Oncologist Enthusiastic About Capitated Plan

DUARTE, Calif--An oncologist passionate about the advantages ofmanaged care? Oncology News International met just such a physician,Myron H. Goldsmith, who provides medical oncology services ona capitated basis to the City of Hope Oncology Network, whilealso maintaining his fee-for-service practice. "You haveto be passionate about what you believe in," this on-the-godoctor said from his cellular phone.

The City of Hope Oncology Network is part of a growing movementby cancer centers and oncologists to take the managed care bullby the horns and get the system to work for patients, providersand payers.

"By the year 2000, 20% of all health-care spending in thiscountry is going to be oncology related . . . outstripping cardiologyand orthopedics," Dr. Goldsmith said. "I would ratherthat physicians get involved in controlling cost in a manner thatmakes sense rather than having it dictated to us how it is goingto be done."

Cancer patients linked to the City of Hope network will generallynot have to leave their local community to receive top qualitycancer treatment. "Instead of the patient going to the tertiarycenter for their surgery, for example, a significant proportionwill now be done in the community," Dr. Goldsmith said.

Other unique benefits for patients in the City of Hope networkinclude second opinions as a covered benefit, access to state-of-the-arttreatment options, educational services, and cancer screeningprovided through mobile vans. "We are absolutely community-baseddriven," he commented.

The network offers benefits to third-party payers as well, Dr.Goldsmith believes, including outcomes research, practice guidelines,quality assurance, and patient satisfaction surveys. "Wewant to be partners with the payers and meet their needs. Outcomesresearch, for example, allows payers to show that they are providingquality care."

Extends Beyond California

John S. Kovach, MD, executive vice president of medical and scientificaffairs at City of Hope, said that the newly formed network formalizesthrough contractual arrangements the cancer center's existingcommunity network in Southern California and extends the networkto other underserved areas.

"Right now, the farthest contract is one in Arizona, fora defined service, bone marrow transplantation," he saidin an interview. Overall, he said, the network covers 700,000lives on a capitated basis for various cancer services.

Dr. Kovach emphasized that community oncologists who join thenetwork must go through a rigorous credentialing process, "toensure that services can be provided at the same level as at Cityof Hope, using the same practice guidelines."

City of Hope is also a member of the newly formed National ComprehensiveCancer Network, which will operate on a national level to developcommon pathways for treatment and negotiate managed care contractswith very large companies, organizations, and third-party payers.

Dwindling Fee-for-Service

Dr. Goldsmith pointed out that managed care in California is atleast 10 years ahead of other parts of the country. "Thefee-for-service market has dwindled in southern California, andthe number of oncologists is at an all time high, so the numberof patients available to doctors is diluted, unless they're inmanaged care," he said.

He firmly believes that quality of care has not been adverselyaffected by managed care arrangements: "I've been doing bothfee-for-service and managed care contracting for 12 years, andthe two practices are mirror images of each other."