The National Practice Benchmark for Oncology, 2013 Report on 2012 Data

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1 Special Series: State of Oncology Practice Original Contribution The National Practice Benchmark for Oncology, 213 Report on 212 Data By Elaine L. Towle, CMPE, Thomas R. Barr, MBA, and James L. Senese, RPh Oncology Metrics, a division of Altos Solutions, Los Altos, CA Abstract The National Practice Benchmark (NPB) is a unique tool to measure oncology practices against others in the country in a way that allows for meaningful comparisons across practices of all sizes and practice settings. In today s economic environment every oncology practice should be able to produce, monitor, and benchmark basic metrics to meet current business pressures for increased efficiency and efficacy of care. In this year s NPB report, we see a reduction from last year in the total number of participants and in the number able to provide valid quantitative data necessary to produce representative benchmarks. The NPB survey results can never capture the experience of all oncology practices, but we believe that successful participants in this survey are exemplary practices and the benchmarks are characteristic of well-managed clinical businesses. These practices demonstrate exceptional managerial capability and are likely to be among the bestmanaged practices in the country. In this report, we continue with the methodology introduced last year where we reported medical revenue net of the cost of the drugs as net medical revenue for the hematology/oncology product line. The effect of this is to capture only the gross margin attributable to drugs as revenue. We continue to report hematology/oncology physician productivity on the basis of work relative value units. New this year, we include radiation oncology benchmarks including productivity based on average daily treatments. Finally, we have expanded the staff productivity metrics and have included some staffing benchmarks for radiation oncology. Introduction In this eighth year of the National Practice Benchmark (NPB), we continue to see a reduction in the total number of participants and, more troubling perhaps, in the number able to provide valid quantitative data necessary to produce representative benchmarks. The NPB findings have been justifiably criticized in the past as not representative of community oncology. Part of the reasoning for this is the presumption that only larger practices have the managerial capacity and time to produce quantitative data that are necessary to participate. Although many smaller practices do participate successfully in the NPB, in an effort to become more accessible to all practices and in particular those with a limited ability to get the necessary data, last year we stratified the survey into two sections. The first section, called the minimum data set, required few hard numbers and no revenue numbers at all. Although we have repeated that approach this year, the number of practices able to participate has not grown. We believe that today, in the face of price and quality pressures, it is necessary that every oncology business unit produce, monitor, and benchmark basic metrics to meet current business pressures for increased efficiency and efficacy of care. The NPB is a tool for oncology practices to use to measure against other comparable practices. Although these survey results do not capture the experience of all oncology practices, we now characterize the participants in this survey as exemplary practices and the benchmarks as characteristic of well-managed clinical businesses. These top-tier practices continue to innovate and adapt. They demonstrate exceptional managerial capability, and we believe the group of NPB participants who were able to provide complete data are among the best-managed practices in the country. We thank them for their participation and their contribution to the practice of oncology. Calculations Using the Benchmarks Each benchmark presented in this year s report includes the number of practices and the number of denominator units. You will notice that these numbers vary by benchmark. This variation reflects the presence or absence of usable data in the computation. Given that the data contributors are not consistent across the benchmarks, we caution readers not to combine various benchmarks to derive secondary or aggregated new metrics. Denominators and Physician Productivity The denominator for most of the benchmarks in this report is the number of full-time equivalent (FTE) physicians represented in the data. This may be reported as FTE hematology/oncology(hemonc) physicians, FTE radiation oncology (RadOnc) physicians, or FTE physicians (indicating all physicians in the practice regardless of specialty). Many benchmarks are also reported on the basis of physician productivity or a standard physician. In the past, we reported HemOnc physician productivity based on the number of new patients per year. We now report HemOnc physician productivity on the basis of work relative value units (wrvu) and use 7, wrvu per year as the productive capacity of a standard HemOnc physician (wrvu). When used in the aggregate, there are often only slight differences between the results expressed per FTE 2s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

2 National Practice Benchmark, 213 Report on 212 Data HemOnc or per standard HemOnc (wrvu). This is reasonable because these two measures are derived from the same aggregated data in which the number of new patients and the amount of wrvu are strongly correlated. When applying any individual benchmark to an individual practice, we encourage the conversion of the count for the practice to standard HemOnc (wrvu) and suggest using that as the standard of comparison. This provides useful comparisons both for busy practices and for those that are less busy. In this report, we are including RadOnc benchmarks for the first time and are tentatively introducing a new standard for the productive capacity of a radiation oncologist. We define a standard RadOnc physician as one with 26 average daily treatments (on the basis of 254 working days per year). We also measured wrvu per RadOnc physician and see an average of around 14,9 wrvu per RadOnc per year. There is, however, considerable variability in that number, which we believe reflects the ratio of complex treatments to total treatments, and we are not yet prepared to establish a standard RadOnc on the basis of wrvu. Raising the Bar Last year, we introduced the concept of the minimum data set to collect the fewest individual data elements necessary to produce meaningful statistics. Several practices did provide just the minimum data and not the full data set; more often though, practices provided all or none for participation with real numbers. In this report, our analytic methodology includes all usable individual data elements, including data from practices that did not provide even the complete minimum data set. We excluded individual data elements that were inconsistent within an individual practice. We also completely rejected several participants for whom the reported data were obviously fabricated or nonsensical. In future surveys, inclusion in the published results will be limited to those practices that provide usable key data according to product line for HemOnc, RadOnc, and all other oncology product lines ( Other ). For each of these product lines, it will be necessary to report total medical revenue, total practice expense less physician compensation, total wrvu, total drug revenue, and cost of drugs. Net Revenue and Net Drug Revenue In this report, we continue with the methodology introduced in last year s NPB 1 in which we reported medical revenue net of the cost of the drugs as net medical revenue for the HemOnc product line. The effect of this is to capture only the gross margin attributable to drugs as revenue. For example, the total revenue per standard HemOnc (wrvu) in 211 was $4.9 million; it is about the same in this year s report. When the cost of drugs is subtracted, the net revenue for 211 was $2 million, and for 212 was approximately $1.7 million. Almost $3 million in gross top-line revenue per standard HemOnc (wrvu) is used to purchase drugs and is not available for practice operations. We encourage all who use these survey results to be aware of this change in perspective. The cost of drugs must be subtracted from top-line gross revenue to accurately understand the revenue structure of the practice. Although still commonly done, reporting total revenue other than as net of the cost of drugs is misleading and a gross distortion of medical oncology practice economics. Methodology Approximately 1,9 medical oncologists, practice administrators, and other key staff members from more than 1,2 practices and institutions across the country were invited to participate in the 213 NPB survey. Participants were invited by , and the survey was completed entirely online. Practices were instructed to submit only one survey per practice; multiple results from the same practice were deleted. Respondents completing the minimum data set received a copy of the survey report. Respondents completing the full survey whose data passed the validation process received a full survey report as well as a practice-specific benchmarking analysis. The NPB survey instrument reflects data from calendar year 212 or the most recently completed 12-month accounting period. Practices were not required to answer all questions and data from incomplete surveys are included in the final survey results. Data were submitted by HemOnc single-specialty practices as well as by multispecialty practices. Confidentiality Oncology Metrics is committed to protecting the confidentiality of individual practice data and makes the following data commitment to NPB participants: All of the individual data that you provide in the survey is absolutely confidential and will never be disclosed. Access to the data file that Oncology Metrics creates from this survey will never be made available to any party. Oncology Metrics will create analytic reports including aggregated data from this survey but will always publish in a manner that completely obscures the source of the data so that no reader can make any supported inference of data to any individual practice. Understanding the NPB Report NPB data are presented in an easy-to-understand format using pie charts and bar graphs. Data are generally presented in vertical bar graphs using percentile, 5th percentile (or median), adjusted average, average, and percentile. The adjusted average is the average calculated without the highest and lowest values. Whereas in most cases this does not dramatically alter the resulting benchmark, there are some situations in which it makes a material difference. Including the adjusted average allows us to responsibly include more data contributors while still offering our best efforts to keep the underlying credible. When interpreting these data, remember that a percentile is a point on a scale below which a certain percentage of responses fall. For example, the percentile is the point in a distribution of data below which 75% of responses fall. Likewise, the Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 21s

