Bruce J. Gould, MD
On October 4, the Community Oncology Alliance (COA) released the 2016 Community Oncology Practice Impact Report, which tracks the changing landscape of cancer care in the United States. It documents a 121% increase in community cancer clinic closings and a 172% increase in consolidation into hospitals since 2008. In that period, 380 cancer treatment facilities have closed and 609 community cancer practices have been acquired by or become affiliated with hospitals. Another 390 practices report they are struggling to stay open due to financial stresses.
Sixth Report in the Series
This is the 6th Community Oncology Practice Impact Report in the series, and it covers activity for a 9-year period, from January 2008 through September 2016. It notes that the monthly rate of community oncology practice closures has increased 87% since the previous practice impact report.
“In the 9 years since this report was first issued, 1,581 community oncology practices have closed, been acquired, merged, or are struggling to stay open. An average of 3.6 practices have closed per month since COA began tracking these data,” said Bruce J. Gould, MD, President and Medical Director of Northwest Georgia Oncology Centers in Marietta, Georgia, and President of COA. “Treatment advances like oral drugs and immunotherapy have the potential to save lives. That will not matter if patients can no longer afford care or if care simply disappears from their community.”
In the 9 years since this report was first issued, 1,581 community oncology practices have closed, been acquired, merged, or are struggling to stay open.— Bruce J. Gould, MD
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“We are witnessing the dismantling of the best cancer delivery system in the world when the Cancer Moonshot calls for the exact opposite,” said Ted Okon, Executive Director of COA. “It is no coincidence that this aligns perfectly with the enormous growth of the 340B program and misguided government experiments that continually ratchet down reimbursement. Policymakers should be alarmed at the real-world impact DC has had on community oncology and particularly think twice about the proposed CMS Part B experiment on cancer care. This must stop before it is too late. As the Baby-Boomers age and the number of survivors increases every year, lives depend on a strong community cancer care system.”
Compiled from public and private data sources, the 2016 Practice Impact Report provides a unique look at community oncology trends at both the national and state levels. The states with the largest number of closures are Florida (37), Texas (36), and Michigan (34). The states with the most practices struggling financially are Michigan (43), New York (41), and California (40). Detailed data for all states are included in the report.
Consolidation and hospital acquisition place an additional burden on the nearly 20% of Americans living in rural areas. If the only community cancer clinic in those areas closes or is acquired by a hospital, local care may no longer be available. A morning treatment evolves into a daylong excursion. Access-limiting consolidation and closures make that scenario increasingly prevalent.
We are witnessing the dismantling of the best cancer delivery system in the world when the Cancer Moonshot calls for the exact opposite.— Ted Okon
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The trend of closures and consolidation of community oncology clinics into the hospital setting has had a significant and permanent impact on patient access to local, affordable cancer care. The most profound effect has been the hospital acquisition of community oncology practices, which has been fueled by the 340B drug discount program. Originally intended to support hospitals serving high numbers of indigent patients, instead, the 340B program has created a profit motive for hospitals to obtain community oncology practices.
Additionally, disparate site payment policies that reimburse hospitals more for the same cancer care they can receive in community practices, has contributed to this shift. The result is that patients pay up to 53% more when they receive hospital-based cancer care vs care in a physician office setting. That cost is borne by both the patient and the system, most often Medicare. In 2014 alone, Medicare spending would have been about $2 billion lower if the site of chemotherapy had not shifted to the hospital setting.
Studies by Avalere, BRG, Milliman, and The Moran Group1 for COA have shown both the higher cost of cancer care delivered in hospital settings and the impact of the 340B drug discount program.1
The complete 2016 Community Oncology Practice Impact Report is available at http://www.communityoncology.org/2016-coa-practice-impact-report. ■
1. Various Community Oncology Alliance studies. Available at http://www.communityoncology.org/home/studies/. Accessed October 4, 2016.