Transition to Managed Care Will Bring Changes for Oncologists, Need for Guidelines, Says ACCC Panel

For the oncology profession, the transition period to managedcare will mean new relationships with other providers, some lossof control over patient care, and the need for practice and ethicalguidelines, concluded panelists participating in a session onmanaged care at the Association of Community Cancer Centers' 1995Oncology Symposium.

A number of new relationships are forming, including joint ventures,preferred provider relationships, carve-outs, and management servicesorganizations, said Lee E. Mortenson, DPA, executive directorof the ACCC. "The number of entities in the health-care marketplacewill decrease as physician groups join with others and with hospitals.Ultimately, there will be fewer providers of care," he said.

To control costs, some managed care organizations may decide tokeep cancer patient care with primary care physicians as longas possible, said David K. King, MD, chairman of the ACCC Ad HocCommittee on Reimbursement and a Phoenix oncologist.

"As specialty caregivers, we can follow that population muchmore efficiently than a primary care physician," Dr. Kingsaid. "We know what to look for, what tests are and are notneeded. With the provider at risk in a managed care contract,there are no guarantees that the patient is going to get all thecare that he or she needs."

Dr. Mortenson pointed out that in markets undergoing the transitionto managed care, it is possible that an oncologist will see apatient during the first half of the course of treatment, withthe patient going to another physician for management of the secondhalf of treatment.

Physician behavior may also change with capitation, Dr. King said.A physician who might previously have treated a cancer patientaggressively from the onset may now think twice about it and mayneed to call for permission to perform the treatment.

The changes that managed care is forcing on physicians reallymay be a "wonderful opportunity to improve the delivery ofcancer care," said Barry Lembersky, MD, board member of thePennsylvania Oncologic Society and assistant professor of medicineat the University of Pittsburgh Medical Center's Pittsburgh CancerInstitute.

Dr. Lembersky said that practice guidelines will be "moreimportant than ever. Ethically, medically, and fiscally sensibleguidelines need to be developed." Dr. Mortenson agreed, sayingthat guidelines will help ensure that quality oncology care-usingthe multidisciplinary approach that oncologists believe worksbest-continues to be available to cancer patients.