3 Towle et al percentile is the point below which 25% of responses fall. Note that a percentile may or may not correspond to a value judgment about whether it is favorable or unfavorable. The interpretation of whether a certain percentile is favorable or unfavorable depends on the context to which the data apply. In some situations, a low percentile would be considered favorable for example, number of days sales outstanding. In other contexts, a high percentile might be considered favorable, such as the number of new patients per FTE HemOnc physician. Our goal in producing and presenting this report continues to be to provide readers with a valuable tool to evaluate one s own practice and manage in today s complex health care environment. We encourage all oncology practices to review the data provided and use them as appropriate for managing today s oncology practice. Results Respondent Demographics Survey responses were submitted from 15 practices in 35 states. The number of practices responding to individual questions varies and is noted in the data. Respondents identified their role in the practice as practice administrator/office manager (63% of respondents), physician (14%), chief financial officer/director of finance (1%), chief executive officer/executive director (6%), billing manager (2%), registered nurse (2%), and other (3%). Respondents from 97 practices reported an average of 7.3 physicians per practice. For the purposes of the survey, an physician is defined as one who spends four full days in clinic seeing patients and part of the fifth day on clinic business and one who shares call equally with other physicians. Practices were identified by the number of physicians (Fig 1) and 5% of survey respondents were from practices of zero to five FTE HemOnc physicians. The data set includes a total of 713 physicians and 862 FTE physicians in all specialties. The majority of survey respondents described their current business structure as physician-owned practice (8%). Additional responses included hospital-owned practice (7%), academic practice (1%), and other (5%). Most of the practices in these latter categories responded only to the minimum data set questions. A few of the hospital-owned practices were, however, able to contribute complete data. This group continues to function as physician-owned practices in their ability to track and report on these metrics. Hospital-specific data are not included. Notably, 79% of respondents reported no business structure changes in the last year, and 57% expect their current business structure to remain viable for at least 5 years. Responding practices reported an average of 2.1 clinical sites per practice, and the majority of respondents (87%) reported that they did not close clinic sites in the past year. Figure 2 shows the services provided by the reporting practices. 5% 24% 11% No response Figure 1. Practice size by number of full-time equivalent (FTE) hematology/ oncology (HemOnc) physicians (practices, 97; physicians, 713). Medical oncology, including infusion Hematology Laboratory Clinical trials Imaging Genetic counseling Closed-door/ retail pharmacy Radiation oncology Psychosocial support Gynecologic oncology Other Surgical oncology Medical oncology, professional services only Practice Operations and Planning Practices were asked about their expected involvement with accountable care organizations (ACOs) in the next year. ACO is defined as a health care organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Ninety-three practices (814 FTE physicians) responded to this question, and 32% of the respondents expect to be impacted by an ACO in the coming year (Fig 3). Figure 4 shows the percentage of practices that expect to participate in risk/reward relationships with the ACO. Sixty-one percent of survey respondents perform clinical trials in their practice. Respondents report having an average of 32 trials open at the end of 212, with a wide range of responses from eight at the percentile to 43 at the percentile. A similar wide range of responses was seen regarding the number of patients accrued to trials in 212 with 15 at the percentile, an average of 77, and 72 at the percentile. Eighty-five percent of the NPB respondents report that their practice currently uses an electronic medical record 8% 7% No. of Responses Figure 2. Services provided by practice (practices, 93; full-time equivalent physicians, 814). 22s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

4 National Practice Benchmark, 213 Report on 212 Data Yes 32% 36% Maybe someday No Not yet, but soon Probably never 32% Yes No Unsure Figure 3. Response to survey question Do you expect to be impacted by an ACO [accountable care organization] in the coming year? (practices, 93; full-time equivalent physicians, 814) No. of Responses Figure 6. Response to survey question Is your practice paperless? (practices, 75; full-time equivalent physicians, 774). 35% 25% 48% 58% 7% Yes No Unsure 27% Yes No Unsure Figure 4. Response to survey question If yes, do you expect to participate in risk/reward with the ACO [accountable care organization]? (practices, 67; full-time equivalent physicians, 637). Figure 7. Response to survey question Has your practice received payment from the Medicare Electronic Health Record incentive program? (practices, 75; full-time equivalent physicians, 774). Varian (Aria) Altos (OncoEMR) IKnowMed Elekta/IMPAC (Mosaiq) NextGen Centricity (GE Healthcare) Alteer Other eclinical Works STI/Perfect Care SequelMed Pulse Pegasus & Integrate EHRMedSym IntelliDose (has many features of an EMR) GeniusDoc Epic Drs Enterprise Amazing Chart Allscripts Touch Chart No. of Responses Figure 5. Electronic medical record systems used by survey respondents (practices, 74; full-time equivalent physicians, 762). 65% 34% Yes No Unsure Figure 8. Response to survey question Do you have a patient portal that allows patient access to EMR [electronic medical record] content? (practices, 75; full-time equivalent physicians, 774). (EMR). Practices were asked to identify their EMR (Fig 5) and whether their practice is paperless (Fig 6). Practices were also asked whether they have received payment from the Medicare EMR incentive program, an indication of successful demonstration of meaningful use (Fig 7), and whether they have a patient portal that allows patient access to EMR content, an important consideration for stage II meaningful use (Fig 8). 1% Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 23s

