CPC & CBEx Session Preview: Updates from Washington, Healthcare Industry Consolidation, and Cancer Care at Home

CPC & CBEx faculty member Barbara McAneny, MD, CEO of New Mexico Oncology, gives a preview of her three featured sessions from the conference, including key points on health care industry consolidation, legislative updates, and important considerations for delivering cancer care at home. Learn more at www.clinicalpathwayscongress.oncnet.com.

Transcript:

Dr McAneny: I have the honor to participate at this meeting in a session on consolidation of the market, which I think is a significant problem in health care today, and I have the opportunity to talk about physicians taking risk, and what that means for the health care ecosystem and a third panel on infusions in the home.

What are you most excited about sharing with attendees from each session?

Dr McAneny: So consolidation was originally seen as a way to control health care costs by aggregating everybody under one umbrella organization, thinking that that organization would then improve interactions between physicians and the rest of the team, and with lower costs. But, in fact, what we found is exactly the opposite is true. That costs go up, access goes down and quality sometimes stays the same, but often it's lost. And communities have less input into what their hospitals are focused on when the hospitals are part of a major system. So all in all this has been a failure. Consolidating the market has not saved money. It's cost more, and quality is not as good.

What are some of the most important developments from Washington that you expect will have a major impact on community oncology practices?

Dr McAneny: I think the major thing that is going to damage community oncology practices that came out of a FAQ issued by Medicare, by CMS, in December of 2022, was that we are no longer able to mail prescription models to our patients, or even have their caregiver or spouse come and pick up the bottle when they don't feel well enough to come to the office and pick it up. Medicare decided that this was a Stark violation, and Stark would put a practice out of business if that statute were violated, and so patients often have to travel hours and often don't feel well enough to to come and get their own medicines. So the idea that we're gonna make them get out of bed, come to the office, pick up their own medicine, spend all their time and effort getting their medicines, benefits no one. So I don't see why that should be a Stark violation. We're hoping that Congress is going to fix this and say that my delivering a bottle of pills to the patient's caregiver has nothing to do with Stark.

What do you see as the biggest impact on cancer care from health care industry consolidation?

Dr McAneny: Prices go up, access goes down, and we're squeezing out the community oncology setting. So community oncologists are paid about one half to 2 thirds of the same price for the service if it's given in a hospital setting, same service, same quality, sometimes the same people, just from a different fee schedule. So consolidation has made community oncology less viable and more integrated into the hospitals. And that's the bad thing. The other thing to consider is, during COVID, when hospitals were overwhelmed doing their core function, which is taking care of acute illness, they also took down the chronic disease management part of health care for those practices that had already been assimilated into hospitals. And when that happened, people couldn't get cancer care, they couldn't get their cardiac care. They could get nothing done. And we in the community stayed open during COVID, we continued to treat patients. So the consolidation has really been demonstrated to be bad for access to care.

Plus, I'll add in that patients are going broke from care. Two-thirds of bankruptcies are triggered by a health care event so increasing the cost of health care by billing the patients under the hospital outpatient perspective payment system and therefore increasing their copay is a big step in the wrong direction.

What are some of the main benefits and challenges of cancer care at home?

Dr McAneny: Well, everyone who lives in a nice, clean home that's a safe environment would love to have the convenience of not having to go into an office or a clinical practice to get their infusion. However, they're only comfortable with that until they have an infusion reaction, which can happen at any time. When we're treating people in the office, and there's an infusion reaction, we have a physician on site, we have pharmacists, we have oncology-trained nurses, we have an entire staff ready to assist that patient in overcoming that infusion reaction. Sometimes it takes extra drugs to treat it. If the patient is at home by themselves, with one nurse, they're gonna be in trouble with that infusion reaction. So I think there's a lot of safety issues in infusions at home, and I am strongly opposed to giving chemotherapy in the home.

Is there anything else you would like to add?

Dr McAneny: When we're thinking about chemotherapy in the home, the people that will benefit from this most are going to be the affluent who live in nice neighborhoods and nice clean homes. I take care of a lot of poor people who don't live in the best part of town or live out on the Navajo reservation. They don't have running water. They don't have cell phone service. Sometimes they don't have electricity or land lines. I don't see anybody planning to give them chemotherapy in their home. So this is gonna be one more way that the rich get a different kind of care than people who are poorer, and that will not be a fair distribution of health care resources. Plus, there's a limited number of health care nurses who are oncology certified to give chemotherapy. If someone is sitting in my office giving chemotherapy, they can treat 7 to 10 patients during the course of that day. If they're out driving for an hour to get to one patient and then driving back for another hour. They can maybe treat 3 patients that day. So that's lovely for the patient who's sitting at home and didn't happen to have an infusion reaction, but what about those other patients who can't access care because we don't have enough nurses to deliver that care?