Payment reform, ‘runaway growth’ of 340B top new COA president’s priorities

Jeff Vacirca, MD, FACP, CEO and managing director of clinical research at New York Cancer Specialists in Long Island, N.Y., has been elected President of Community Oncology Alliance for the 2017-2018 term.

Vacirca — who specializes in breast cancer, prostate cancer and complicated cancers — serves as president of Mather Memorial Hospital’s physician hospital organization. He is a member of the hospital’s breast cancer leadership committee and serves as chairman of the managed care committee for Long Island Health Network’s physician hospital organization.

HemOnc Today spoke with Vacirca about what he hopes to accomplish during his term as Community Oncology Alliance (COA) president, as well as how alliance members can ensure his term is a success.

Question: What excites you most about this opportunity? Answer: This opportunity is just like everything I do — I do it because I love it. For me, it is all about being able to make a difference for patients with cancer, their families and caregivers, and the community oncology practices that go out and do the work that they do every day. I have been looking forward to the opportunity to do more with the amazing team at COA.

Q: How has your prior experience prepared you for this role?

A: I have been a member of national and local advocacy organizations for most of my career in oncology. I have had the opportunity to serve on the COA board and have worked very closely with the group purchasing organizations during the past 10 years. These experiences taught me how to be active and engaged in groups like COA. Additionally, my practice — for which I have been the CEO for the past 10 years — was among the first to transform itself into a value-based care model. This is a critical part of our changing landscape in patient care. I understand the challenges that community oncology practices have faced, and what we have to do every day to stay in business. Like my phenomenal predecessors, I bring real-life experience to this role as COA president. I also had the opportunity to work with prior presidents and absorb their knowledge.

Q: What are your priorities for your term?

A: We want to continue helping to shape good public policy that supports community oncology practices and, most importantly, the patients they serve. We also want to continue all of the great initiatives that COA has already started, such as the Practice Administrators Network, the COA Patient Advocacy Network and the Community Oncology Pharmacy Association. Personally, I want to see the sequester cut ended. We firmly believe that CMS did not have the constitutional authority to impose this, and we will do everything in our power to immediately put an end to this. We see what it has done to oncology practices. We have seen the sequester be a part in the shift of care, and we all know what that has cost. I also am excited to be a part of moving oncology payment reform forward, which includes thinking about how we can make the oncology care model better and support the CMMI Institute through this. We also want to see reintroduction of COA’s oncology payment reform bill in both the House and Senate. Once we get these items complete, we would like to be a part of protecting patients from the pharmacy benefit managers and the many problems these are causing for patient care and oncology practices, including restricting patients from being able to get their medications. We want to address the various fees these middleman corporations are collecting and better understand how they are driving up costs for our patients and health care system. Finally, I have to be a part of stopping the runaway growth and abuse of the 340B Drug Pricing Program. COA supports the 340B program. We just do not support what has become an abusive system.

Q: In the past decade, more than 1,500 community oncology clinics or practices across the country have closed, been acquired by a hospital or merged with another entity. What challenges does this create for providers and patients?

A: This has become a nightmare. We know that closure and consolidation of community oncology clinics has a tremendous impact on access to cancer care and costs. As the baby boomers age and the number of cancer survivors increases, American lives will depend more on the community cancer system. Consolidation and closure place a particular burden on the 20% of Americans who live in rural areas. If the only community cancer clinic in these areas closes or is acquired by a hospital, local care may not be available anymore. Patients will have to travel long distances for their care. One can only imagine how this will limit access to cancer care tremendously.

Q: How do you see the community oncology landscape evolving over the short term and long term?

A: A lot of the evolution of the community oncology landscape will be dependent on what happens in Congress and with legislation. It will depend on public policy changes, and we cannot be certain about this because we know Congress is hard to predict. I think we will see trends continue, but not at the same pace as we have seen before. The consolidation of practices banding together will continue for strength against hospital expansion. This is true for my practice. We have grown by 50% in the last 6 months, and we except to grow even more in the coming year. We will certainly see hospital acquisitions continue, especially with the 340B hospitals, but it will not be at the same pace as before.

Q: What can you do as COA president to help practices that are struggling to stay open?

A: We need to focus on building a more cooperative spirit among community oncology practices. The more that get involved, the more we can accomplish. I have to make — with help from my COA team — the four specific priorities that COA has put forth for 2017 a reality. It is great when we see remarkable things happen when we all get together. What did we see happen in 2016? We saw the Medicare Part B payment model demonstration project killed. It was an atrocity to begin with. It would have been a disaster for patient care. All of community oncology got together and put a stop to it. CVS Caremark dropped its plan to cut physician-owned dispensaries out of Medicare Part D oral drug distribution. This would have been horrible for patients and would have made access to drugs significantly impaired. We know what we can accomplish as a team. We now need to end the sequester cut and move oncology payment reform forward. We have to protect patients from pharmacy benefit managers and we have to stop the runaway growth of the 340B program. We need to level the playing field so patients will continue to have access to great cancer care at the community centers they have been going to.

Q: You have been vocal about the threat that the 340B program to community practices. Can you explain why you feel this way, and what you think is the most appropriate solution?

A: COA fully supports that the 340B program is a critical safety net for patients in need, but we need to ensure that this program is about the patients and not about hospital profits. Originally, this was intended to support hospitals that serve high numbers of indigent patients. Instead, the program has created a profit motive for hospitals to obtain community oncology practices. Once a 340B hospital acquires a private oncology practice, it receives discounts of 30% to 50%, and these discounts are not required to be passed on to patients. It is pure profit for the hospital. This is not what the program was intended to do, and it provides a powerful incentive for hospitals to purchase these independent cancer clinics. We know from multiple studies that, when a hospital acquires a community cancer clinic, it costs the patient and the taxpayers more. There are certain parts of the program that are related specifically to hospitals that should be fixed. There is no guarantee that patients treated at a 340B hospital are receiving the benefits of that discount, and that is a problem.

Q: The COA has joined the Alliance for Site Neutral Payment Reform. What is this initiative, and why is it important?

A: It is a coalition of patient advocates, providers, payers and employers who support payment parity across the sites of service. This is because unequal payment policies give hospital outpatient departments higher reimbursement rates for the same cancer care that can be received in the community setting. This has contributed to the shift in more cancer care being delivered at hospitals. Patients pay up to 53% more when they receive hospital-based cancer care compared with a physician office setting.

Q: How can alliance members help ensure your term is a success?

A: COA is strong because of its members, who are active and engaged advocates of community oncology. We have to continue to grow and build the energy. We want people to be a part of our programs, conferences and publications. I hope our members will help spread the word about the great work we are doing and invite more people to join us. We have many ambitious goals for 2017, and it will take the strength of the entire community oncology system to come together to make all of this happen. The important thing about COA is that we have something to offer for every member of the cancer care team. It is not just about the doctors. It is about the doctors, nurses, pharmacists and, most importantly, the patients. – By: Jennifer Southall

For More Information:

Jeff Vacirca, MD, FACP, can be reached at Community Oncology Alliance, 1101 Pennsylvania Ave. NW, Suite 700, Washington, DC 20004; email: info@coacancer.org.

Disclosure: Vacirca reports no relevant financial disclosures.