5 Towle et al No. of Respondents 9 Yes 8 No Practice Guidelines? Clinical Pathways? Figure 9. Responses to survey questions Do the physicians in your practice regularly use practice guidelines or clinical pathways for patient care? Practice guidelines (practices, 86; full-time equivalent [FTE] hematology/oncology [HemOnc] physicians, 663; FTE physicians, 812) and/or clinical pathways (practices, 85; physicians, 66; FTE physicians, 89). No. of Respondents No Yes, manual process Yes, via EMR Yes, via electronic pathway tool (not EMR) Figure 11. Responses to survey question Do you routinely measure physician compliance with clinical pathways? (practices, 43; full-time equivalent [FTE] hematology/oncology physicians, 291; FTE physicians, 376). EMR, electronic medical record. Practice generated Other Payer generated P4 Via Oncology Innovent/US Oncology Hospital generated No. of Responses Figure 1. Source of clinical pathways (practices, 46; full-time equivalent [FTE] hematology/oncology physicians, 34; FTE physicians, 391). Practice Guidelines and Clinical Pathways The survey asked whether physicians in the practices use practice guidelines and clinical pathways (Fig 9). For survey purposes, practice guidelines were defined as evidence-based recommendations for treatment and clinical pathways as standard protocols for treating specific groups of patients with cancer with standardization of care processes as a key element. Practices that responded no to using clinical pathways were asked whether they plan to implement them in the next year. Sixty-four percent of those respondents (39 practices; 417 FTE physicians) said yes. Figure 1 shows the source of clinical pathways used by survey participants. Practices were also asked whether they routinely measure physician compliance with clinical pathways (Fig 11) and how they use clinical pathway data (Fig 12). Pharmacy Operations Respondents were asked how drugs are purchased/procured by their practice and were instructed to estimate the percentage by dollar amount of drug spent for the 12-month period in each category provided. Categories included the traditional buyand-bill method (the business entity purchases drugs and bills payers); specialty pharmacy/preferred provider with drugs delivered to the patient who transports to the practice (brownbagging); specialty pharmacy/preferred provider with drugs delivered to the practice (whitebagging); 34B pricing; drugs Quality improvement Payer negotiation strategy Reimbursement compliance Physician scorecard Management scorecard Other No. of Responses Figure 12. Responses to survey question How do you use clinical pathway data? (practices, 43; full-time equivalent [FTE] hematology/ oncology physicians, 291; FTE physicians, 376). not purchased by the practice; and other. Not surprisingly for this data set, 87% of survey respondents report obtaining drugs through the buy-and-bill method (Fig 13). This year s survey also asked about point-of-care drug dispensing, specifically through closed-door/retail pharmacy and through physician dispensing units (Fig 14). A closed-door/ retail pharmacy is defined as a licensed entity that provides pharmacy services to patients and employees of the practice but is not available to the public at large (note: not all states allow this practice). A physician dispensing unit is defined as a nonlicensed entity that allows physicians to stock and dispense medications (generally oral) to patients of the practice. Oral drugs have become increasingly important to oncology practice today, so several questions were added to the survey about this trend. First, practices were asked about the typical distribution channel for all oral drugs prescribed by the practice (Fig 15). Choices included percentage filled through a practiceowned/affiliated closed-door/retail pharmacy; percentage filled through a practice-owned/affiliated dispensing unit; percentage filled through a nonpractice-affiliated retail pharmacy (eg, CVS, Walgreens); and percentage filled through specialty or mail-order pharmacy. Practices were then asked additional questions about prescriptions filled through specialty or mail-order pharmacies. 24s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

6 National Practice Benchmark, 213 Report on 212 Data 1% 5% Excellent Good Adverse effects Adherence, refills Patient drug education Okay 87% 5% 1% 1% Brownbagging Whitebagging 34B pricing Buy and bill Drugs not purchased by practice Other Poor Not known No. of Responses 25 3 Figure 13. Responses to survey question How are drugs purchased/ procured by your practice? (practices, 89; full-time equivalent hematology/oncology physicians, 634). No. of Responses 7 Yes 6 No Closed-Door/ Retail Pharmacy? Physician Dispensing Unit? Figure 14. Responses to survey questions Do you dispense medications to your patients via a closed door/retail pharmacy or a dispensing unit? Closed-door/retail pharmacy (practices, 87; full-time equivalent [FTE] hematology/oncology (HemOnc) physician, 665; FTE physicians, 814) or physician dispensing unit (practices, 84; physicians, 641; FTE physicians, 784). 43% 37% 1% 1% Specialty/mail-order pharmacy Closed-door/retail pharmacy in practice Physician dispensing unit in practice Retail pharmacy Figure 15. Oral drug distribution channel (practices, 81; full-time equivalent [FTE] hematology/oncology physicians, 612; FTE physicians, 749). Fifty-seven percent of respondents report receiving timely feedback on clinical support services (pharmacist, nurse) provided by the pharmacy. Figure 16 shows the experience of survey respondents with clinical support services provided by specialty or mail-order pharmacies in several specific clinical areas. Practices were also asked about the time required Figure 16. Responses to survey question Please rate your experience with clinical support services provided by specialty/mail-order pharmacy in each of the indicated categories (practices, 81; full-time equivalent [FTE] hematology/oncology physicians, 625; FTE physicians, 769). < 15 minutes > 15 minutes and < 3 minutes > 3 minutes and < 1 hour > 1 hour No. of Responses Figure 17. Responses to survey question: What is the average time required to complete all necessary prescription-related communications with a specialty/mail-order pharmacy? (practices, 81; full-time equivalent (FTE) hematology/oncology physicians, 625; FTE physicians, 769). to complete prescription paperwork for specialty/mail-order pharmacies (Fig 17). Physician Productivity Physician productivity is reported and measured several ways in this report number of new patients per per year, wrvu per per year, and visit counts for both office established patient visits and hospital established patient visits. New patient volume continues to be an important measure of productivity and an essential tool for practice planning. Survey respondents reported the number of new HemOnc patients who entered the practice in the 12-month period in both the office and inpatient hospital settings (Fig 18). A new patient is defined as one that has not received services in the practice in the last 3 years. wrvu is also used to measure physician productivity. wrvu is the measure of the physician work component that is assigned to each procedure code in the Resource-Based Relative Value System. This is the system used by the Centers of Medicare and Medicaid Services and most other payers to assign reimbursement amounts to procedure codes. Productivity measured using wrvu is a valuable management tool for oncology Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 25s

