How long has the organization tried to address this issue?
I have been the CFO of the organization for the past 10 years and the ever-escalating costs of cancer medications and health care in general has always been a problem for the hospital and patients. This has been worsened by increased cost-cutting by insurers like Medicare. Some of the cancer drugs cost on average $ 60, 000 which is simply beyond the reach of many patients. New drugs are even more expensive. Although insurers cover part of the costs of the drugs for most patients, patients still bear a significant proportion of these costs. Some of our patients have become bankrupt due to cost of cancer treatment. The uninsured and underinsured are the most affected group. Hence I would say it has been a recurring problem that we have always tried to address.
What measures have been taken to address this issue in the past?
We introduced the use of evidence-based clinical pathways about 5 years ago. They have greatly mitigated these costs because they help to standardize care. We collaborated with various payers and oncology specialists in developing these guidelines. They are evaluated and updated regularly to conform to current practices. Use of these pathways has helped to reduce drug costs by up to 10% in some cases without compromising quality of care and patient outcomes. Another cost-cutting measure we implemented is the proactive management of diseases. Staffs were trained to provide direct, proactive patient interventions with an aim of reducing emergency room visits, hospital admissions, and fostering patient compliance with prescribed medications.
What future steps have been planned to address this issue?
In line with ASCO’S (2009) recommendations, we are encouraging our oncologists to hold cost-related discussions with their patients particularly in regard to the costs of alternative cancer treatments. Support tools for guiding both oncologists and patients on this issue are currently being developed and will be introduced within the next 6 months. We are also encouraging the health staffs to help patients with terminal cancer explore the option of palliative care as opposed to expensive treatments that prolong life for only a couple of months. Hospice care has been shown to be cost-effective for this patient population.
What problems does the organization foresee as blocks to addressing this issue?
The blocks we expect to encounter include governmental policies that enable pharmaceutical companies to create monopoly situations. These companies set the price of their drugs far above their developmental costs. This may limit the effectiveness of our-cost cutting measures. Lack of data on the costs of these drugs is another problem. These companies provide information on clinical outcomes but not on the costs related to the use of their drugs in the long run hence we are having difficulties developing support tools for patients and oncologists.
How long has the organization tried to address this issue?
The hospital administration has been grappling with the issue for as long as I can remember. It is a perpetual problem that crops up every often. The pharmaceutical companies pass on the costs development and marketing of these drugs to payers and patients. Insurers, on the other hand, have resulted to passing the costs to patients via schemes like co-pays and deductibles. Most patients are incurring numerous out-of-pocket expenses related to cancer medications. This financial burden is worsened by the high costs of imaging and diagnostic procedures.
What measures have been taken in the past to address this issue?
We instituted policies that required oncologists to provide care according to clinical pathways. These pathways outline evidence-based treatments and practices for every cancer. They help to mitigate costs related to the use of expensive drugs with no significant advantages over more affordable drugs. Prior to the introduction of the policy, there was a tendency for oncologists to prescribe novel and off-label drugs whose benefits have not been clearly elucidated. The other measure has been to enhance efficiency in the use of imaging and diagnostic procedures so as to limit the expenses patient incur. For instance, use of MRIs only when indicated. We have also placed great emphasis on prevention and early detection of cancer because cancer is more expensive to manage at its late stages.
What steps have been planned to address this issue?
We plan to continue utilizing clinical pathways. We also want to partner with pharmaceutical companies so that they can be providing free or subsidized medications to the uninsured or underinsured. We are also encouraging health care providers to be cost conscious when prescribing and to hold costs discussions with their patients. This will enable patients and their families to weigh the benefits of these drugs against their costs.
What problems does the organization foresee as blocks to addressing this issue?
Oncologists are expressing concern that the requirements to be cost-effective may interfere with their professional obligations to their patients. They also say they have minimal knowledge of the costs of most of these medications and the development of support tools has been slow due to lack of pertinent data. The ultimate concern though is whether reduction of costs will compromise quality of care and patient outcomes. For instance, how do we determine whether a few months of added life merit the extra expense related to the use of costly medications required to achieve this.
How did your perception of the financial issue differ from the perception of those who are actually working on finances in the organization?
The two managers differed with my perceptions on how the issue should be addressed. They introduced the components of palliative care and soliciting for subsidies and free medications from pharmaceutical companies. They, however, concurred with my position that the ever-spiraling costs of cancer medications pose a significant problem to the organization and its stakeholders. They both point out that an increasing number of patients are unable to afford treatment due to the high costs associated with them. The two also agree with some of my perspectives on how the issue should be addressed specifically the utilization of clinical pathways and prioritization of cost-effectiveness in clinical decision making.
