Community Cancer Practices Battered by Closures, Now COVID-19

May 07, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The past decade has seen a trend in community oncology clinics and practices closing, being acquired, merging, or struggling financially. In recent months, these clinics have also seen a substantial decline in office visits and new patients, owing to the COVID-19 pandemic.

But there is good news, says Ted Okon, MBA, executive director of the Community Oncology Alliance (COA).

The latest report from the organization shows that "the number of treatment sites closing appears to be plateauing," he said. "When clinics close, that means patients often have to travel to get care, so this is a good sign."

Since 2018, there has been a 20.8% increase in practices merging with or being acquired by another community oncology practice or being acquired by a corporate entity.

This major jump is likely the result of practices seeking protection from hospital mergers, says the COA.

"We are still seeing acquisition of physician practices by hospitals, but what we are also seeing now are mergers among practices and acquisition by physician-run organizations," Okon told Medscape Medical News.

"They are looking to stay independent and not be taken over," he added.

That is one of the big take-aways from this report, he emphasized. "Physicians are coming together and joining forces."

The rate of practices being acquired by hospitals continues to rise, with a 9.7% reported increase from 2018 to 2020.

This has been largely fueled by hospitals' financial incentives stemming from the 340B Drug Discount Program and by higher payments to hospitals for cancer care services. Community oncology practices have become desirable acquisitions by hospitals because of an unintended use of 340B. Hospitals and hospital-owned practices make significant profits by exploiting extra payments intended to benefit poor patients in need, as previously reported by Medscape Medical News.

The new COA report says that from 2008–2020, 1748 community oncology clinics or practices changed status. Specifically, 435 have closed; 722 have been acquired by hospitals; 203 practices have merged or been acquired by a corporate entity; 348 report struggling financially; and 40 practices report sending patients elsewhere.

COA found that the states with the most clinic closures are Florida (47), Texas (44), California (36), and Michigan (36). The states with the most practices that are struggling financially are Michigan (42), California (38), New York (38), and Illinois (26).

Impact of COVID-19

Early data indicate that the COVID-19 pandemic has had an impact on community oncology practices, with substantial declines in office visits, treatment, and new patients, presumably as a result of stay-at-home mandates and anxiety over being infected by the virus.

The new data come from Flatiron Health, a healthcare technology and services company, and were first reported in the Cancer Letter. The researchers analyzed data from 270 oncology practices that use Flatiron's OncoEMR platform. The data indicate a sharp drop in new patients during the 6-week period following the advent of the pandemic in the United States. In early February 2020, new patients accounted for about 8000 visits, but that rate had dropped by about 40%, to fewer than 5000, toward the end of April.

Patient visits for chemotherapy decreased between 3% and 17%, depending on the region. The decrease in visits was lowest in the South (24%) and highest in the Northeast (37%). The decline was much higher for non–chemotherapy related visits.

Cancellations and no-shows nearly doubled across the board. The largest increase ― 80% ― was in the Northeast, although rates were similar in other regions.

Total patient visits overall decreased dramatically after March 9, according to the Flatiron data.

Okon commented that many patients are afraid to leave their home to come to the clinic for treatment, and there is concern that their cancer will progress. "There is fear that many patients will be sicker when the crisis calms down, because they've missed treatments," he said.

"We kind of hit the pause button on the country and the economy, but cancer knows no pause button," he added.

2020 Community Oncology Alliance Practice Impact Report. Published April 24, 2020. Full text

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