7 Towle et al No. of New Patients Office Hospital 5th wrvu 7, 6, 5, 4, 3, 2, 1, 5th Figure 18. Number of new hematology/oncology patients in the 12- month period. New patients in the office (practices, 75; full-time equivalent [FTE] hematology/oncology [HemOnc] physicians, 67.9); new patients in the hospital (practices, 64; physicians, 559.8). Figure 21. Work relative value unit (wrvu) per full-time equivalent (FTE) hematology/oncology (HemOnc) physician, office evaluation and management and infusion services (practices, 37; physicians, 483.4). 9, 6, 8, 7, 5, 6, 4, wrvu 5, 4, wrvu 3, 3, 2, 2, 1, 1, 5th 5th Figure 19. Work relative value unit (wrvu) per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 42; FTE HemOnc physicians, 53.2). Figure 22. Work relative value unit (wrvu) per full-time equivalent (FTE) hematology/oncology (HemOnc) physician, office evaluation and management services only (practices, 37; physicians, 483.4). wrvu 8, 7, 6, 5, 4, 3, 2, 1, 5th Figure 2. Work relative value unit (wrvu) less infusion services per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (n 53.2) or standard (STD) HemOnc physician (n 581.9; practices, 42). practices. Figure 19 shows wrvu per and includes all services and settings for which wrvu applies (including evaluation and management services, procedures, and chemotherapy administration). wrvu 2, 1,8 1,6 1,4 1,2 1, th Figure 23. Work relative value unit (wrvu) per full-time equivalent (FTE) hematology/oncology (HemOnc) physician, hospital evaluation and management services only (practices, 37; physicians, 483.4). It is also interesting to look at wrvu for selected groups of services. Figure 2 shows wrvu per for all services except infusion/drug administration services. This is a benchmark of interest to many hospital-employed oncologists when wrvu for the drug administration codes is not 26s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

8 National Practice Benchmark, 213 Report on 212 Data No. of Established Patient Visits 3,5 3, 2,5 2, 1,5 1, 5 5th Capacity Ratio NP 7, wrvu 5th Figure 24. Established office patient visits per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 44; FTE HemOnc physicians, 5.9). Figure 26. Hematology/oncology (HemOnc) capacity ratio for 35 new patients (NP; practices, 74; full-time equivalent [FTE] HemOnc physicians, 66.9) and for 7, work relative value units (wrvu; practices, 42; full-time equivalent [FTE] HemOnc physicians, 53.2). No. of Established Patient Visits th Figure 25. Established hospital patient visits per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 43; FTE HemOnc physicians, 496.9). attributed to a specific physician. Figure 21 presents wrvu per for office services including evaluation and management (E&M) services and infusion/drug administration services. Figure 22 breaks this down further and presents office E&M services; Figure 23 shows hospital E&M services. Figure 24 presents the number of established patient office visits (Current Procedural Terminology codes ) per for the 12-month reporting period. Figure 25 reports on established patient hospital visits (codes , , , ) for the reporting period. The HemOnc capacity ratio illustrates the productivity capacity of the HemOnc physicians in the practice to see more patients in addition to their current workload on the basis of the industry standard of 35 new patients per year or 7, wrvu per year. Figure 26 presents the HemOnc capacity ratio for the reporting practices in the data set. Results significantly less than one indicate existing capacity for the HemOnc physicians to see more patients. Near one means the physicians are working near or at full capacity, and growth in patient volume will require the addition of more physicians or nonphysician practitioners. Expense ($) 7,, 6,, 5,, 4,, 3,, 2,, 1,, FTE physician 5th Figure 27. Total practice expense per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 4; FTE HemOnc physicians, 48.8), standard (STD) HemOnc physician (work relative value units [wrvu]; practices, 36; physicians [wrvu], 555.4), and FTE physician (practices, 4; FTE physicians, 48.8). Financial Benchmarks Total practice expense is defined as all cash expenses for the business entity for the 12-month period. This includes cost of drugs, W-2 salaries for physicians and all staff, and all other expenses for the period. We present total practice expense per, standard HemOnc (wrvu), and FTE physician (Fig 27). Figure 28 presents total practice expense less cost of goods paid for (COGPF). COGPF is defined as the total of all money paid for drugs in the 12-month period less any rebates or other cost reductions for drugs taken in the same period. Total operating expense is defined as total practice expense less W-2 physician compensation (Fig 29), and net operating expense is total practice expense less W-2 physician compensation less COGPF (Fig 3). As practices have added electronic medical records and other sophisticated technology, information technology (IT) expense has become more important. Figure 31 presents IT direct expense, which includes software, hardware, license fees, interfaces, support, maintenance, upgrades, and IT staff W-2 salary reported on a cash Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 27s

