Steven D’Amato, BSPharm
Staff attrition generally does not come in the size and shape it did for a small New England practice that constitutes the last independent oncology practice in Maine. It happened when the clinic switched over to the Come Home model of coordinated care that emphasizes patient access. The group, New England Cancer Specialists, lost 50 workers to the transition. The demands of adapting to new schedules and ways of doing things were simply too much for the workers.
“When you have a practice that’s 35 years old and employees have never worked weekends or extended hours, when you change that model, obviously you’re going to lose some personnel,” said Steven D’Amato, BSPharm, executive director. He said a senior manager with two decades in the practice had to be let go because she wouldn’t embrace the vision of Come Home. Another bumpy ride may be in store for D’Amato’s practice of 15 physicians and 12 nurse practitioners and physician assistants. They are now deeply invested in the Oncology Care Model experiment, which D’Amato describes as “the Come Home model on steroids.”
The difficulties of adjusting to new value-based systems in the age of immuno-oncology were discussed by a panel of three oncology executives at the national conference of the Institute for Clinical Immuno-Oncology, held in Philadelphia in October. The discussion ranged over many issues related to the financial side of managing practices. Keeping drugs stocked at in-house pharmacies is a huge expense that is getting bigger, thanks to newer, more expensive medications, the speakers said. They foresee the cost barrier rising higher as combination therapies in immuno-oncology begin to proliferate. Not enough data exists for professionals to understand the nancial implications of these therapies, they said. In addition, staff training has gotten much more important as the pace of discovery rapidly outdates much of what physicians and other practice members need to know to stay in the forefront of treatment. Furthermore, meeting the need for patient access to care has necessitated the hiring of additional staff on all levels, the panelists said.
One essential part of patient access is offering the same clinical trial enrollments as urban centers are able to do, the speakers said. At the Dickstein Cancer Center in White Plains, New York, clinical trial participation has been ramped up with the aid of an af liation with an academic institution, said center administrator Una Hopkins, DNP. “Most pharmaceutical companies do not like to go to community settings because they don’t feel like they get enough bang for their buck with respect to the amount of patients going on clinical trials,” Hopkins said. The academic affiliation not only made it possible for Dickstein to become more of a player in trial therapies but also helped out patients considerably by alleviating the need for them to travel to urban centers for experimental-but-promising treatments. “When I started in my community center five years ago, we had two patients on two clinical trials, and now we have 21 open clinical trials. We have 753 patients on clinical trials,” Hopkins said. Part of the challenge is finding clinical trials that match the needs of the patient population that the clinic serves, Hopkins said.