Why community oncology matters

Pharmaceutical CommercePharmaceutical Commerce - March/April 2013

Oncology is the market for today's pipeline products. Here's why the community setting needs to be preserved as a primary site of care to administer those products

I have a friend who is a two-time cancer survivor—breast cancer in 2001 and pancreatic cancer in 2010. Both times she had the option of seeking care at an academic medical center or another, more renowned facility. Both times she chose her local community practice to provide a successful course of action.

But that’s not why I believe in community oncology.

At ION Solutions, we had a physician member who served patients in rural Montana. Every month, he would crisscross the state in a small plane (at his own expense) to make sure cancer patients had access to care near their homes.

But that’s also not why I believe in community oncology.

I believe in community oncology because anecdotes and analysis both show definitively that patients receive quality care at appropriate costs in cancer clinics located right in their neighborhoods. Community oncology delivers greater access, high quality and lower costs when compared to other sites of care.

So why are community practices under fire? Why do there continue to be discussions around Medicare cuts that would reduce reimbursement in the community setting from ASP+6% to ASP+4%—effectively cutting physician reimbursements on drug costs by one-third? Haven’t community oncologists done enough to demonstrate their value?

Let’s look at the metrics.

When it comes to patient access, community oncology rules the day. More than 70% of patients nationally receive cancer care in community practices. The wait time between diagnosis and initial chemotherapy visit is 7% shorter at community practices. And this applies in both urban and rural areas.

When it comes to quality of care, community oncology shows compliance with national, evidence-based guidelines across many common cancer types: from breast and colon to prostate and melanoma.

When it comes to the cost of care, we see significant cost savings in multiple scenarios. One report stated that patients managed in an office setting are 24% less costly than hospital-managed patients for common cancer types, and that office-managed patients had fewer hospitalizations during chemotherapy. Another report showed the mean chemotherapy costs across all regimens for breast, lung and colorectal cancers were significantly lower for office-managed patients.

All of this is not to disparage hospital-based care or academic medical center-based care. Quality care can be found across all types of provider organizations.

What I’m saying is that patients deserve a choice in where they receive care, and physicians deserve a choice in where they practice care. With proposed reimbursement and cost-cutting measures, that choice is being threatened. More than 700 community practices merged with other sites of care or closed altogether in the last few years. Patients are having to travel farther and wait longer to receive treatment—a troubling trend for the manufacturers who make the cancer drugs, the providers who administer them and most of all, the patients who receive them. These trends will accelerate unless legislators and policymakers recognize how important community practices are in the care delivery process.

To help community oncologists band together and present an unmistakably clear message of quality and value to payers, patients and government agencies, we are working with our customers on a campaign called Community Counts (www.ourcommunitycounts.org). This physician-led movement educates and advocates about what community practices contribute to both the quality and economics of oncology care.

Practices can access validated data that speaks to their cost-efficiency and positive patient outcomes. They can then take this data personally to their legislators or use an online tool to contact those lawmakers directly.

The goal is to give practices a single, unified and loud voice to communicate the reality of what they face and why it matters for the community setting to be preserved in cancer care—why it matters for the providers, for payers, for manufacturers and most of all, for patients.


Dr. Barry Fortner is senior vice president of operations for ION Solutions, part of AmerisourceBergen Specialty Group, where he works to develop relationship models that benefit the provider, the payer and the patient. Dr. Fortner holds a Ph.D. in clinical psychology from the University of Memphis.

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