Why Your Cancer Specialist (in the USA) May Be Forced Out of Business

Everyone knows that getting chemotherapy for cancer is usually an awful experience. The nausea, the vomiting, and the loss of hair and skin color and taste and smell make most cancer patients think twice about whether chemotherapy isn't as bad as the disease. The fact is, chemotherapy usually extends life, and there can be more good days than bad, but the last thing cancer patients need is long waits and bureaucratic hassles to get their treatment.

The Pros And Cons of Getting Chemo At The Hospital Or At the Doctor's Office

And that's exactly what happens at most university hospitals. The problem is that university hospitals offer more services and different kinds of services that private cancer doctors cannot. Hospitals can do MRIs, CT scans, and all kinds of lab work on site. A private practice oncologist can refer you to those services, of course, but chances are what you'll get when you go to your oncologist's office is just the treatment you need that day, in, out, go home. 

At a hospital, you can get other services. You aren't the hospital's only patient, however, so appointments for other services can run behind. That can make you late for your chemotherapy, or make other patients late for their chemotherapy. It's not unusual for chemotherapy sessions to run 60 minutes, 90 minutes, or even 2 or 3 hours late, meaning you have to spend the entire day at the hospital, feeling awful. At a private oncology clinic, you'll at least only have to feel awful for the length of your visit and maybe a few minutes more.

Your doctor's insurance staff — many private cancer clinics have 20 to 40 support staff for each doctor — will know how to get your coverage to pay for the treatments you need. And your doctor's in-house pharmacy will be more likely to be aware of potential drug interactions and how you react to your treatment, helping you avoid some of the side effects and some of the complications of treatment.

Just How Many Private Oncologists Are Going Out of Business?

It's getting harder and harder, however, to find a private clinic for cancer treatment. The Community Oncology Alliance, an advocacy group representing about 1,500 private cancer clinics in the United States, notes that since 2008:

• 544 independent cancer practices were purchased by or entered into contractual relationships with hospitals,
• 395 independent cancer practices reported they were operating at a loss, and
• 313 independent cancer practices went out of business.

See Also: Chemotherapy For Colorectal Cancer

This means that either the clinic where you can get faster service that allows you get home sooner is under considerable stress, many clinics not able to pay their doctors, or the clinic you could have gone to a few years ago has closed. More and more cancer patients have to go to hospitals for treatment, where it's almost guaranteed that every chemo session will take most of a day or an entire day, every time. 

How Insurance Companies and Drug Companies Are Putting the Squeeze on Doctors, and What This Means for Patients

Insurance companies and drug companies have stacked the deck against private doctors providing cancer treatment. An oncologist in private practice has to buy the same drugs as the hospitals, but pays about twice as much for them. Hospitals can get a 50% discount on cancer chemotherapy agents through a federal program that private doctors cannot. Doctors have to buy all the chemotherapy drugs for a patient's course of treatment up front. If the patient dies, or develops severe complications necessitating a change in medication, or decides he or she just doesn't want to continue the treatment, the doctor is out the cost of the medications nonetheless, and may not be able to use them to treat another patient.

Missing Incentive Payments, Facing Greater Costs

Making matters worse for the doctor, insurance companies pay more for the same services from hospitals, often about twice as much, as they pay private doctors. Hospitals get incentives for staying open 24 hours a day for treating patients who do not have health insurance.

The Affordable Care Act imposes the same reporting requirements on doctors as it does on hospitals, even though doctors have fewer resources to deal with the paperwork. There is an incentive of about $8,000 a year from the federal government to doctors to make changes in their medical records systems, but this is only a small part of the cost of even one employee.

What Pressures on Oncologists Mean for Cancer Patients

Financial pressures on oncologists force many of them to close their offices, or to offer patients with different levels of financial resources different levels of care. A doctor might decline to treat patients who do not have insurance or patients on Medicaid or Medicare. The doctor may tell a patient, sorry, you need to take your infusion of chemotherapy at the hospital, because giving the patient chemotherapy at the office actually costs the doctor money, sometimes $200 to $500 a treatment.

Moreover, private oncologists are likely to be hesitant to prescribe expensive cancer drugs that come with fewer side effects. It's not unusual for the latest cancer treatments to cost between $7500 and $15,000 (US) a month. Your doctor isn't going to plunk down $180,000 for a year's medication for you without some assurances of getting reimbursement.

The answer seems to be to find an oncologist who still manages his or her own office and pharmacy, but who has entered a partnership with a hospital. Seeing your oncologist in a private clinic makes it a lot less likely that you will suffer the hassles and delays that are inevitable in hospital settings. On the other hand, because your doctor has access to more services and more treatments at lower prices, you are more likely to get the treatment that works best for you with the fewest side effects at the earliest stage of treatment.

See Also: Chemotherapy And Cancer: Questions And Answers

Just be sure that your health insurance covers not just your oncologist, but also the hospital with which they have partnered. Both your doctor and your doctor's hospital need to be in-network for hassle-free access to treatment.