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Alternatives to Fee for Service Involve Risks

Alternatives to Fee for Service Involve Risks

To do better than merely survive under managed care, oncologists
who are accustomed to fee-for-service practice must plan new strategies,
particularly if they expect to stay in practice more than a few
more years.

Oncologists, like other specialty physicians, will be more likely
to preserve their professional integrity in this new era if their
skills in making business decisions are on par with their clinical
skills in evaluation and management. Thus, they should be aware
of the risks and benefits involved when choosing an alternative
to private practice.

First, however, oncologists ought to ask themselves why they need
to change.

A majority of oncologists have cared for patients without regard
for cost, because costs were borne by third parties. Oncologists
achieved high quality aided by a broad latitude of clinical choices
that permitted high variability in clinical practice and innumerable
paths to the same end--a paradise for individual practitioners,
the opposite for anyone trying to simplify choices in oncologic

Indeed, oncology may be an extreme example of variability in medical
practice, given the wide range of methods of diagnostic evaluation,
therapeutic intervention, and palliative support. Treatment objectives
have also varied widely. The intense economic scrutiny of the
current era has forced us to recognize that latitude of choice
is, in itself, costly.

In the current environment, a rapidly growing segment of the health-care
budget is controlled by economic managers intent on reducing the
disproportionate growth in the cost of health care with respect
to the gross national product. Managers regard the escalation
in diagnostic and therapeutic choices as a major cause of the
current crisis.

These health-care managers may be expected to exert pressure on
oncologists because of the costs of hospitalizations, outpatient
interventions, and supportive care. They will cite high relapse
rates, ineffective therapies, and fatal outcomes in defense of
budgetary cuts.


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