ORLANDO"Even with 1.2 million new cancer cases diagnosed each
year, 4.5 million cancer patients, and cancer the costliest disease,
there are still more oncologists out there than we need," said
Harold Wodinsky, vice president of managed care and network
development for EquiMed, Inc., a national multispecialty physician
practice management firm.
With oncologists scrambling for position in this new marketplace,
"consolidation is inevitable," he said at a conference
organized by International Business Communications. "I predict
that there will be only three or four major physician practice
management players in the oncology market by the year 2000."
In fact, such consolidation of providers is becoming more widespread,
with numerous types of networks and alliances currently in operation.
Mr. Wodinsky cited both publicly traded and private equity
affiliations (in which the physician has a financial stake in the
network) as well as a long list of nonequity networks such as IPAs
(independent practice associations), PPOs (preferred provider
organizations), HMOs (health maintenance organizations), PHOs
(physician hospital organizations), MSOs (managed services
organizations), and something he referred to as OWAs ("other
It is increasingly common to see an individual, group, or university
or comprehensive cancer center sponsor a network of providers, Mr.
Group affiliation models include solo subspecialty oncology groups
consisting solely of either medical oncologists or radiation
oncologists; multisubspecialty oncology groups that can include both
medical and radiation oncologists; and multispecialty primary care,
internal medicine, and other physician groups that include
oncologists in their network.
Advice for Networks
Mr. Wodinsky cited a number of factors essential to the success of an
oncology alliance. First, he advised, make an effort to work through
ego issues. Expect problems with differing reimbursement
methodologies in the same network, such as both fee-for-service and
capitation, and try to align them. It's also critical, he said, to
bind participants together with "glue" such as stock shares.
Make an effort to involve physicians in running the network, to avoid
creating a "bureaucratic monster," and find reasons to
persuade providers to join. "Trust is incredibly important,"
he said. "Networks and providers have a fiduciary
responsibility to each other."
On the other side of the contracting table, the oncologists receive
certain benefits from networks they join (see below). Optimally,
they'll have access to financial, clinical, and operational systems;
managed care contracting expertise; physician profiling data;
corporate services such as marketing, strategic planning, insurance
and employee benefits, and practice consulting; and capital for
expansion or purchasing new technologies.
Potential Benefits to the Oncologist of Joining a Network
Alliances can also offer participating providers ancillary services
such as labs and diagnostic imaging, home care and alternative site
treatment, hospice care, psychological services, pharmacy benefit
management, stem cell technology, and disease management programs.
Not so optimally, Mr. Wodinsky added, oncologists may also have to
contend with unwanted intrusion into their offices and practices.
With so many types of alliances available, Mr. Wodinsky said, the
important thing is to study the situation and choose one of them,
"or someone else will choose for you. In the next few years, the
only thing that won't remain constant is the status quo."