A recent article published in
Health Affairs, authored by Sanir Soneji, a PhD working in the Dartmouth Institute of
Health Policy and Clinical Practice, questions the value of U.S. cancer
care. He states that: “screening, prevention, and treatment have
extended life for oncology patients, but at a higher cost in the U.S.
than in Europe, without a corresponding decrease in cancer deaths. For
multiple reasons, including payment reform, health care providers are
being required to see if each of their service lines are enhancing the
Value = [Clinical Quality + Service Quality ] divided by Cost
It would appear that from this recent report that Value may not be the
case in relationship to cancer care in this country.
Most hospitals today are providing some cancer diagnostic studies and treatments,
while many larger systems have spent millions of dollars building elaborate
Comprehensive Cancer Centers on their campuses providing the full menu
of cancer services as part of a traditional health system delivery model.
In contrast, we are seeing regular advertisements on TV for the Cancer
Centers of America, a national network of five regional comprehensive
cancers centers developed in the last decade which are solely focused
on one service line. They guarantee quick access, high patient satisfaction,
strong family support, and best practices clinical outcomes validated
by metrics posted on their web page. They aggressively manage their business
expenses through supply chain and revenue cycle programs, and their myriad
of providers utilize standardized evidence-based protocols across the
entire system. All of their clinical and research efforts are focused
on discovering and utilizing the best and most efficacious cancer treatments
as validated through their transparent results. This one-stop shopping
at a single service line provider appears to be significantly improving
the value equations for those cancer patients who enter the Cancer Center
of America’s doors.
For years, it has been proven by clinical outcome metrics, that certain
services lines are best treated in Regional Centers that have a unilateral
focus and mission, such as for severely burned patients, acute trauma
patients requiring level 1 care, and those neonates that are at extremely
high risk for survival. And the recent Ebola outbreak reaffirmed that
the best treatments for such diseases can be best rendered in a small
number of nationally designated centers whose expertise assure that value,
not volume, drives the most favorable outcomes.
In the early 70’s, many healthcare leaders predicted that most diseases
would best be treated in regional centers focused on a relatively small
number of service lines. But as clinical technologies have resulted in
safer and safer diagnostic and treatment modalities, most services lines
have been safely distributed across the U.S., both in small community
providers and large integrated health systems. A prime example is cardiac
care, both medical and surgical.
However, a question that probably needs further study is the one proposed
by this blog’s title, and supported by Dr. Sanji’s study:
“Are there certain diseases that would be best diagnosed and treated
at a national network of regionalized centers focusing on one service