Nearly every American’s life has been touched by cancer in some way. The American Cancer Society estimates more than 2 million people will be diagnosed with cancer in 2025, with over 171,000 of those cases in Florida.
As an oncologist to the Florida community, I have seen that access to treatment, cost of care, and being close to supportive family and friends are critical factors in a patient’s fight against cancer.
Community oncologists are focused on building trust with patients. We excel in delivering high-quality, patient-centered care, supported by the latest advancements in research and technology, while allowing patients to stay near their loved ones.
The option to pick a health care provider built around these principles should be a no brainer. Unfortunately, patients’ access to cancer care, close to home, in their communities, has decreased as many local practices across the country have struggled financially.
Medicare reimbursement rate cuts have taken a toll as the costs for drugs, salaries, and equipment have increased. This is especially impactful in Florida, where we have the second highest number of Medicare enrollees in the country.
As a result, a large and growing number of physician-led community-based practices across the country have been rolled up into large hospital systems just to stay afloat.
This trend has not only shifted clinical decision-making away from local, independent physicians towards more distant health systems and academic medical centers, but it does so at a significantly higher cost.
Cancer care providers in local communities must have financially viable options to maintain their practice and care for their patients beyond closing their practices or selling to distant hospital systems.
Studies comparing cancer treatment by providers in the community to cancer treatment in hospitals show significant benefits of community-based care. Patients treated in a community setting were 28% less likely to visit the emergency department in the 72 hours post-treatment.
Additionally, a study I co-authored in the Journal of Oncology Practice found that patients with breast, lung, and colorectal cancers faced increased costs of care in a hospital setting versus a community-based clinic, where costs are a staggering 40-50% lower on average.
Oftentimes, a hospital’s competitive advantage is driven in part by unlevel reimbursement and their ability to participate in the federal 340B drug discount program.
In fact, 340B has become a huge profit-driver for hospitals, which utilize the discount program and retain the difference between the deeply discounted 340B price and insurance reimbursement. Recent research shows that price markups on drugs at 340B-eligible hospitals were nearly 7 times higher than in independent physician practices.
Though the intent of the 340B program is laudable in the context of serving indigent patients, if a community oncology practice is acquired by a 340B hospital system, it suddenly becomes a huge source of financial advantage creating unfair competitive forces in the market.
Hospital and health system ownership of oncology practices more than doubled between 2007 and 2017. In Florida alone, 36 community oncology practices were acquired by hospitals between 2008 and 2020. Today, 50-60% of US cancer care physicians are affiliated with more expensive site of care, a hospital system.
Unfortunately, some hospitals have used their considerable advantages to squeeze independent, community-based oncology practices on both sides, offering community oncologists significant money to sell their practices while threatening dire consequences for the practice and its patients if they reject an offer, such as revoking their admitting privileges at the hospital.
Hospitals are capitalizing on these pressures, leading to ongoing consolidation. The impact to patient access to care is severe, chiefly in rural and or less affluent areas.
One way community-based oncologists and cancer care can relieve the financial pressure to join hospitals and instead maintain their independence and community presence is working with practice management organizations.
These organizations handle a practice’s administrative obligations, such as keeping up with medical billing and collections, managing office staffing, and ensuring that the practice’s locations have access to medical supplies and leading-edge drugs at a competitive cost.
This allows healthcare providers to remain independent and do what they do best: Take care of patients.
Community oncologists should not be left with the choice of closing their practice or joining a large hospital system, which increases the cost to all stakeholders. This path significantly reduces access to care and curtails competition.
We must ensure that oncologists have viable opportunities to maintain their independence and practice in their communities. Creating a level playing field for such opportunities involves offering community-based practices fair Medicare reimbursement rates and allowing providers to optimize their business operations.
We can achieve greater efficiencies for practice operations while giving local doctors and patients the last word on healthcare decisions.
Dr. Lucio Gordan is a practicing medical oncologist in Gainesville, Fla. He serves as President & Managing Physician of Florida Cancer Specialists & Research Institute, LLC.
