COA Practice Impact Report Details Consolidation, Shift of U.S. Cancer Care System Into More Expensive Hospital Setting
Community Oncology Alliance (COA) Practice Impact Report Data Shows 1,653 Clinics and/or Practices Have Closed, Been Acquired by Hospitals, Merged, or Reported Financial Struggles Since 2008
Misguided Public Policies of 340B and Sequester Continue Decade-Long Push and Pull of Cancer Care into Hospital Setting
The Community Oncology Alliance (COA) today released the 2018 Community Oncology Practice Impact Report which tracks data on the changing landscape of cancer care in the United States. It details a decade long trend of closure and consolidation in the U.S. cancer system that has resulted in a dramatic shift of cancer care into the more expensive hospital setting. The report was released today at the 2018 Community Oncology Conference.
The 2018 Practice Impact Report data show that, over the last decade, 1,653 community oncology clinics and/or practices have closed, been acquired by hospitals, undergone corporate mergers, or reported that they are struggling financially. An average of 3.5 community oncology practices have closed per month, a rate that remains unchanged since the last report issued in 2016. Overall, 13.8 practices per month have been affected by closings, hospital acquisitions, and corporate mergers since 2008.
The 2018 Community Oncology Practice Impact Report data shows:
- 423 clinics closed — Individual clinic treatment sites that have closed.
- 658 practices acquired by hospitals – Practices (typically comprised of multiple clinic sites) acquired by a hospital or, with less frequency, have entered into a contractual professional services agreement binding them to a hospital.
- 168 practices merged or acquired – Practices (typically comprised of multiple clinic sites) merged or acquired by a corporate entity.
- 359 practices struggling financially – Practices (typically comprised of multiple clinic sites) having financial difficulties, struggling to pay bills and/or stay open.
- 45 practices sending patients elsewhere – Practices (typically comprised of multiple clinic sites) sending their Medicare patients elsewhere for chemotherapy.
“The shifting and shrinking community cancer care system reduces access to cancer care, inflates spending at the more expensive hospital setting, and is a disservice to patients, their caregivers, and support networks,” said Jeff Vacirca, MD, CEO of New York Cancer Specialists and president of COA. “Patients deserve accessible and affordable cancer care in the communities where they live and work. Community oncology practices provide that now, and they do it exceedingly well. But as long as policymakers continue to allow misguided policymaking that has the unintended consequences we see in this report, community oncology practices may not be here tomorrow to provide that kind of care.”
Since the last Practice Impact Report in 2016, the data show an 11.3% increase in the number of community cancer clinic closings and an 8% increase in the number of consolidations into the hospital setting. COA notes that the number of practices struggling financially has declined by 7.9% which is proportional to the number of practices that have been acquired or moved into the hospital setting. At the state level, the largest number of closures is again in Florida (47), followed by Texas (43) and Michigan (36).
Studies by Avalere, BRG, Milliman, and The Moran Group have shown both the higher cost of cancer care delivered in the hospital setting and the impact of the 340B drug discount program. It is noteworthy that despite the severe pressures facing community cancer clinics, they lead the way in enhancing the quality of cancer care and controlling costs through new care delivery models, such as the Oncology Medical Home and Oncology Care Model.
COA notes that the trends are reflective of the push and pull of misguided public policies on cancer care. On one side, practices are facing enormous operating pressures because of the ongoing 2% sequester payment cut to Medicare enacted by the Centers for Medicare & Medicaid Services (CMS) in 2013. Many oncology practices have not survived or are struggling to survive under the sequester cut to Medicare drugs that often brings reimbursements below drug costs. In fact, COA notes that since the sequester went into effect, 135 cancer treatment clinics have closed (46.9% increase), and 189 practices (with multiple clinic locations) have been bought by hospitals (40.3% increase).
On the other side, community oncology practices face the economic pull of the 340B Drug Discount Program which some hospitals abuse to make tremendous profits without benefitting patients in need. Today, there is widespread, independent evidence that the 340B program is out of control as highlighted in the findings of a recent, independent study in the New England Journal of Medicine and an exhaustive two-year investigation by the United States House Committee on Energy and Commerce. Because of the high volume of cancer drugs covered by the 340B program, hospitals have been buying up or forcing independent community cancer clinics out of business. Indeed, the 2018 COA Practice Impact Report shows that 658 practices – often comprised of multiple sites – have been acquired by hospitals.
“No one can look at the Practice Impact Report trends and say that there hasn’t been a clear and negative dismantling of our cancer care system over the last decade,” said Ted Okon, executive director of COA. “This situation is the direct result of the misguided 340B and sequester cut allowed to take place by our elected officials in Washington. The pressures of these misguided public policies have been a one-two punch, pushing and pulling community oncology practices to close, consolidate, or be acquired by hospitals, all at the expense of patients.”
This is the seventh COA Practice Impact Report and covers activity for a ten-year period, from January 2008 through February 2018. Compiled by COA from public and private data sources, it provides a unique look at community oncology trends at both the national and state levels.
The COA Practice Impact Report was released today at the 2018 Community Oncology Conference. The theme this year is “Keeping Patients at the Center” which is reflected in all sessions across the conference’s four distinct agenda tracks with content covering clinical, business, pharmacy, and patient advocacy. Featured keynote speakers include Scott Gottlieb, MD, the 23rd Commissioner of the U.S. Food & Drug Administration, and Mark Herzlich, author, Super Bowl championship linebacker for the NFL’s New York Giants, and a cancer survivor who was treated in the community setting. The largest community oncology conference ever, this year nearly 1,500 oncologists, allied health professionals, advocates, payers, employers, and industry partners are meeting for two days of learning and networking at the Gaylord National Harbor outside of Washington, DC.