For the oncology profession, the transition period to managed
care will mean new relationships with other providers, some loss
of control over patient care, and the need for practice and ethical
guidelines, concluded panelists participating in a session on
managed care at the Association of Community Cancer Centers' 1995
A number of new relationships are forming, including joint ventures,
preferred provider relationships, carve-outs, and management services
organizations, said Lee E. Mortenson, DPA, executive director
of the ACCC. "The number of entities in the health-care marketplace
will decrease as physician groups join with others and with hospitals.
Ultimately, there will be fewer providers of care," he said.
To control costs, some managed care organizations may decide to
keep cancer patient care with primary care physicians as long
as possible, said David K. King, MD, chairman of the ACCC Ad Hoc
Committee on Reimbursement and a Phoenix oncologist.
"As specialty caregivers, we can follow that population much
more efficiently than a primary care physician," Dr. King
said. "We know what to look for, what tests are and are not
needed. With the provider at risk in a managed care contract,
there are no guarantees that the patient is going to get all the
care that he or she needs."
Dr. Mortenson pointed out that in markets undergoing the transition
to managed care, it is possible that an oncologist will see a
patient during the first half of the course of treatment, with
the patient going to another physician for management of the second
half of treatment.
Physician behavior may also change with capitation, Dr. King said.
A physician who might previously have treated a cancer patient
aggressively from the onset may now think twice about it and may
need to call for permission to perform the treatment.
The changes that managed care is forcing on physicians really
may be a "wonderful opportunity to improve the delivery of
cancer care," said Barry Lembersky, MD, board member of the
Pennsylvania Oncologic Society and assistant professor of medicine
at the University of Pittsburgh Medical Center's Pittsburgh Cancer
Dr. Lembersky said that practice guidelines will be "more
important than ever. Ethically, medically, and fiscally sensible
guidelines need to be developed." Dr. Mortenson agreed, saying
that guidelines will help ensure that quality oncology care-using
the multidisciplinary approach that oncologists believe works
best-continues to be available to cancer patients.