We saw in the news this week that an oncologist from Tennessee pleaded guilty to illegal purchasing of foreign drugs. How did it come to this? If you’ll recall, we heard back in February that there were counterfeit versions of Avastin in the market, and oncologists were (knowingly and/or unknowingly) administering fake Avastin to patients that has no active ingredient (bevacizumab) in it. The physician in this probe, William Kincaid of Tennessee, has signed a plea agreement.
The only people that truly know the facts are those involved in this probe, but there are a couple of themes that emerge from a case like this that are worth acknowledging. We asked another oncologist from Tennessee, Jeff Patton, MD, CEO of Tennessee Oncology, his thoughts on what may have happened here and what others should learn from this example.
OBR: In addition to the case example we saw this week regarding illegal purchase of unapproved Avastin, we have also seen examples of Medicare fraud amongst oncologists. Is it really the buy and bill model that is at fault here? Are practices so financially stressed that some are taking drastic steps to stay alive? Or is it unfair to generalize?
JP: Decreasing margins are driving small and medium size practices out of business across the country. Unfortunately, people sometimes do desperate things in desperate times. I’m not saying I’m ok with it. I think the buy and bill model is the most efficient, cost effective, patient centric model out there. But any model can be squeezed out of business if the margins are shaved too thin.
OBR: What should other practices, operating a small business, learn from this example?
JP: I think practices need to be proactive. If they don’t have the scale for employee professional management they should engage outside consultants to help them evaluate their options. For many small practices, staying the same is just not an option long term. They should evaluate merging with other practices vs. exploring a financial relationship with their local health system.
OBR: Do you think this situation will continue to worsen? Will oncologists be surprised at the depth of the problem?
JP: Healthcare is clearly in transition and I do fear that it will become more difficult short term. In the fee for service model, I think the proposed healthcare exchanges will accelerate the closing of community oncology practices. We as community oncology practices need to develop partnerships with our payers to evolve to value based payment models to survive as independent entities.
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