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 Oncology Symposium.
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 Institute.
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.