9 Towle et al 3,, 2,5, FTE physician 6, 5, FTE physician Expense ($) 2,, 1,5, 1,, Expense ($) 4, 3, 2, 5, 1, 5th 5th Figure 28. Total practice expense less cost of goods paid for per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 39; physicians, 475.1), standard (STD) HemOnc physician (work relative value units [wrvu]; practices, 35; physicians [wrvu], 467.6), and FTE physician (practices, 39; FTE physicians, 475.1). Expense ($) 6,, 5,, 4,, 3,, 2,, 1,, 5th Figure 29. Total operating expense per full-time equivalent (FTE) hematology/ oncology (HemOnc) physician (practices, 4; physicians, 48.8) and standard (STD) HemOnc physician (work relative value units [wrvu]; practices, 36; physicians [wrvu], 555.4). Figure 31. Information technology direct expense per full-time equivalent (FTE) physician (practices, 39; FTE physicians, 467.8) and FTE hematology/ oncology (HemOnc) physician (practices, 39; physicians, 467.8). COGPF ($) 4,, 3,5, 3,, 2,5, 2,, 1,5, 1,, 5, 5th Figure 32. Cost of goods paid for (COGPF) per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 46; FTE HemOnc physicians, 512.3) and standard (STD) HemOnc physician (work relative value units [wrvu]; practices, 36; physicians [wrvu], 556.7). 6 5 Expense ($) 2,5, 2,, 1,5, 1,, 5, COGPF/wRVU th 5th Figure 33. Cost of goods paid for (COGPF) per work relative value unit (wrvu; practices, 36; full-time equivalent hematology/oncology physicians, 475.8). Figure 3. Net operating expense per full-time equivalent (FTE) hematology/ oncology (HemOnc) physician (practices, 36; physicians, 476.4) and standard (STD) HemOnc physician (work relative value units [wrvu]; practices, 33; physicians [wrvu], 363.3). basis for the 12-month period. Practices were instructed to include only depreciation taken in the reporting period for hardware or software that was capitalized. 28s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

10 National Practice Benchmark, 213 Report on 212 Data 2% 7, 6, 7% 11% 1% 61% Other expense HemOnc physician pay COGPF HemOnc staff pay IT direct expense 5, 4, 3, 2, 1, 5th Figure 34. Practice expense mix per standard hematology/oncology (HemOnc) physician (work relative value unit). IT, information technology. Figure 37. Total medical revenue per full-time equivalent (FTE) staff (practices, 39; FTE physicians, 466.7). 7,, 6,, 5,, 4,, 3,, 2,, 1,, 5th Figure 35. Total revenue per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 46; physicians, 513.3). 6,, 7,, 6,, 5,, 4,, 3,, 2,, 1,, 5th Figure 38. Total medical revenue less radiation oncology revenue per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 5; physicians, 526.9) and per standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 37; STD HemOnc physicians, 563.1). 5,, 4,, 3,, 2,, 1,, 2,5, 2,, 1,5, 1,, 5th Figure 36. Total medical revenue per full-time equivalent (FTE) physician (practices, 5; FTE physicians, 526.9). COGPF continues to be the single largest expense for most HemOnc practices. COGPF per and per standard HemOnc (wrvu) are reported on Figure 32. Figure 33 presents COGPF per wrvu. Practice expense mix (Fig 34) is reported per standard HemOnc (wrvu). These data include all practices reporting in each category; the number of respondents varies from one category to the next. COGPF represents 5, 5th Figure 39. Net medical revenue per full-time equivalent (FTE) hematology/ oncology (HemOnc) physician (practices, 45; physicians, 513.9) and per FTE standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 36;, 561.4). 61% of the practice expense mix for the practices included in the data. Total revenue (Fig 35) is defined as total cash collections (medical and nonmedical) for the business entity for the 12- Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 29s

11 Towle et al 4,5, 4,, 3,5, 3,, 2,5, 2,, 1,5, 1,, 5, Revenue (%) th 5th Figure 4. Drug revenue per full-time equivalent (FTE) hematology/ oncology (HemOnc) physician (practices, 44; physicians, 51.3) and per standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 35; physicians, 556). 6, 5, 4, 3, 2, 1, 5th Figure 41. Net drug revenue per full-time equivalent (FTE) hematology/ oncology (HemOnc) physician (practices, 41; physicians, 494.6) and per standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 34; physicians, 548.9). COGPF (%) th Figure 42. Net drug revenue as a percentage of cost of goods paid for (practices, 44; full-time equivalent hematology/oncology physicians, 51.3). month period. Total medical revenue is all revenue attributed to medical operations and is reported per FTE physician (Fig 36) and per FTE staff (Fig 37). Total medical revenue is also reported without revenue from RadOnc operations (Fig 38). Figure 43. Net drug revenue as a percentage of total medical revenue (practices, 41; full-time equivalent hematology/oncology physicians, 494.6). Revenue (%) th Figure 44. Net drug revenue as a percentage net medical revenue (less radiation oncology revenue; practices, 35; full-time equivalent hematology/oncology physicians, 469.6). 1,8 1,6 1,4 1,2 1, th Figure 45. Total revenue per established patient visit (office and hospital; practices, 4; full-time equivalent physicians, 487.3). Net medical revenue is defined as total medical revenue less RadOnc revenue less COGPF and is reported per and per standard HemOnc (wrvu; Fig 39). Net medical revenue represents the revenue available for practice operations (including physician compensation) for HemOnc practices and is a key metric for practices to measure and understand. 3s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

12 National Practice Benchmark, 213 Report on 212 Data 1,8 1,6 1,4 12, 1, 1,2 1, 8 6 8, 6, 4, 4 2 2, 5th 5th Figure 46. Medical revenue (less radiation oncology revenue) per established patient visit (practices, 41; full-time equivalent hematology/oncology physicians, 493.9). 5, 45, 4, 35, 3, 25, 2, 15, 1, 5, 5th Figure 47. Evaluation and management service revenue per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 41; physicians, 492.9) and standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 37; physicians, 563.1). 45, 4, 35, 3, 25, 2, 15, 1, 5, 5th Figure 48. Infusion service revenue per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 39; physicians, 485.3) and standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 35; physicians, 474.8). Figure 4 presents drug revenue, which is defined as total collected revenue for all drugs purchased and administered by the practice in the 12-month period. Net drug revenue (Fig 41) is total drug revenue less COGPF and is a much Figure 49. Laboratory revenue per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 34; FTE HemOnc physicians, 449.6) and standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 31; physicians, 442.1). 35, 3, 25, 2, 15, 1, 5, FTE physician 5th Figure 5. Imaging revenue per full-time equivalent (FTE) hematology/ oncology (HemOnc) physician (practices, 2; physicians, 354.1), standard (STD) HemOnc (work relative value unit [wrvu]; practices, 19; physicians, 353.1), and FTE physician (practices, 2; FTE physicians, 354.1). 45, 4, 35, 3, 25, 2, 15, 1, 5, FTE physician 5th Figure 51. Clinical trial revenue per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 24; physicians, 362.4), standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 21; physicians, 436.3), and FTE physician (practices, 24; FTE physicians, 362.4). Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 31s

