Oncologists being forced out of private practice

Excerpted from "Private Oncologists Being Forced Out, Leaving Patients to Face Higher Bills," The New York Times. November 23, 2014 — When Dr. Jeffery Ward, a cancer specialist, and his partners sold their private practice to the Swedish Medical Center in Seattle, the hospital built them a new office suite 50 yards from the old place. The practice was bigger, but Dr. Ward saw the same patients and provided chemotherapy just like before. On the surface, nothing had changed but the setting.

But there was one big difference. Treatments suddenly cost more, with higher co-payments for patients and higher bills for insurers. Because of quirks in the payment system, patients and their insurers pay hospitals and their doctors about twice what they pay independent oncologists for administering cancer treatments.

There also was a hidden difference — the money made from the drugs themselves. Swedish Medical Center, like many others, participates in a federal program that lets it purchase these drugs for about half what private practice doctors pay, greatly increasing profits. Oncologists like Dr. Ward say the reason they are being forced to sell or close their practices is because insurers have severely reduced payments to them and because the drugs they buy and sell to patients are now so expensive.

It raises questions about whether independent doctors, squeezed by finances, might be swayed to use drugs that give them greater profits or treat poorer patients differently than those who are better insured. Health care economists say they have little data on how the costs and profits from selling chemotherapy drugs are affecting patient care. Doctors are constantly reminded, though, of how much they can make if they buy more of a company’s drug.

While individual oncologists deny choosing treatments that provide them with the greatest profit, Dr. Kanti Rai, a cancer specialist at North Shore-Long Island Jewish Cancer Center, said it would be foolish to believe financial considerations never influence doctors’ choices of drugs. “Sometimes hidden in such choices — and many times not so hidden — are considerations of what also might be financially more profitable,” he said.

Commentary

CMDA Past President and Oncologist Al Weir, MD: “As Christian healthcare professionals, even as we care for those who suffer most, we are caught up in questions of motive and profit. Kolata’s article is quite accurate regarding system changes and finances in oncology. Hospitals are buying oncology practices rapidly on a large scale. Oncologists are fleeing toward hospital ownership as a place of financial refuge from falling incomes. Profits are higher for hospitals than for private doctors. Patients are paying higher copays. Some uninsured are receiving better care. And most of us as healthcare professionals just want to settle into the new systems as we treat individual patients with good science and compassion, as we did before.

“Biblically, I do not know how much profit healthcare professionals should make in caring for the suffering---I have made such profit most of my career and have probably made too much. I do know that we must weigh our profits against the financial suffering we add to our patients' physical sufferings. I do know that we must care for those who cannot afford the standard cost of care, even if we sacrifice to do so. I do know that we are not only responsible for the economic suffering of each individual patient, but also for the suffering caused as we accept system changes. We have a voice; and within these system changes, we, as Christian healthcare professionals, must speak out for the welfare of all patients, just as if they were telling us their individual stories in our own exam rooms.”

Resources

Professionalism in Peril – Part 2: Unjust Scales in Healthcare by Gene Rudd, MD
The Changing Role of the Doctor by Richard A. Swenson, MD
CMDA’s Professionalism Ethics Statement