National Regionalized Service-Line Centers--Better care?

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 Equation:

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 line?”

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