13 Towle et al 7, 6, FTE physician , 4, 3, 2, Days , 2 5th 5th Figure 52. Closed-door/retail pharmacy revenue per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 16; physicians, 323.2), standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 16; physicians, 414.1), and FTE physician (practices, 16; FTE physicians, 323.2). 2% 12% 4% 18% 19% 24% 21% Net drug revenue E&M revenue Infusion revenue Lab revenue Imaging revenue Clinical trial revenue Retail/CD pharmacy revenue Figure 53. Revenue mix. CD, closed door; E&M, evaluation and management. Figure 55. Business days inventory on hand (practices, 33; full-time equivalent hematology/oncology physicians, 32.4). Accounts Receivable ($) 8, 7, 6, 5, 4, 3, 2, 1, FTE physician 5th Figure 56. Collectible accounts receivable per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 38; physicians, 458.9), standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 35; physicians, 535.6), and FTE physician (practices, 38; FTE physicians, 458.9) Inventory ($) 16, 14, 12, 1, 8, 6, 4, 2, 5th Figure 54. Inventory on hand at the end of the 12-month period per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 33; physicians, 32.4) and standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 31; physicians, 34.8). Days th Figure 57. Business days sales outstanding (practices, 37; full-time equivalent physicians, 458.9). more realistic way to look at revenue from drugs available for practice operations. Drug purchases continue to be the largest expense incurred by oncology practices, and margins on those purchases are quite slim. There is no room for error in the pharmacy component of the practice. Figures 42 through 44 32s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

14 National Practice Benchmark, 213 Report on 212 Data Table 1. Staffing Categories and Definitions Category Definition Figure All staff All staff working in all departments/specialties in the practice; includes NPPs but does not include 58, 6 physicians. HemOnc staff All staff in the HemOnc line of business in the practice; includes NPPs but does not include physicians. 59, 6 NPP Includes nurse practitioners and physician s assistants working the HemOnc line of business. 61, 62, 71, 72 Executive staff Includes all executive and senior management staff in all departments/specialties in the practice; includes all staff who report to the physician executive or the Board and the physician executive but does not include department-level supervisors. 63, 64 Chemotherapy administration staff Includes all staff responsible for drug purchasing, drug mixing and preparation, delivery to patients, documentation of services provided, and management of these processes, reported on a FTE basis. Staff is included in proportion to the amount of time spent on chemotherapy management activities. 69, 7, 75 Billing staff Includes all staff in the billing and collecting process in the practice for all departments/specialties but does 65, 66, 73 not include patient financial advocates. Financial advocate Includes all staff in the patient financial advocate or financial counseling process in the practice for all 65, 66 departments/specialties. Imaging staff Includes all nonphysician imaging staff employed by the practice. 67, 68, 74 Laboratory staff Includes all laboratory staff employed by the practice. 67, 68, 74 Research staff Includes all staff performing clinical research and research clerical support for all departments/specialties in the practice but does not include physician research time. 67, 68, 74 Abbreviations: FTE, full-time equivalent; HemOnc, hematology/oncology; NPP, nonphysician practitioner No. of FTE Staff No. of FTE Staff th 5th Figure 58. All full-time equivalent (FTE) staff per FTE physician (practices, 44; FTE physicians, 477.9). demonstrate this margin expressed as a percentage of COGPF, total medical revenue, and net medical revenue (less RadOnc revenue). Figures 45 through 52 present additional revenue metrics: total revenue per established patient visit; E&M service revenue; infusion service revenue; laboratory service revenue; imaging service revenue; clinical trial revenue; and closed-door/retail pharmacy revenue. Revenue mix per standard HemOnc (wrvu) is presented as Figure 53 and includes all practices reporting in each revenue category. The number of respondents varies from one category to the next. It is important to note that we now report drug revenue as net drug revenue that is total drug revenue less COGPF given that we believe this presents a much more accurate picture of revenue for the oncology practice. During the last few years, we have observed that most oncology practices have decreased the amount of drug inventory on hand. Figure 54 presents drug inventory on hand (in dollars) at the end of the 12-month period per and standard HemOnc (wrvu). Business days inventory on hand Figure 59. Full-time equivalent (FTE) hematology/oncology (HemOnc) staff per physician (practices, 54; physicians, 524) and standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 37; physicians, 653). is calculated by dividing the ending inventory for a period by COGPF per business day (254 business days per year) and is presented in Figure 55. Collectible accounts receivable is presented in Figure 56. It is also called net accounts receivable and is defined as gross accounts receivable less contractual allowances less allowance for bad debt less allowance for charity care. Figure 57 presents business days sales outstanding, which is calculated by dividing net accounts receivable by average collections per business day (254 business days per year). Staffing and Productivity Staffing information was collected and reported for the categories presented and defined in Table 1. All staff positions are reported as FTE. One FTE staff is a person working 4 hours per week or 2,8 hours per year. Respondents were instructed that staff may be counted in more than one category as appropriate but no individual staff person should be counted as more Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 33s

15 Towle et al Compensation ($) 6, 5, 4, 3, 2, 1, FTE physician No. of Staff th 5th Figure 6. Annual staff compensation per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 36; physicians, 44.6), standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 34; physicians, 635.7), and FTE physician (practices, 39; FTE physicians, 461.6). No. of Practitioners Figure 63. Full-time equivalent (FTE) executive staff per FTE physician (practices, 4; FTE physicians, 469.5). Compensation ($) 2, 18, 16, 14, 12, 1, 8, 6, 4, 2, 5th 5th Figure 64. Annual compensation per full-time equivalent (FTE) executive staff (practices, 36; FTE executive staff, 129.3). Figure 61. Full-time equivalent (FTE) nonphysician hematology/oncology (HemOnc) practitioner per physician (practices, 38; FTE HemOnc physicians, 474.2) and standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 29; physicians, 514.4) FTE Billing FTE Finan Adv Compensation ($) 15, 1, 95, 9, 85, 8, 5th No. of Staff th Figure 65. Full-time equivalent (FTE) billing staff (practices, 41; FTE physicians, 472.9) and FTE financial advocates (finan adv; practices, 39; FTE physicians, 38.6) per FTE physician. Figure 62. Annual compensation per full-time equivalent (FTE) nonphysician hematology/oncology practitioner (practices, 29; FTE nonphysican practitioners, 223.2). than one FTE. Staffing information is reported per FTE physician for staff categories that support all specialties in a multispecialty practice such as executive staff and billing staff. Other staff categories such as chemotherapy administration staff are reported per physician. Number of FTE staff and annual compensation by staff categories are reported in Figures 58 through 7. Productivity measures are reported for several staff categories. Figure 71 presents nonphysician practitioner (NPP) wrvu per and standard HemOnc (wrvu). NPP wrvu includes both wrvu billed incident to a physician 34s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

