public and private organizations attempting to decrease mortality and reduce errors in care, helped improve survival, according to one study (Surgery. 2004;135:569-575).
More questions need to be answered, however, Dr. Nathan said, including whether to move to a three-tier system in which patients will be referred from community centers to regional medical centers to tertiary centers. But patient concerns need to figure prominently in the solution, she said. “Who’s going to drive this model? Is it going to be purchasers, CMS (Centers for Medicare and Medicaid Services), managed care, or is it going to be our informed patients?” she asked. “There are realities we’ve got to understand that our patients face. Can they really get to us from these rural areas? We have patients where even the cost of gas is not affordable, and they don’t have the social infrastructure to make it to their appointments.”
Physician extenders not only facilitate patient care, but may be the key to maintaining the viability of traditional, independent private practice. —John McElveen, MD
Physician Extenders in Private Practice
John McElveen, MD, founder of the Carolina Ear and Hearing Clinic in Raleigh, N.C., said that physician extenders such as physician’s assistants (PAs) and nurse practitioners (NPs) can bring advantages to private practice but have to be incorporated into a practice in a way that makes sense. “All nurse practitioners are not created equally; they are only certified based on their training,” he said. “Some nurse practitioners are limited to seeing adult patients, while others can see both adult and pediatric patients. You want to make sure you’re hiring the right one for your specific patient demographics.”
Dr. McElveen said those in these positions can help lower salary, insurance, and liability costs and reduce the amount of “digital paperwork” for otolaryngologists, but it is important to be cognizant of their actual cost to the practice, too, he said, noting that even though the national average salary for a PA or NP is about $97,000, the actual cost—after payroll taxes, benefits, and other expenses—is approximately $117,000. With an overhead cost of about 52%, the PA or NP break-even point for revenue would be about $245,000 a year, he said.