Building for the future on shifting ground

Everyone involved in budgeting knows the process includes reviewing past performance, determining how to use resources, and projecting future performance based on the outlined plans. In a steady state, or in environments where change is incremental, the outcome of this process can be straight-forward, predictable and similar from year to year. The process is more challenging in times of dramatic change when past performance can be a poor predictor of future success. Planning in such times is analogous to constructing a building on shifting ground.

Indeed, the ground on which we base clinical care for cancer patients is undergoing major shifts in not one, but two dimensions.

1)     We are experiencing major shifts in the overall health care environment including:

  • A healthcare system that is adjusting to the implementation of the Affordable Care Act (a.k.a. Obamacare).
  • Establishment of Accountable Care Organizations, which are designed to keep people well and not just take care of the sick.
  • Shifts in where patients receive their care based on approval from insurance companies and other payers.
  • Changes in reimbursement to health care providers and organizations.

2)     We are also seeing remarkable shifts in cancer care based on research advances including:

  • Use of molecular tools in the diagnosis of cancer, which is allowing us to determine the best treatment for individual patients.
  • Delineation of the complexity of cancer, which makes it impossible for even the best general oncologist to keep up with all the advances taking place. To give optimal care, we need faculty who subspecialize in specific cancers. They are up to date on (indeed in many cases to have participated in) the latest research in specific cancers and can bring the resulting advances to patients right away.
  • Recognition of the value of interdisciplinary decision making. Our faculty—including medical oncologists, surgical oncologists, radiation oncologists, pathologists, radiologists and others—need to work side by side in the clinic, and discuss patient care at tumor boards, so each patient can get the best possible care based on the joint expertise of the whole team.

In order to deal with these shifts in how we care for patients, we need open communication throughout the organization related to how we are responding to the changes that are taking place.

We need creative thinking. New investments, including some untried approaches, are needed to help us deal with the changes taking place. It can be difficult to identify precise financial metrics or predict return on investment for new concepts when the ground is moving underneath. This should not prevent us from trying them.

We need a balance between the financial bottom line of the organization and the need for investment in the long term with new programs and initiatives that address the rapidly changing environment.

Our ongoing efforts include:

  • Adopting new technologies and clinical practices quickly as research demonstrates their value.
  • Adjusting to an environment where multiple departments are not working in silos but are working together to provide interdisciplinary, personalized, precise cancer care.
  • Informing community physicians and the public at large about the unique services available through our academic cancer center.
  • Establishing new partnerships with community physicians so patients can receive as much care as possible close to home, while also having access to the interdisciplinary expertise, skills, and technologies only available at our academic cancer center.
  • Assuring patient safety, quality of care, service excellence, and efficiency are enhanced despite the rapid shifts taking place.

Every organization goes through a budget process. Indeed, we are at a key point in our budget cycle right now. With all the shifts taking place, it is more important than ever that we do so with open communication, creative thinking, and balance. That is the only way to successfully build for the future on shifting ground.