16 National Practice Benchmark, 213 Report on 212 Data Compensation ($) 5, 45, 4, 35, 3, 25, 2, 15, 1, 5, FTE Billing FTE Finan Adv 5th No. of Staff Std HemOnc 5th Figure 66. Annual compensation for full-time equivalent (FTE) billing staff (practices, 35; FTE billing staff, 479.3) and FTE financial advocates (finan adv; practices, 32; FTE finan adv, 298.1). No. of Staff FTE imaging FTE lab FTE research 5th Figure 67. Full-time equivalent (FTE) imaging staff (practices, 16; FTE physicians, 317.7), FTE laboratory (lab) staff (practices, 29; FTE physicians, 389.3), and FTE research staff (practices, 2; FTE physicians, 339.2) per FTE physician. Figure 69. Full-time equivalent (FTE) chemotherapy administration staff per FTE hematology/oncology (HemOnc) physician (practices, 54; FTE HemOnc physicians, 358.4) and standard (STD) HemOnc physician (work relative value unit [wrvu]; practices, 35; physicians, 358.4). Compensation ($) 7, 6, 5, 4, 3, 2, 1, 5th Figure 7. Annual compensation per full-time equivalent (FTE) chemotherapy administration staff (practices, 35; FTE chemotherapy administration staff, 732.8). Compensation ($) 7, 6, 5, 4, 3, 2, 1, FTE imaging FTE lab FTE research 5th wrvu 1,6 1,4 1,2 1, Std HemOnc 5th Figure 68. Annual compensation per full-time equivalent (FTE) imaging staff (practices, 15; FTE imaging staff, 131), FTE laboratory (lab) staff (practices, 26; FTE lab staff, 221.3) and FTE research staff (practices, 18; FTE research staff, 165.1). service as well as wrvu billed directly by the NPP. Figure 72 presents NPP wrvu per FTE NPP. This is specific to NPPs working in HemOnc and does not include NPPs working any other specialties in the reporting practices. Figure 71. Nonphysician practitioner work relative value unit (wrvu) per full-time equivalent (FTE) hematology/oncology (HemOnc) physician (practices, 27; physicians, 317.2) and standard (STD) HemOnc physician (wrvu; practices, 27; physicians, 333.6). Figure 73 presents total medical revenue per FTE billing staff. This is collected medical revenue and can serve as a productivity measure for the billing department. Note that we report both including RadOnc revenue and excluding RadOnc Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 35s

17 Towle et al 3, 9 wrvu 2,5 2, 1,5 1, 5 No. of Infusions per Staff th 5th Figure 72. Nonphysician practitioner (NPP) work relative value unit per full-time equivalent (FTE) nonphysician practitioner (hematology/oncology only; practices, 26; FTE NPPs, 146.2). Figure 75. Initial infusions per full-time equivalent (FTE) chemotherapy administration staff (practices, 37; FTE chemotherapy administration, 752.8). 7,, 6,, 5,, 4,, 3,, 2,, 1,, Including RadOnc No RadOnc No. of New Patients th 5th Figure 73. Total medical revenue per full-time equivalent (FTE) billing staff both including radiation oncology (RadOnc) and without RadOnc (practices, 37; FTE billing staff, 54.8). Figure 76. New radiation oncology (RadOnc) patients per full-time equivalent (FTE) RadOnc physician (practices, 17; FTE RadOnc physicians, 76). 1,, 9, 8, 7, 6, 5, 4, 3, 2, 1, Imaging revenue/fte imaging Lab revenue/fte lab Clinical trial revenue/fte research 5th No. of Treatments FTE RadOnc FTE LinAc 5th Figure 74. Imaging revenue per full-time equivalent (FTE) imaging staff (practices, 16; FTE physicians, 317.7); laboratory (lab) revenue per FTE lab staff (practices, 25; FTE lab staff, 221.3); clinical trial revenue per FTE research staff (practices, 17; FTE physicians, 323.2). revenue. This year, we have added to the productivity measures we are reporting. Figure 74 presents department-specific revenue per FTE staff for the imaging, laboratory, and research departments. Figure 77. daily treatments per full-time equivalent (FTE) radiation oncology (RadOnc) physician (practices, 13; FTE RadOnc physicians, 46.6) and FTE linear accelerator (LinAc; practices, 13; FTE LinAcs, 4.6). We continue to report the number of initial infusions per FTE chemotherapy administration staff as a productivity measure for the infusion suite (Fig 75). The number of initial infusions is a count of the initial drug administration codes (as defined in the coding manual) billed by the practice during the 36s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

18 National Practice Benchmark, 213 Report on 212 Data No. of Treatments 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, FTE RadOnc FTE LinAc 5th No. of Staff th Figure 78. Total treatments per year per full-time equivalent (FTE) radiation oncology (RadOnc) physician (practices, 13; FTE RadOnc physicians, 46.6) and FTE linear accelerator (LinAc; practices, 13; FTE LinAcs, 4.6). Figure 81. Full-time equivalent (FTE) nonphysician practitioners per FTE radiation oncology (RadOnc) physician (practices, 8; FTE RadOnc physicians, 1.1). No. of Oncologists th Figure 79. Full-time equivalent (FTE) radiation oncology physician per FTE linear accelerator (LinAc; practices, 17; FTE LinAcs, 55.6). No. of Staff FTE dosimetrists FTE physicists FTE radiation therapists 5th Figure 8. Full-time equivalent (FTE) dosimetrists (practices, 16; FTE linear accelerators [LinAcs], 49.6), FTE physicists (practices, 15; FTE LinAcs, 44.4), and FTE radiation therapists (practices, 16; FTE LinAcs, 49.6) per FTE LinAc. period and includes initial infusions, initial hydrations, and initial intravenous push services. Each patient receiving infusion services is billed for one and only one of these initial drug administration codes; these codes become a surrogate for Compensation ($) 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, 5th Figure 82. Annual compensation per full-time equivalent (FTE) nonphysician practitioners (radiation oncology; practices, 7; FTE nonphysicians practitioners, 9.1). the number of patients receiving infusion services. Last year, we noted that this number has varied considerably for the last several years and this year is no exception, with an average of 655 and adjusted average of 633, down from an average of 715 and adjusted average of 72 last year. RadOnc We are introducing several new benchmarks for RadOnc in this report. Although the number of practices contributing RadOnc data are smaller than the HemOnc data set, we have tested these benchmarks with a core group of practices and believe we have enough data to report meaningful results. We begin with productivity measures; Figure 76 presents new RadOnc patients per FTE RadOnc physician. New RadOnc patients are defined as new patients who entered the RadOnc practice in the 12- month period. An FTE RadOnc is defined as a RadOnc physician who is in clinic 4 days per week, works on clinic business at least part of the fifth day each week, and shares call. daily treatments is calculated by dividing the total number of treatments (all modalities) in the 12-month period by the number of business days in the period. Figure 77 presents average daily treatments per FTE RadOnc and per FTE linear accelerator (LinAc). An FTE LinAc is defined as one that is Copyright 213 by American Society of Clinical Oncology SUPPLEMENT TO NOVEMBER 213 jop.ascopubs.org 37s

