In the annual president's address, Steinberg emphasized the need for ASTRO to adapt to the major changes facing both healthcare and radiation oncology in the years to come. The trends run the gamut from population growth to rising healthcare costs, and in some cases, radiation oncology could be a top target in terms of healthcare providers who will have to react to the changes.
The first megatrend is population growth, with the rising U.S. population continuing to outpace previous predictions.
Dr. Michael Steinberg, ASTRO president. Image courtesy of ASTRO.
Steinberg cited a report from the Brookings Institution's Metropolitan Policy Program, which anticipates that there will be some 100 million senior citizens by 2050. Right now, Steinberg said that the healthcare industry is meeting the coming challenge with adequate infrastructure to deliver necessary services.
Second, the U.S. will become a "minority majority" country by 2050. "This diverse population will be served by a physician workforce that is likely to remain greater than 90% white and Asian," Steinberg said. Minority groups, who disproportionately suffer from poverty, are historically underserved. "Will this demographic trend create disconnects and further disparity in our healthcare system?" he asked.
A third megatrend is a physician-based system that cannot meet the demand. Shortages of 90,000 to 170,000 physicians are predicted by 2020, with a shortage of 45,000 primary care physicians alone. All specialties, including radiation oncology, will be adversely affected, and the shortage will intensify as another 32 million newly insured patients join healthcare rolls within the next few years, due to healthcare reform, with at least 50% of those people added to Medicaid.
"We can't train ourselves out of the problem simply by training more physicians," Steinberg said. "We will be forced to rethink scope-of-practice issues."
Fourth, there has been unprecedented, accelerated growth in science and technology. Money spent on medical research and development between 1950 and 2000 totaled approximately $1 trillion. That same amount was invested in medical R&D between 2000 and 2010.
"This breakneck pace and introduction of new technology will have untold effects on healthcare delivery in how we practice," he said.
Fifth, there has been a significant shift in healthcare-related consumer attitudes and expectations. Patients are continually exploring the Internet to learn what might be best for their healthcare needs. At the same time, studies have shown that they do not embrace the notion of evidence-based medical practice.
Steinberg cited a 2010 study in Health Affairs that found that most patients do not accept the concept of evidence in medicine, they believe more care means better care, and they feel that medical guidelines represent a "bargain-basement approach" to medical care.
These five megatrends come as healthcare is increasingly unaffordable, a sixth megatrend.
"Our fee-for-service payment system is fundamentally inflationary and does not reward quality, safety, or value," Steinberg said, conceding that radiation oncology is perceived as one of the worst offenders.
He noted a study in the New England Journal of Medicine in which radiation oncology was portrayed as a specialty that has contributed to excess spending in the past decade as it relates to the sustainable growth rate formula.
"If anyone can explain the fallacy of that portrayal, it is me," Steinberg said. "But our problem is not a lack of an explanation; [the issue is] who will listen?"
And, finally, the seventh issue concerns the widespread call to confirm the value of care, in terms of cost and quality. In a recent book titled Redefining Health Care, the authors highlight patient-centered care, provider accountability, and competition based on value.
"These ideas have found traction in the current healthcare reform debate," Steinberg said.
What is ASTRO doing to prepare for the arrival of these megatrends? In health policy, the organization is looking to counter evidence that as much as 30% of care delivered by the U.S. healthcare system is duplicative, unnecessary, and may not improve people's health.
Thus, ASTRO has joined the American Board of Internal Medicine Foundation's "Choosing Wisely" national campaign to educate and encourage patients to ask informed questions about their healthcare. Another goal is to create a list of medical procedures that must be discussed between patients and their physician before proceeding with the appropriate care.
"Shining on a light on our potentially wasteful practices will be difficult for us," Steinberg said, "but it is necessary if our specialty is to gain credibility in the healthcare reform debate."
ASTRO has formed a task force in cancer and radiation biology to develop accurate benchmarking for grant funding and research, as well as to develop education priorities to advance the specialty in the coming years. The task force is scheduled to release its report and action plan early next year.
Another critical area in health policy is comparative effectiveness research. Currently, oncology research in general is not a high priority for government research and, consequently, few studies relevant to radiation oncology have been funded, Steinberg said.
In response, ASTRO has initiated grant support for health services researchers to tackle comparative effectiveness in radiation oncology.
"These studies will directly challenge conventional wisdom about our technology and candidly address the cost of our treatment," Steinberg added. "This exercise will not be about self-promotion, but about proving the value of what we do. And if what we do is not truly valuable, we will need to say so."
The most essential change ASTRO will need to make is for its patients.
"We will need to learn much more about how patients make their medical decisions and about the so-called shared-decision model," he said. "New disease management models will improve coordination of care and decision-making for our most complex patients. A critical change to the process is, as providers, we will be expected to understand the total cost of care for our patients."
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