Practice Administrators: Bridging the Medical and Business Worlds

Practice Administrators: Bridging the Medical and Business Worlds

By Robin T. Zon, MD, FACP, FASCO

Article Highlights

  • Practice administrators are vital to medical oncology organizations, promoting effective financial and system processes so that physicians can optimally care for patients.
  • The role and utilization of practice administrators outside the United States needs further research for better understanding.
  • ASCO’s Clinical Affairs Department is integrating practice administrators into its administrative, operational, financial, and quality-improvement activities.

The wild ride on the sustainable growth rate rollercoaster may have come to a halt with the signing of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), but oncology practices still must navigate the challenges of cancer care delivery while also preparing for MACRA-required performance measurement. As the United States continues to experience significant volatility in the practice landscape because of policy, economic, and workforce issues, practice administrators across all practice settings have been charged with bridging the business and medical worlds in an effort to preserve the care delivery model.

Practice administrators are vital to medical oncology organizations. They navigate and promote effective financial and system processes so that physicians and oncology care teams can optimally care for patients. Administrators discover and implement best practices, collaborate with multiple stakeholders, and make decisions necessary to achieve the organizational goals set forth by physicians. Practice managers often have different qualifications, education, experience, and financial acumen depending on the administrator’s practice setting. Irrespective of the diversity of the practice managers’ resumes or practice environment, the practice administrator remains critically important to the organization they serve.

Who Are Practice Administrators?

Practice administrators have a diverse set of skills and qualifications. They include, among others, nurses who rose up through ranks of their practice and professional administrators with a background in finance and operations, including MBAs. An administrator’s role and responsibilities are varied and may include both chief operating officer and chief financial officer duties. These duties may include full human resource department activities; coordinating accounting and legal services; negotiating contracts with payers; interacting with the local institutional politics; drug, medical, and business supply purchasing; IT supervision and maintenance; building and growing cancer centers; serving as administrative leaders of local research programs; and assuring compliance with quality reporting and regulations. Practice administrators serve within organizational structures ranging from small single-practice oncology groups to multispecialty oncology groups, including independent practices and hospital service lines. In essence, the practice environment influences and defines the needed and required skillsets for the administrative leadership.

Where Do Practice Administrators Go for Resources and Education?

Practice administrators seek support from many organizations in order to achieve their goals. Historically, many administrators have migrated toward the Medical Group Management Association (MGMA), which began in 1926 and serves all medical group practice professionals, including oncology managers. Under the auspices of MGMA is the American College of Medical Practice Executives, which was established in 1956 and awards Certified Medical Practice Executive and Fellowship status to those who qualify. However, this certification is not specific to hematology and/or oncology. In the past, MGMA had a variety of assemblies that represented a number of medical specialties, including the Assembly of Oncology Hematology Administrators, but they are no longer active. Other organizations have stepped up to fill this void, including the Association of Community Cancer Centers, Community Oncology Alliance, Oncology Metrics (formally Oncology Circle), and group purchasing organizations, just to name a few. However, finding the needed resources and support from multiple organizations is inefficient and costly for both the administrator and the organization they represent.

As a result, some practice administrators have requested that ASCO serve as a stable, comprehensive, cohesive support of knowledge and resources, which would include acknowledging and leveraging practice administrators’ expertise through expanded membership benefits and providing opportunity for volunteer engagement.

How ASCO Supports Practice Administrators

ASCO offers a number of tools and resources for practice administrators including the Oncology Practice Insider, a free bimonthly e-newsletter specifically devoted to oncology practice management, and Practical Tips for the Oncology Practice, a comprehensive manual on coding, billing, and regulatory resources for oncology practices, now it its 6th Edition. ASCO also provides free coding and billing assistance through the ASCO Coding and Reimbursement Service. Questions can be sent online through ASCO.org or by emailing billingandcoding@asco.org.

Practice administrators may become ASCO members under the Affiliate Heath Professional category. Although ASCO bylaws do not currently recognize practice managers as a separate membership category, there is a bylaw proposal to establish this under consideration. The proposed Practice Administrator/Manager category would include individuals who monitor and supervise the business operations of an oncology medical practice, cancer center, or facility who devote a majority of their professional activity to financial, facility, reimbursement, and human resource management. A practice administrator in this membership category would have voting privileges while serving on committees and have access to both online and print copies of Journal of Oncology Practice.

