Survival of Community Oncology Hinges on Unity, Strong Voice

March 2022 Vol 13, No 3


Community Oncology

Fifty-five percent of cancer care is delivered in the community and alternate local sites of care around the country today. Community-based cancer care remains at the core of the community cancer care delivery system. A panel moderated by Barbara McAneny, MD, CEO, New Mexico Oncology Hematology Consultants, explored the road ahead in balancing value and delivering optimal access to care.

The impact of a declining physician fee schedule on independent practices, while at the same time hospitals receive a 2.5% to 3% yearly increase under the Medicare Economic Index, was the first topic discussed. With the advent of price transparency comes the recognition that hospital care is far more expensive than community oncology care, pointed out panelist Jeff Patton, MD, CEO, OneOncology and executive chairman of the board, Tennessee Oncology. “Where in this country do you have the high-quality, low-cost provider being disadvantaged by the system?” he asked. “It makes no sense.” To this end, community practices must promote that the care delivered there is equal to that provided by hospitals.

On the radiation oncology side, the site neutrality provision in the Centers for Medicare & Medicaid Services (CMS) Radiation Oncology Alternative Payment Model (APM), along with price transparency, may work in favor of community practices, said Vivek Kavadi, MD, chief radiation oncologist, The US Oncology Network. The CMS Radiation Oncology APM advances a prospective, episode-based payment methodology to address coding and payment challenges and to promote value over volume of services while preserving or enhancing quality of care.

The solution is to prepare for opportunities around the corner, when properly prepared physician organizations can take advantage of a more rational healthcare system, said Edward J. Licitra, MD, PhD, chairman and CEO, Astera Health Partners/Astera Cancer Care. “Unfortunately, physician practices and physicians in general have not done what’s necessary to come together and march as a single army,” he said. “We try to create a model where physicians want to be part of the team, which allows us to have a bigger seat at the table. Coupled with our ability to continuously innovate across the entire organization, I’m hopeful it will allow us to survive long enough so that we will be able to benefit from a reorganization of the healthcare market.”

“We see the absurdity of what comes out of Washington all too often…the fee schedule cuts, the complete lack of transparency from hospitals,” said Nick Ferreyros, director of communications, Community Oncology Alliance (COA). “The real message and takeaway that community oncology has figured out over the last few years is that without a strong voice, without having boots on the ground, and without getting into politics, you end up being a passive victim to the whims of politicians and these political games. You end up being a football with budgetary games, like the fee schedule. That’s not a position you want to be left in.”

Dr McAneny wondered how community oncology can preserve its referral base in an era when referral networks (ie, primary care) are being bought by hospitals. “We created National Cancer Care Alliance as a way to try to allow practices to be small and nimble in their own market when they need to be small and nimble, but still have some economies of scale, and to be sizeable when it’s useful to be sizeable,” she said. “But I found that the number of single specialty med/onc practices seems to be shrinking rapidly. We need collaboration with radiation oncologists obviously, but we’ve added urologists, and EMT, and pulmonary docs, and others into our practice to be able to try to solidify that part of the market.”

Helping small practices in rural areas in OneOncology’s network become sustainable is a challenge, said Dr Patton, as commutes for clinicians can be long. He related that a physician recruiter at OneOncology spoke to every medical oncology fellow in the country last year, placing 70 across the network. “Scale affords you resources that you wouldn’t have as an individual practice,” he said. “We have been able to recruit physicians to practices when they join us that have been looking for somebody for 2 or 3 years.”

Mr Ferreyos said that COA reaches out to all fellowship programs across the country. “We’ve built a great relationship with them,” he said. “Pre-COVID, we would go and have dinners with the fellows and have a local community oncologist come and talk about what life is like in independent practice.”

Risk Sharing

The discussion turned to risk sharing and its impact on community oncology. The CMS Shared Savings Program moves CMS’ payment system away from volume and toward value and outcomes. It is an alternative payment model that promotes accountability, coordinates items and services for Medicare fee-for-service beneficiaries, and encourages investment in high-quality and efficient services.

“None of the data show that risk is working,” said Dr McAneny. To take on risk, community practices must have reserves to manage a financially bad year, but unfortunately, most do not, she said.

A value-based process that has the potential to destroy the infrastructure of care delivery needs to be rethought, she added. A structure to manage risk, or to switch the conversations from risk to accountability to prove that community oncology is delivering quality care, is needed. “One of the challenges of community oncology going forward is figuring out how we’re going to manage risk and survive,” she said.

“Scale matters,” said Dr Patton. “Once you get big enough, you can afford stop loss insurance. It’s not that expensive. Tennessee Oncology has stop loss for the oncology care model, and it’s not that expensive. You underwrite your risk as opposed to having reserves. You off-load and buy an insurance policy. It’s a lot easier. There are ways to take on risk.”

I am very intrigued at the idea of taking on risk,” said Dr Licitra. “At OneOncology, we’re developing a platform for how we would do that. It obviously takes the integration of lots of tools and assets, and cross-disciplinary teams to figure it out.” Taking on risk and having yourself as a comparator from year to year is difficult, he said.

“There’s a huge opportunity if we create a healthcare market, and our costs are pegged against others within that market. I think we could really do some meaningful work there,” he said.

Last modified: August 10, 2023

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