19 Towle et al available for patient care by the practice 5 days per week. It may be owned by the practice or leased from another entity. Survey respondents were asked to report the number of FTE LinAcs available to their practice. For example, a LinAc available only 2 days per week would be counted as.4 FTE LinAc. We also report the total number of RadOnc treatments (all modalities) per year (Fig 78). Figure 79 shows the relationship between FTE RadOnc physicians and FTE LinAcs. Figures 8 through 82 present some staffing benchmarks for RadOnc practices. Figure 8 reports the number of FTE dosimetrists, physicists, and radiation therapists per FTE LinAc. Figure 81 presents the number of FTE NPPs per RadOnc physician. Figure 82 presents annual compensation per FTE NPP in RadOnc. Our goal is to expand the RadOnc benchmarks in future reports. Closing Thoughts The NPB offers the unique opportunity to measure your practice against many others in the country in a way that allows meaningful comparisons to be made across practices of all sizes and practice settings. The strong central tendency that is seen in many of the benchmarks on a standard HemOnc basis indicates that the observed similarities can be applied to your practice, too. We encourage you to use these data and see how your oncology business operations and clinical productive capacity measure up. Commit to the continuation of the long tradition of creative innovation and positive evolution of the oncology delivery system. Although we do not offer a specific pathway to improvement for your practice, we believe that measurement and comparison to these benchmarks will guide you to practice improvement in your particular market. We look forward to your participation in the 214 NPB. Economic, media, and social pressures have never been greater on those who deliver oncology services. Benchmarking your data is the right thing to do for your patients, your practice, and the continuance of community-based oncology in the future. See how well your practice compares in 214 and how prepared your practice is to face the uncertain challenges of 215. Elaine L. Towle, CMPE, is director of consulting services for the Oncology Metrics division of Altos Solutions. She has more than 25 years of experience in oncology practice management, and before she joined Oncology Metrics, she was practice administrator for a 15-provider medical oncology group practice. Towle is on the board of the Northern New England Clinical Oncology Society and is a member of the Medical Group Management Association (MGMA), ASCO, and the Association of Community Cancer Centers. She is a past president of the Administrators in Oncology Hematology Assembly (AOHA) of MGMA and served as a founding member of the ASCO/AOHA liaison committee. She currently serves as a consulting editor for Journal of Oncology Practice. Thomas R. Barr, MBA, is general manager of the Oncology Metrics division of Altos Solutions. He is a past president of the Administrators in Hematology Oncology Assembly of the Medical Group Management Association (MGMA) and was an advisor to the MGMA 2, 21, and 23 Cost Survey for Hematology/Oncology Practices and the author of the summary of key observations published by MGMA in the 23 report. Before founding Oncology Metrics, Barr was chief executive officer and executive director of The Center for Cancer and Blood Disorders in Fort Worth, TX. He is a past member of the Clinical Practice Committee of ASCO, serves on the Strategic Planning Committee of the Florida Society of Clinical Oncology, and is widely published in the area of oncology measurement and management. James L. Senese, MS, RPh, is director of network development for the Oncology Metrics division of Altos Solutions. He has more than 25 years of experience in the medical field with a broad background in practice management, operations, and medical sales. Before joining Oncology Metrics, he was the Eastern Regional Vice President for US Oncology. Before US Oncology, Senese was with Caremark, the alternate site health care division of Baxter Travenol. In addition, he has held senior positions with the Oley Foundation, a 51(c)(3) organization dedicated to consumers on long-term parenteral and enteral nutrition. He maintains a pharmacist license in New York state. He is a member of ASCO and the Association of Community Cancer Centers. Oncology Metrics, a division of Altos Solutions, develops information products and services for the oncology community to help accelerate advancements in the treatment of cancer. Oncology Metrics has built networks of community-based oncology practices from which it gathers financial, operational, and clinical information and aggregates the information to provide a platform of knowledge-based products and services. The cornerstone of Oncology Metrics approach is to promote the discovery and adoption of best practices. Oncology Metrics customers include oncology care providers and all organizations involved in the quest to improve cancer diagnosis and treatment. Authors Disclosures of Potential Conflicts of Interest Although all authors completed the disclosure declaration, the following author(s) and/or an author s immediate family member(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a U are those for which no compensation was received; those relationships marked with a C were compensated. For a detailed description of the disclosure categories, or for more information about ASCO s conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors. Employment or Leadership Position: Elaine L. Towle, Altos Solutions (C); Thomas R. Barr, Altos Solutions (C); James L. Senese, Altos Solutions (C) Consultant or Advisory Role: None Stock Ownership: None Honoraria: None Research Funding: None Expert Testimony: None Patents, Licenses, or Royalties: None Other Remuneration: None Author Contributions Conception and design: All authors Collection and assembly of data: Elaine L. Towle, Thomas R. Barr Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors Corresponding author: Elaine L. Towle, CMPE, 351 Fremont Rd, Chester, NH 336; DOI: 1.12/JOP Reference 1. Towle EL, Barr TR, Senese JL: National oncology practice benchmark, 212 report on 211 data. J Oncol Pract 8:51s 7s, s JOURNAL OF ONCOLOGY PRACTICE VOL. 9,ISSUE 6S Copyright 213 by American Society of Clinical Oncology

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