Attempting to keep cancer treatment costs down for all involved, an oncology medical group with offices in Corona and Rancho Cucamonga has partnered with one of the state's largest insurance providers on a one-year pilot program that could change the way doctors do business.
Instead of earning a profit by prescribing certain drug treatments to patients, since Medicare has slashed the amount it's willing to reimburse them, cancer care physicians would essentially be rewarded by an insurance company for keeping their patients from having to make a costly hospital visit by treating them early and often before.
A team approach that would include everything from preventative care to what a patient would need when the end is near, would pay doctors based on keeping their patients well, not necessarily the sheer amount of care or the most expensive drugs to go along with it.
"It's about taking care of the patient," said Dr. Linda Bosserman, who in between seeing patients leads Wilshire Oncology Medical Group as its president.
Wilshire Oncology has 11 physicians and 11 mid-level providers who do everything a doctor would except make decisions about a patient's care.
Bosserman sees her group growing to 50 or 100 physicians based on the new business model it will test for the next year, with talk of expanding further in Orange County, Los Angeles and San Diego. She said several doctors will soon join the group's Inland medical offices. An ad seeking doctors solicited 12 responses in one day.
For more than a decade, cancer care that didn't come from a hospital or an academic institution had grown at an aggressive pace with medical group revenue fueled by the profit that came with offering certain high-priced drugs. A few years ago, though, Medicare payments were slashed and community oncology providers, as they're called, struggled to cover costs, she said.
The changes affected more than 1,000 clinics nationwide, according to the Community Oncology Alliance, which has been lobbying Washington on behalf of medical groups like Wilshire and has been tracking the impact of Medicare's decision to slash the amount it pays doctors to reimburse them for cancer-treating drugs.
As of March, 199 private cancer care clinics had closed and another 369 were struggling to pay bills or remain open, according to the group. In California, 13 clinics have closed and another 31 were struggling financially as of March. Another 19 merged with another company, were bought by a hospital or had begun sending patients elsewhere for treatment.
That's why Bosserman said her group started working with health plans about three years ago to come up with a better way of doing business and caring for patients, dubbed "medical oncology home." The pilot launched in August with an as-yet-unnamed insurance provider.
The plan follows a decade of instituting electronic records for all of its patients at all of its locations, including the hospitals it serves such as Arrowhead Regional Medical Center in San Bernardino and Riverside County Regional Medical Center in Moreno Valley. That record system also tracks all cancer treatment medications from the day purchased and where to whom it was given and how much was left over, an assurance insurance companies enjoy since they want to know what drugs they're really paying for. It also ensures patients are receiving FDA-approved medication.
Caring for a patient that comprehensively, though, would naturally be more staff-intensive.
Still, Bosserman predicts her group's program will ultimately earn it money since it has negotiated a payment plan with the insurance company that encourages more prevention and continuous care, which should minimize side effects and costly hospital stays, she said. . Patients would avoid costlier co-pays, some of which can reach 20 percent or more, she said.
"It's a lot better to pay people to stay after hours or come in early (to help a patient) ... than to go to the emergency room," she said.
For example, a patient recently called around 4:30 p.m. on a Friday complaining of a blood clot. Normally the patient would have gone into the emergency room, racking up a bill worth $8,000 for the hospital stay, Bosserman said. Instead, staff stayed in the office an extra two hours so the patient could come in and get a routine blood thinning medication to solve the problem and daily shots the patient could take home and administer herself to heal the blood clots.
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