Community Oncology Experts Review Challenges, Opportunities to Coexist With Health Systems


Despite tensions that can occur, building relationships with health systems and finding opportunities to collaborate is crucial to improve cancer care.

In a panel discussion at the Community Oncology Alliance (COA) 2023 meeting, a panel of experts in independent community oncology discussed how they fend off consolidation efforts and coexist with larger health systems.

Large health systems often seek to acquire smaller, independent community oncology practices, particularly given the current landscape of 340B, according to moderator Nick Ferreyros, managing director of policy, advocacy, and communications with COA.

“When a 340B institution can buy a drug at 50% to 60% and then sell that drug for full price and markup…that’s a very hefty profit margin that they can make,” Ferreyros told Pharmacy Times in an interview. “So, when the hospital sees those dollar signs and realizes these business lines can provide a lot of added profit, that incentivizes them to go out and purchase or merge with independent practices—in our cases, independent oncology practices.”

The other panelists discussed their experiences in a variety of environments, including south Texas, Philadelphia, Virginia, and Alabama. Anne Marie Rainey, MSN, RN, CHC, director of quality and value-based care at Clearview Cancer Institute in Alabama, said her institution recently acquired 3 smaller practices, opening up 3 larger markets in North Alabama, 1 of which has a 340B hospital.

“We have to sort of play nice in the sandbox with those hospitals because we share space with them, which also means sometimes we share staff in some circumstances,” Rainey said.

Building and maintaining relationships with surrounding health systems is crucial, Rainey added. Clearview has organized networking events including staff from nearby hospitals. Similarly, they recently had a physician’s assistant go to the local emergency department to host a session on oncologic emergencies, because Rainey said that is the largest facility where oncology patients would most likely go in an emergency.

Jodi Young, executive director of Texas Oncology, said she has also focused on building and maintaining relationships. Texas Oncology has been the dominant oncology provider in South Texas; however, Young said there has been a push by hospitals in the past 2 years to elevate cancer care services in their region, where patients historically would go to Houston for that care. In response, Young said she has made efforts to strengthen relationships and find opportunities for collaboration.

She advised attendees to engage with hospital leadership and use them as their eyes and ears to be aware of plans for growth. Independent community oncology leaders can then find ways to collaborate and allow their growth plans to coincide without competing.

Panelist Moshe C. Chasky, MD, FACP, said his work with Alliance Cancer Specialists (ACS) is in a different environment, situated in highly competitive Philadelphia. In 2015, Chasky said ACS was the primary oncology provider for a hospital and provided care for all patients there.

Around that time there was a focus on hospital consolidation, and Chasky said he and his colleagues chose a partner who said they valued the oncology providers and wanted to support them. By 2019, however, it became clear that the administrators did not value oncology when Chasky was told that their priority was making the hospital a 340B facility, he noted. Chasky and his colleagues were given the choice of either joining the 340B hospital or becoming a competitor.

“From my standpoint, when I looked at the bigger picture of believing in community oncology, believing in the delivery of care that we could give to our patients, I looked at it as an existential crisis,” Chasky said. “So, we looked at this as, if we go down, it’s the end of community oncology in the eastern part of Pennsylvania.”

Instead, Chasky and his colleagues remained independent and have found ways to continue delivering care while avoiding consolidation and, instead, collaborating with the health system. Chasky emphasized that any physicians can prescribe the necessary drugs, but delivering the day-to-day, 24/7 care is much more difficult, and no one can do that better than independent community oncologists.

When he works at the hospital, Chasky said he walks in with a smile and makes sure that all patients and staff know that they are there to support them. They also have residents from the hospital who rotate through their oncology practice.

“Why does it make sense that we’re giving back to the hospital?” Chasky said. “You have to look at it as the hospital administrators are different from the staff. We are there to serve everyone.”


Chasky M, Ferreyros N, Rainey AM, Wade SM, Young J. The Hospital Conundrum: A Gameplan for Fending Off Attacks and Coexisting. Presented at: Community Oncology Alliance 2023 Meeting. March 23, 2023.

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