The building spree raises questions about how consumers can know whether they will receive the same quality of care for their condition at a community hospital as they would get from a major cancer center. There are just 45 NCI-designated centers, while there are about 1,500 cancer programs accredited by the Commission on Cancer, which is run by the American College of Surgeons.
Determining quality of care is not easy for cancer patients, said Ann Geiger, acting associate director of the NCI's Healthcare Delivery Research Program. “There's not a lot of good information out there with which patients can make decisions,” she said.
Dr. Randall Holcombe, chief medical officer for cancer care at Mount Sinai Health System in New York, said it's critical for a program not just to provide all the pieces of cancer care but to coordinate them. “Some places call themselves a cancer center but don't really provide coordinated care,” he said. “It can be a marketing ploy to encourage patients to come.”
To demonstrate their quality, some community hospitals are affiliating with a big-name center. MD Anderson Cancer Center, for example, plans to add up to six partner institutions that aspire to provide an MD Anderson-level of care. The Houston-based center's plan also involves offering a network of community hospitals with “certified membership.” So far, 13 hospitals have joined that program. One of them, Community Health Network in Indianapolis, reports that in three years, its affiliation with MD Anderson has increased its volume of cancer patients by 250%.
“MD Anderson's mission is to eradicate cancer,” said Amy Hay, vice president of global business development for MD Anderson. “To do that, we have to have an impact, not only here in Houston, but across the U.S. and the globe.”
Similarly, ProHealth Care in Milwaukee is contracting with the University of Wisconsin Carbone Cancer Center in Madison, which is NCI-designated. ProHealth opened a $70 million cancer center in August.
For community hospitals that are building new cancer centers without the imprimatur of a prestigious cancer-care brand, their marketing usually focuses on the benefits of getting quality cancer care close to home. That's increasingly important to patients undergoing lengthy courses of treatment with difficult side effects.
“When it comes to the more common types of cancer, community hospitals are often well-equipped to provide excellent care,” said Lindsay Conway, managing director of research and insights for the Advisory Board.
Baptist Health Paducah (Ky.) broke ground in September for an $8.3 million regional cancer-care center with private chemotherapy rooms, family space, lab and physician offices, with a radiation therapy center next door. Its purpose is to pull Baptist's far-flung treatment centers into one location and offer a local alternative for patients who might otherwise travel 135 miles to Vanderbilt University Medical Center in Nashville, said Baptist Health Paducah President William Brown. He doesn't see the expansion as a challenge to Vanderbilt, where Paducah patients may still go for second opinions or highly specialized care.
In Maine, a rural state where most residents lack nearby access to an academic medical center, New England Cancer Specialists has adopted an oncology medical home model for its 13 oncologists, with each specialist leading a multidisciplinary team that provides comprehensive care.
Steve D'Amato, the oncology practice's executive director, said that with the expansion of alternative payment models, the only way large oncology practices will be able to survive in the future will be by providing comprehensive care. That includes access to clinical trials, genetic testing, oncological rehabilitation, functional medicine, long-term support for cancer survivors and palliative care, he said.
There is no generally accepted definition of the term cancer center. Facilities that call themselves cancer centers may offer any or all of an array of services, including diagnostic imaging, surgery, radiation therapy, chemotherapy, immunotherapy, access to clinical trials, support services such as physical therapy, rehabilitation, support for cancer survivors, nutrition and palliative care.
In its accreditation program, the Commission on Cancer separates cancer programs into several categories including integrated networks, academic programs, community-based programs and free-standing centers. NCI designates 69 comprehensive cancer centers that have a research orientation. The Association of Community Cancer Centers has about 20,000 members that work on multidisciplinary cancer teams in various settings. Then there is the Alliance of Dedicated Cancer Centers, comprising 11 centers that have been exempt from Medicare DRGs since 1983 because of their focus on one disease.