Florida Doctors Trade Independence for Security in Epicenter of Merger Wave

Meir Rinde
Published: Thursday, Jun 04, 2015
Raul Storey, MD

Raul Storey, MD

Just 2 years after oncologist Raul Storey, MD, finished his training and joined a private practice in Vero Beach, Florida, he was already eager to make another change.

He and his partner Noor Merchant, MD, who founded the practice 30 years ago, found themselves battling a familiar set of confounding problems: patients who had to be turned away over insurance issues, limited access to new drugs, narrowing profit margins, and the demands of office administration.

So last October they took the plunge and merged with Florida Cancer Specialists, the nation’s largest independent, physician-owned medical oncology practice. Now they have relationships with 6 times as many insurers, a centralized business office, and access to more than 100 clinical trials, which Storey called “a dream come true for hematology-oncology.”

“We are able to basically focus on the clinical part of the treatment of patients with hematological diseases and cancer, instead of all the administrative business and work you have when you run a practice on your own,” he said.

The array of services and opportunities with which Florida Cancer Specialists provides its physicians, while still allowing them a high degree of autonomy, has proved a powerful draw since the group was founded as a solo practice by William Harwin, MD, in 1984.

The organization now boasts 180 doctors, most of whom are or will become partners, and 120 nurse practitioners, at more than 85 locations around the state. The total staff numbers more than 2000 across a variety of professions. The firm treats 50,000 new patients and takes in more than $1 billion in fees each year, more than 3 times the amount it collected in 2012.1

The company has a practicewide electronic medical record (EMR) system, a central pathology laboratory, an oral oncolytics pharmacy, and on-site radiation facilities at many locations, as well as access to clinical trials through its partnership with Sarah Cannon Research Institute in Tennessee. Thanks to its size, the company can negotiate better drug prices and guarantee patients access to all FDA-approved chemotherapy and immunotherapy treatment options, Harwin said.

Building a Trendsetter

Harwin said he did not originally intend to turn his solo practice into a “great entity.” Initially it grew slowly, to just 48 doctors in 17 offices as of 2008. Over time, however, mounting economic pressures on small practices,the advantages of size, and a reputation for good management allowed Florida Cancer Specialists to become a merger machine and a poster child for the consolidation trend of recent years. By 2011 it had doubled in size to 40 sites and close to 100 doctors, and since then it has nearly doubled again.

William Harwin, MD

William Harwin, MD

Another factor contributing to FCS’s growth may be the state’s size and its large elderly population. Florida’s cancer rates are among the highest in the nation and it has the second-greatest number of people with cancer after California, according to National Cancer Institute data.2 The state has the fifth-highest number of oncologists after New York, California, Texas, and Pennsylvania, according to the Kaiser Family Foundation.3

Florida also has seen the most mergers and acquisitions: from 2008 to 2014, at least 30 oncology practices have been acquired by hospitals and 46 by group practices and other non-hospital entities like Florida Cancer Specialists, according to the Community Oncology Alliance’s most recent Practice Impact Report.

Harwin, who practices in Fort Myers and serves as the company’s president, described its initial expansion as serendipitous. A radiation therapy group in adjacent Charlotte County told him the area needed better oncologists, so his practice started consulting there and eventually hired 2 doctors out of training to staff a new office, he said. Then a staff physician who wanted to be closer to family opened an office in Bonita Springs, a struggling practice in Naples asked for help and was acquired, and many others followed.

“In the early ‘90s, there was a lot of concern about managed care and how that was going, and the thought was, well, if we were a little bit larger we’d be in a better position to compete in what appeared to be a new healthcare environment,” Harwin said.

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