OVERALL SURVIVAL OF THE MEDICAL ONCOLOGIST - A NEW OUTCOME MEASUREMENT IN CANCER MEDICINE

BACKGROUND. Changing patterns of patient referral, decreasing payments for service provision, confusing network participation and reimbursem ent, as well as challenges to autonomous clinical decision-making jeop ardize the traditional role of the oncologist in delivering cancer car e. The cancer patient also may be at risk with unproven cancer deliver y systems that displace the oncologist as decisionmaker and care provi der. The authors have constructed a model that preserves the oncologis t's clinical and financial autonomy while meeting marketplace demands for improved access, decreasing costs and preserved quality of care. M ETHODS. During a 4-year period, a group of private practice medical on cologists initiated a formal business plan to evaluate marketplace nee ds, then designed and implemented a novel cancer care delivery model. The model required reconfiguring the practice into an integrated Joint Commission on Accreditation of Healthcare Organizations-certified can cer service corporation, providing medical, radiation, and gynecologic oncology. Palliative care, pain management, psychologic, and nutritio nal services were instituted as well as the vertical integration of ho me health and hospice care. Clinical pathways and treatment protocols were designed to enhance patient care and facilitate cost-of-care proj ections in designated populations using a cancer incidence forecasting model. Outcomes analysis are performed as part of ongoing continuous quality improvement, which continues to change this health care delive ry system. RESULTS. In the 3 years since implementation of the model, the practice has increased from 16 to 24 physicians, and the number of offices has increased from 12 to 17. Patient encounters, both new and established, have doubled. Cost of services, specifically hospitaliza tion, have been reduced by 50%. Clinical research referrals have incre ased 300%. Physician compensation has improved > 20%. CONCLUSIONS. The model created a low cost, high value provider not burdened by allocat ed overhead. Decentralized care enhanced community access, which impro ved patient compliance, enhanced patient satisfaction, decreased hospi talization, and thereby decreased cost. The horizontal structure permi ted the flexibility for varied purchaser products and politically sens itive physician and hospital provider panels. Consensus-based protocol and pathway determination achieved maximum physician participation, w hich preserved clinical and financial autonomy, decreased variance, an d facilitated clinical research. (C) 1998 American Cancer Society.