For more than 2 decades, the guiding principle of the Medical Oncology Association of Southern California (MOASC) has been to ensure the continuation of the private practice of medical oncology and to provide the highest quality care to cancer patients. Founded in 1990, MOASC is the largest oncology society in the region and has approximately 300 members. For the past 7 years, Robert A. Moss, MD, FACP, has been MOASC’s President and has overseen the design and implementation of several initiatives to rein in health-care costs throughout California and maintain adequate reimbursement rates for community oncology practices.
The ASCO Post talked with Dr. Moss about the unique challenges his society faces and how it plans to meet them.
Health-care Policy Legislation
Is MOASC active in health-care policy legislation?
We partner with the Association of Northern California Oncologists and share a legislative lobbyist who gives us monthly updates on any relevant state legislation as well as information on budgetary issues that might affect us. For example, several years ago, then-Governor Arnold Schwarzenegger proposed an expansion of Medi-Cal (the state’s Medicaid health-care program) that called for a 2% revenue tax on physicians to help fund it. The theory was that because Medi-Cal would be expanded, physicians would benefit from having more patients through the Medi-Cal system.
We met with the Governor’s Senior Health Policy Advisor, Herbert Schultz, and explained that a revenue tax on oncologists would affect us disproportionally because so much of our revenue is based on drug costs, where we make very little profit. We also explained that that type of tax would pose an undue burden and result in many community practices closing their doors.
We made the point that because many Medi-Cal beneficiaries receive their health care through managed care plans, many oncologists not in the Medi-Cal physician network would be paying the extra tax but not have access to those patients in the managed care plans. The proposal was eventually scrapped, and we like to feel that we contributed to its demise.
The interesting thing about the conversation we had with Mr. Schultz was that I realized that many public policy decision-makers aren’t aware of what takes place in physicians’ offices and how policies like this can so adversely affect the practice of medicine. It was an eye-opener for me, and now I realize how important it is to make your voice heard and educate legislators about what is really happening in the health-care trenches.
MOASC on Physician-assisted Suicide
A legislative accomplishment we had more recently was the defeat of the physician-assisted suicide bill, which has come up in California several years in a row. I am particularly against physician-assisted suicide, as are my board members, and MOASC has come out against the bill each year.
Last year, the bill was modified and the physician-assisted suicide provision was removed. The new provision calls for physicians to provide hospice and palliative care information to patients with less than 6 months to live. The bill passed, and we hope that it will neutralize the issue of physician-assisted suicide in the future.
One of your major undertakings in 2012 was the creation of the MOASC Contracting Network. What is the purpose of that entity?
A few years ago, California was very hard hit by reductions in reimbursements by managed care health insurers, and many oncologists dropped Blue Cross—our biggest insurance payor—because it pays so little. We needed to come up with a way to solve the problem and negotiate reasonable reimbursement rates with the health insurers and find innovative ways to remove unnecessary costs. We decided to partner with P4, a division of Cardinal Healthcare, which creates payor and provider collaborations to realize both cost-effective and better quality patient care.
The idea is that we will develop our own clinical pathways and agree to stick to them about 80% of the time in exchange for insurers giving us an add-on on evaluation and management (E/M) codes. We did not ask for an increase in drug revenues as long as we were adequately reimbursed for the actual services we provide, to be able to maintain high-quality patient care.
We are in the process of developing those pathways now. We have established four areas for clinical pathways, including cancers of the breast, lung, and colon, and supportive care. We are now in active contract negotiations with several insurance companies. So far, we have 176 members signed on to the MOASC Contracting Network program.
Several years ago, we established the MOASC Purchasing Network, a nonprofit mutual benefit corporation, to help members by negotiating oncology drug prices as well as purchase supplies and equipment directly from manufacturers, distributors, retailers, and wholesalers. We’ve had about 200 members become part of that. We feel it’s a very good deal for our members because they get reduced prices on drugs through a group rate.
Making Practices More Viable
These efforts are all meant to support community oncologists in California?
Yes, we want to keep the office doors open throughout the state. We’ve had group practices bought out by large hospitals and seen several oncology practices close because of poor reimbursement. As a result, physicians are leaving the state. The only way to prevent that is to make community practices more viable. ■
Disclosure: Dr. Moss is President of the Medical Oncology Association of Southern California.