"The most likely thing is oncologists are going to start acting more like coaches of the team rather than the players and the quarterbacks," said health care lobbyist Matt Brow.
"There will be a lot more nurse practitioners in the mix, a lot more physician assistants doing things, particularly around follow-up."
Brow works in Washington, D.C., as vice president of public policy for McKesson Specialty Health, which supports The U.S. Oncology Network, a nationwide system of community-based oncology practices.
hour-long evening talk - which covered a range of topics that included the Medicare sustainable growth rate (SGR) and the potential impacts of this fall's elections - came before a mix of medical students, payors, physicians, and researchers.
Forecasts and Trends
On cancer, Brow
said, increased demand for services could increase daily patient load at practices by as much as 75 percent.
By the middle of the next decade, he
said, the projected number of oncologists will be able to serve only about 90 percent of the expected demand for services.
Forecasts are for cancer diagnoses to grow at a much higher pace than the population as a whole, he
said, and the gap
will likely widen in the next 10 to 20 years.
The trends driving those figures are familiar to health care professionals across the board: an aging population and an increasing pool of insured patients.
Within the next decade, as Baby Boomers continue turning 65, Brow
said the nation could experience a doubling of the Medicare population.
"Imagine 80 million Medicare beneficiaries," he
"That is a lot of people."
said, the Affordable Care Act
should have a profound impact on the number of people without insurance.
said, estimate the nation will have roughly half the number of uninsured (about 31 million) than it would have had without the health reform law in the year 2024.
Shorter-term statistics also suggest that the ACA
is helping to reduce the ranks of the uninsured, Brow
Since the fourth quarter of 2013, Brow
said survey results have found that the uninsured rate dropped from 18 percent to 15.6 percent.
On the topic of the health reform law, Brow
also said that:
"The way to think about this is don't," Brow
But Congress has routinely passed "doc fix" legislation for the past decade to temporarily delay the cuts by adding each year's cost to an every-growing deficit, which Brow
said now stands at about $350 billion.
said there is little appetite in Congress to raid other parts of the budget to pay off that deficit - a move that would essentially pit doctors against other priorities, including spending allocated for military operations in Iraq and Afghanistan.
said, lawmakers have a built in incentive to maintain the status quo because it keeps the medical community beholden to Congress each and every year - creating a potential inducement for campaign support.
Politics and the Future
As for the elections this fall, Brow said conventional wisdom is that the Republicans will pick up the six seats needed to take control of the U.S. Senate while also retaining the majority in the House.
said that Republican control of Congress during the waning days of the Democratic administration in the White House could result in a more flexible stance than President Obama has shown in the past.
A similar situation toward the end of the Clinton presidency, he
said, resulted in compromise welfare reform legislation.
A wildcard in the equation, Brow
said, is the Halbig case now pending before the U.S. Court of Appeals
for the D.C. Circuit.
If the full court upholds the ruling of a three-judge panel, which said the government can only pay subsidies for health policies sold on state-based exchanges, Brow
said Obama might be scrambling to save his
signature domestic achievement.
"If the Halbig ruling comes out and knocks the wind out of the sale of Obamacare, and he
has a year to see if he
can fix it," Brow
said, "on that day, all bets are off.