When Darwin, Kafka, Orwell and oncology can all be mentioned in one sentence

The days of auld lang syne are past. Welcome to the new world of oncology. Embrace it, and move along. Whether you like it or not, you must adapt. This is the message reported on page four of this month’s BAON, where we report on an Association of Northern California Oncologists oncology reimbursements seminar presented last month.

The future that was long discussed is now furiously present. In order to survive, oncology practices must stay lean and strong. Consolidations and mergers will occur. The weak will fail or merge into larger practices.

Code words of this new age are benchmarking, transparency, standardization, quality and pay for performance.

Tools of the new age are electronic medical records (EMR), data management, and ruthlessly efficient business management.

And the architects of the future of oncology include Medicare, Congress, third party payors and the pharmaceutical industry.

The community oncologist is now the manager of more risk than ever imagined. Pharmas set the ceiling with the price of drugs — and government (with private insurers closely in tow)--sets the floor with their reimbursements. In between lies the oncologist who must navigate a maze of regulations and requirements to get properly reimbursed. With leagues of accountants monitoring Average Sales Price,oncologists can’t even catch a break and keep the discounts they earn when they pay their invoices promptly.

No doubt a high quality, patient driven practice is every oncologist’s goal. But like every other laudable goal, it will be hard to accomplish this with a loaded gun pointed at our heads. Patients will suffer too as oncologic healthcare consolidates and assumes a purely business driven model.

Is there anything more absurd than a system in which government exerts no regulatory power over the cost of drugs it pays for, and subjects oncologists to the humiliation of bearing all the risk for their procurement and use? Probably not. But this is the hand that has been dealt.

Maybe it’s time to throw in the towel. Maybe it is time for oncologists to fall in line and volunteer for complete regulation of their clinical practices. Maybe all diseases should be treated uniformly, according to rigidly established guidelines and without regard to individual circumstances. Maybe it’s time for full standardization of reimbursements and for use of DRG’s (diagnosis related groups) in everyday clinical practice.

On the other hand, perhaps it’s time for all oncologists to pull together like never before, and get involved in current healthcare reform proposals--or leave our future to the bureaucrats.

Oncologists—and for that matter, all physicians—do not have to settle. Adapt, yes. But capitulate, no. Collectively, we can fight back and garner the public’s support over government and the Big Business healthcare companies. Cancer is the American public’s greatest health fear, and our citizens feel entitled to the best possible care for this disease. We should be at the forefront of this cause.

Quality should remain our highest goal. Those of us at the forefront of the war on cancer should continue to labor for the good of our patients, in spite of the obstacles put in front of us. They are a community in need.

After all, isn’t that the meaning of the phrase “community oncology”?port over government and the Big Business healthcare companies. Cancer is the American public’s greatest health fear, and our citizens feel entitled to the best possible care for this disease. We should be at the forefront of this cause.

Quality should remain our highest goal. Those of us at the forefront of the war on cancer should continue to labor for the good of our patients, in spite of the obstacles put in front of us. They are a community in need.

After all, isn’t that the meaning of the phrase “community oncology”?

Posted on February 14, 2007 08:55 AM