WASHINGTON--Managed care holds tremendous opportunities for oncologists
who are able to restructure their practices to meet the challenge,
Merrick Reese, MD, said at the Association of Community Cancer
Centers (ACCC) meeting.
Dr. Reese, of Physician Reliance Network, a Texas-based oncology
practice management company, believes that the aim of oncology
practices should be cancer management, in which care is provided
from the time of diagnosis, through active treatment and follow-up,
and ending with the patient's re-entry into primary care.
In such a system, the oncologist becomes the gatekeeper, in effect,
the primary care physician, for the cancer patient, which eliminates
barriers to referral and avoids fragmentation of care, he said.
Such a strategy means forming multispecialty physician networks
and bundling all the services the cancer patient requires into
one entity for purposes of contracting with plans seeking to "carve
out" their oncology services.
Such contracts could include all the medical oncology inpatient
and outpatient services, pharmacy and diagnostic services, radiation
therapy and professional technical services, and all hospital
days not related to surgery, although he expects oncologists eventually
to be able to include the cost of surgery in their capitation
He also warned that if oncologists don't take the lead in forming
cancer management groups, they may be left behind, as psychiatrists
were when investors and psychologists joined together to provide
substance abuse management and mental health services to managed
Dr. Reese believes that such integrated physician networks will
also play a major role in clinical trial management. For example,
the Physician Reliance Network was asked by a major pharmaceutical
company to provide 25 patients for a trial within 6 months, and
was able to provide 50 patients in 4 weeks. "I think that
really got their attention," he said.