Lack of reimbursement for supportive care services topped the list of challenges facing cancer programs today, with 65% of programs naming this as their biggest challenge, despite the increase in communication with payers on the value of these services. The Association of Community Cancer Centers (ACCC) recently released these findings in its sixth annual Trends in Cancer Programs survey (, which highlights the challenges and recent trends seen in US cancer programs.

As seen in last year’s survey, the number of patient-centered services provided has continued to grow, but the reimbursement necessary to provide these services is lagging. The majority of cancer programs now offer nurse navigation (89%), psychological counseling (88%), survivorship care (87%), and palliative care (87%). This expansion of services may have contributed to the 61% of survey respondents who cited budget restrictions as their second biggest challenge.

“America’s cancer programs are increasingly being asked to do more with less, a trend we are seeing across health care,” said ACCC President Steven L. D’Amato, BSPharm, BCOP. “As these programs strive to provide more patient-centered services, knowing the positive effect these services have on improving patient health outcomes, reimbursement has become a bigger challenge. Payers will need to recognize the efforts from cancer programs to better communicate the value of these services.”

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To improve provider-payer communication, the survey found that more cancer programs are tracking quality metrics and using these data to show payers the value of the care provided. Nearly all respondents communicated value to payers through various metrics. These metrics include American College of Surgeons Commission on Cancer (CoC) accreditation (87%), The Joint Commission accreditation (74%), Press Ganey scores (57%), reporting data on quality improvement initiatives (52%), National Accreditation Program for Breast Centers accreditation (51%), and benchmarking patient outcomes against other programs (51%).

“Measuring and tracking quality is an important part of the overall care delivery process and a majority of cancer programs are taking the lead in not only gathering and analyzing the data, but also in sharing it with payers,” said D’Amato. “Reporting this information is one of the best ways that programs can show the value of the services they provide, especially new services designed to better meet patient needs across the spectrum of care, and we encourage programs to continue to take this important step. Year-over-year tracking of this data will be important to illustrate the ongoing benefits of taking a more patient-centric approach to providing cancer care.”

Despite increased focus on providing patient-centered care, cancer programs continue to face challenges to meet CoC patient-centered standards that went into effect in 2015. Highest areas of concern center on survivorship care for 51% of programs and clinical trial accrual for 41% of programs.

More cancer programs are implementing quality and compliance initiatives related to oral drugs: 53% now offer these programs, up from 34% in last year’s survey. Nearly all of these programs (94%) teach/educate patients about issues related to oral medications, and 77% proactively reach out to patients to ensure adherence.

Reimbursement challenges continue despite a larger number of insured patients: While the number of uninsured patients has declined with the rollout of the Affordable Care Act, more than half of the cancer programs (54%) report an increase in under-insured patients, and 44% identified the increase in patients unable to afford treatment as one of their biggest challenges.