ORLANDOCommunity oncologists have a number of options in
attempting to maximize their position in the managed care
environment, said Myron H. Goldsmith, MD, executive director of
development for the City of Hope Oncology Network, Los Angeles.
But to make the choice, the physician must weigh a number of factors,
including his or her age, type of practice, income needs and goals,
autonomy and governance issues, geographic aspects, and practice
philosophy (conservative or aggressive).
"It is also important to look at market issues, paying attention
to what's happening in a particular area. Is the market saturated
with oncologists, or are they scarce?" Dr. Goldsmith said.
Finally, he noted, economic issues related to equity and risk must be examined.
Patients Stick With HMOs After Cancer Diagnosis
HMO memberships are soaring, and, surprisingly, many of these
According to a recent study conducted by the Office of Research and
In fact, after having their cancer diagnosed, patients are less
The study, Dr. Goldsmith noted, calls into question the conventional
Speaking at a conference on managed oncology care organized by
International Business Communications, Dr. Goldsmith outlined a
number of possible strategies for the community oncologist:
Contracting with a managed care health plan (or plans)
- Contracting with a large local multispecialty
- Merging a solo practice with a group practice
- Merging a small group into a larger group
- Forming local or regional single specialty IPAs
(independent practice associations)
- Developing an alliance with a local hospital
- Joining a national, regional, or local specialty network
There is no one right choice. Each option has advantages and
disadvantages, he said. For instance, the advantages of a PHO
(physician hospital organization) are the joint contracting strength
of the combination and the fact that physicians remain in control of
their non-PHO-contracted patients.
On the other hand, doctors and hospitals often have different
objectives regarding managed care (for example, filling hospital beds
versus using outpatient alternatives). Differences related to
control, utilization management, quality assurance, and provider
selection can also arise, Dr. Goldsmith noted.
Multispecialty medical groups offer both primary and specialty
physicians, which is a marketing advantage. However, payers must be
willing to accept the cost and quality of all group physicians.
Groups also tend to be dominated by one particular specialty, and
when contracts are terminated, there is a disruption in patient care,
an aspect of special concern to oncologists and their patients
because of the serious and emotional nature of the disease.
'Networks Are Hot'
One of the most active trends in oncology today involves the
formation of networks. "Oncology networks are hot," Dr.
Goldsmith said. Physicians who decide to affiliate with other
oncologists can choose from among a variety of publicly-traded and
non-publicly-traded networks, national, regional, or local.
There are also a number of what Dr. Goldsmith called hub-spoke
models, in which community oncologists are aligned with tertiary
cancer centers. Examples include the City of Hope Oncology Network
and networks involving cancer centers such as Duke, Fox Chase, M.D.
Anderson, and H. Lee Moffitt.
IPA or Equity Model?
Community oncologists who decide to join an oncology network need to
weigh the pros and cons of the IPA versus the equity model. Both have
benefits and liabilities, Dr. Goldsmith said, and the choice depends
upon which model works best for an individual clinician.
For instance, an IPA offers a high level of physician autonomy and is
relatively easy to establish. It also is less capital-intensive than
an equity-model network, yet offers the opportunity to grow and
develop market share quickly.
However, IPAs tend to have more difficulty keeping physicians in the
network because of their lack of financial investment. This can also
make it difficult to collect funding for high-cost expenditures.
Finally, without a cohesive culture and group commitment, doctors may
be less motivated to change their behavior to comply with practice guidelines.
An equity model, on the other hand, provides more structure and
control for the network itself while demanding a higher level of
integration, commitment, and risk-sharing from participating
physicians. In this model, the physicians have less autonomy but more
potential for network-generated earnings due to their financial
investment in the network.
An equity model is often better at controlling costs and managing the
overall system, Dr. Goldsmith said, and once it is established and
operating successfully, an equity network can attract high caliber
physicians, which ultimately benefits all participants.