Center of excellence programs have a place in offering treatment for exceedingly rare diseases, or access to a particular clinical trial, said Dr. Barbara McAneny, CEO of the New Mexico Cancer Center and past president of the American Medical Association.
But generally, she said these programs are nothing more than a marketing ploy used by academic medical centers to trick patients into thinking their garden-variety breast cancer is better treated out-of-state. Instead of lowering costs for employers, she believes the travel, accommodation and other costs associated with relocating the care often result in a higher price paid for the treatment—not to mention the physical and psychological toll on the patient, who could be exhibiting symptoms from their illness that make travel difficult.
Health systems' slick center of excellence marketing campaigns could mislead individuals into thinking they could experience a better outcome and different treatment at these high-cost centers compared with local providers, even though most of the procedures performed at these sites are standardized, she said. For the half the population who are not covered under their employer's insurance plan, and who might lack the resources to travel out-of-state for care, it can make them feel like they're losing out on a life-or-death opportunity. The reputational harm caused by these programs can also cut into independent providers' revenue.
Under the Medicare program, for example, surgical procedures are paid for through bundled payments. If a patient goes out of state for a hip replacement, suffers a complication that requires a follow-up procedure locally, the independent provider will not get paid for their time, she said.
"The person who files the claim for the hip surgery is supposed to be, per Medicare guidelines, providing all the aftercare, so they are paid to do all that," McAneny said. "But if they're not doing it, because that patient is 1,000 miles away with their infected incision, the local surgeon dealing with it can bill for it, but if it's in that bundled timeframe, they don't get paid."
McAneny believes that academic medical centers' center of excellence programs would be better used as a training ground for physicians who will graduate and go off into their communities to start independent practices. She believes the best care comes locally, with clinically integrated networks between area specialists and primary care providers as the way to go. Academic medical centers can play their part by sharing information around best-practices, she said, and creating pathways that local providers can use to inform their care operations. At her clinic, for example, she follows a pathway laid out by the Dana-Farber Cancer Institute.
"Healthcare really, in my opinion, should be local, and that information should be democratized," McAneny said. "It shouldn't be hoarded, saying 'We're the only people who know how to do this.'"
Her message has started to reverberate across the market.
The Purchaser Business Group on Health in June unveiled its first regional network of excellence, which aims to help local and national employers in Colorado directly contract with area providers to perform common procedures at discounted rates. The San Francisco-based not-for-profit aims to launch more regional programs later this year.
The Community Oncology Alliance, meanwhile, has spent about two years organizing networks of local providers to provide care, gathering outcomes data to prove their results are just as reliable as those at the Cleveland Clinic and talking with telehealth companies to scale hometown clinicians' services virtually, said Dr. Fred Schnell, chief medical officer of the group. He expects the program to be rolled out for self-insured employers in 2022.
"Most patients don't want to travel long distances to get care," Schnell said. "They want to be sure they're doing the right things, but will start to draw limits if it creates undue personal stress. The things they're being asked to do—going away from home, traveling—sometimes that has no clear endpoint."