Beyond these services, ASCO offers the Clinical Practice Committee (CPC), which is designed to support the practice of oncology through advocacy, analysis, and direct assistance to ASCO members. The CPC accomplishes this mission by addressing the full range of practice settings with an emphasis on the coverage of, access to, and quality of oncology care. It also advises the ASCO Board of Directors on policy issues affecting the practice of oncology. The CPC was restructured in 2012 in an effort to better operationalize the committee and address the many challenges in the practice environment.

The CPC, which was then a committee of more than 100 members, was reorganized into the State Affiliate Council and a 22-member CPC with four active workgroups focusing on the following key elements of practice: payment reform, coding and billing, practice policy and emerging issues, and practice management. Appropriately, the CPC and the workgroups were comprised of volunteer physicians, but where were the practice administrators in this reorganization? An additional workgroup dedicated to practice administrators was developed in 2014 to acknowledge the pivotal role administrators play in the oncology business model. The goal was to better understand their world, identify and address their ever-growing needs, and increase their voice and engagement within ASCO.

ASCO Develops the Clinical Affairs Department

In 2014, the ASCO Board of Directors approved the Clinical Affairs Department to provide direct support and services to oncology practices in response to economic pressures, consolidations and mergers, focus on value, shifting care models, and growing administrative burden. The department’s goal is assisting practices in surviving and thriving in present and future environments. The department is led by Vice President Stephen S. Grubbs, MD, who was a community oncologist and researcher for more than 30 years.

The Clinical Affairs Department also includes Elaine L. Towle, CMPE, and Thomas R. Barr, MBA, past leaders of the Assembly of Oncology Hematology Administrators and Oncology Circle, respectively. Initiatives of the Clinical Affairs Department include PracticeNET, a rapid-learning network for oncology practice knowledge as it pertains to benchmarking, standards, and best practices; the Practice Administrators Network; and a Clinical Affairs Data Warehouse.

The Clinical Affairs Department will initially focus on administrative, operational, financial, and quality improvement and is currently identifying and engaging oncology administrators nationwide. In addition to integrating practice administrators into this department’s activities, the CPC Practice Administrator Working Group will also support the department’s mission. The practice administrator’s involvement in this department is critically important for the benefit of the organizations administrators serve as they implement MACRA-utilizing tools developed through collaborative contributions with the Clinical Affairs Department.

Practice Administrators Abroad

The role and utilization of practice administrators globally needs further research for better understanding. In some European countries, the administrator has similar duties as their U.S.-based counterparts: overseeing operations of nurses and clerical staff, in addition to managing finances related to day-to-day operations. The training for practice managers, as in the United States, is quite variable and includes on-the-job training, as well as seminars hosted by private training organizations addressing quality improvements, human relations, conflict management, and patient satisfaction.

As ASCO further develops its international services, including the Quality Oncology Practice Initiative (QOPI®) Certification, there may be an opportunity to support an international group of practice administrators, functioning in a similar manner as their U.S.-based counterparts. Given that many international health care systems are value based in paying for and providing services, practice administrators around the globe may be able to assist each other in ways not fully appreciated at this time.

The Future of ASCO–Practice Administrator Collaboration

Oncology health care has drastically changed no matter where on the globe cancer care is delivered. On the one hand, oncology providers and patients are witnessing the benefits of advancing scientific knowledge and precision medicine, with the availability of new therapies and technologies resulting in an increase in cancer survivors. On the other hand, there are substantial challenges in continuing to implement these advances and maintaining the discovery of life-saving interventions.

As a practicing oncologist, I support and encourage the increasing collaboration between practice administrators and ASCO as an essential relationship in the team approach to the practice of oncology. Oncologists currently promote the strategy of multidisciplinary team-based care as part of the delivery model in order to manage the complexities associated with highest-quality patient care. I propose the same culture of a team-based approach, with integration of oncology administrators within the Society, exemplifying one strategy to answer the current and future challenges of the oncology business model.

ASCO is uniquely positioned to serve as the comprehensive home for practice administrators as they continue serving as organizational business intelligence while bridging the business and medical worlds. Supporting increased integration of this member group, as ASCO is currently doing, will ultimately benefit patients, as we share our “collective wisdom” and leverage actionable insights to assure sustainable business operations for the delivery of high-quality, high-value care.