Practice Consolidation and Growth Improve Outcomes

Meg Barbor, MPH

July 2016, Vol 6, No 7 - COA Conference Highlights

The growth of Florida Cancer Specialists (FCS) has brought together hundreds of physicians, with the ultimate goal of enhancing patient care, said Brad A. Prechtl, MBA, Chief Executive Officer at the 2016 Community Oncology Alliance conference.

“Growth has been an incredible success story for FCS, and ultimately the patients are the ones who benefit in our practice,” he said at the 2016 Community Oncology Alliance conference. “We’ll see 60,000 new patients in this year alone, and we will have over 1 million follow-up visits. We’re trying to bring practices together to keep community oncology alive and well.”

Mr Prechtl discussed how practice survival and the growth of FCS have led to new revenue and improved cancer care.

Florida Cancer Specialists: Largest US Private Practice

FCS is one of the largest privately owned oncology/hematology practice in the United States, currently with 195 physicians and 147 nurse practitioners and physician assistants in 93 offices in Florida. The focus at FCS is to keep practices in Florida open and flourishing, which has allowed the organization to continue growing.

“Our tagline is, ‘World class medicine and hometown care,’ and what we’re trying to do is keep patients close to home. Nearly 70% of our patient base is Medicare and Medicaid, and a lot of patients have difficulty traveling long distances, so our strategy is a number of full-service, smaller locations, so that patients do not have to travel as far,” said Mr Prechtl.

“I think one of the most significant advantages that we have brought the patients as we have consolidated is the amount of ancillary services we have been able to bring into the organization,” Mr Prechtl said.

FCS now boasts a central laboratory with capabilities for extensive in-house testing and outpatient hematopathology services. “We have 4 board-certified hematopathologists, and it is one of the areas that is a key differentiator for us when we bring in groups. The turnaround time and quality of the interpretation is incredible,” he said.

The FCS has added testing, such as histology, fluorescence in situ hybridization testing, and the Prosigna Breast Cancer Prognostic Gene Signature Assay. The organization has 12 fixed positron emission tomography/computed tomography scanners and 3 mobile units, with 7 sites offering radiation therapy, which were gained through the acquisition of practices.

Rx to Go: The Adventures of In-House Pharmacy

FCS also has an in-house pharmacy, called Rx to Go, which started in 2007 and has seen significant growth since the influx of new oral drugs into the market in 2012.

According to Mr Prechtl, a typical community oncology practice would have 81% of its reimbursement based on chemotherapy. “In terms of the ‘Medicare Experiment,’ this could have a devastating impact on a practice and could cause many to be underwater from a reimbursement versus compensation standpoint. Ultimately, that will drive patients to the hospitals, and it’s already been proved that hospitals are more expensive than outpatient facilities for comparable services. So our strategy is to diversify services within FCS to offset this,” Mr Prechtl said.

Approximately 63 cents of every dollar at FCS is chemotherapy-related. “This means we’re that much less at risk if there’s a change just on chemotherapy alone,” Mr Prechtl said. He attributes this security to the growth of Rx to Go.

“Rx to Go has had the most profound impact in reducing our chemotherapy as a percentage of collections. In 2009, only 3% of our collection base was related to Rx to Go, and now it’s at 16% and growing,” said Mr Prechtl.

He emphasized the importance of offering oral oncolytics within a practice. “It’s not only a way to diversify, but it offers a great benefit to patients,” Mr Prechtl said.

Benefits of Merging Practices

Mr Prechtl also stressed the importance of fully integrated technology. “When we converted practices and merged them into FCS, we ensured that we kept one technology platform,” he said.

FCS utilizes 1 electronic medical record system, 1 practice management system, 1 picture archiving and communication system, and 1 laboratory information system, allowing the organization to deliver seamless quality care across their various markets in Florida.

“One of the areas we’re most proud of is our clinical research program,” Mr Prechtl added. FCS has 93 active clinical trials and participated in 23 of the clinical trials that led to the approval of many of the new cancer drugs in 2015.

Other benefits of merging practices include improved revenue cycle processes and performance and less hassle for physicians, because they get the benefit of autonomy without the added responsibility of managing a practice.

“It is a win-win for physicians who join us. They give up the hassle of managing a practice day in and day out, and they get access to our second-to-none ancillary services that they wouldn’t be able to provide otherwise,” Mr Prechtl said.

He stressed the importance of transparency, which “creates an organization where there is trust and confidence that everyone is being treated equally, and everyone has access to the same information.”

FCS purchased more than $1 billion worth of drugs in 2015. “Our goal is to not be in a position where we’re underwater from a cost versus reimbursement standpoint, where we’d have to send patients to a hospital to receive their care,” Mr Prechtl stated. However, FCS keeps an inventory of no more than 3 days for a drug.

“We have acquired 37 practices in our history, and we’re extremely proud of the fact that we’ve never had one group unwind, nor have we had a physician leave other than for relocation, retirement, or disability. But we’re far from perfect, and we learn from the feedback of every group we bring in,” Mr Prechtl concluded.