Jason Call, MD
Research shows that market dominance can improve revenue margins, but Cancer Care Northwest (CCNW) demonstrates that it can also benefit patients in sparsely populated areas.
Four decades ago when CCNW was one of more than a dozen cancer care providers in eastern Washington state, none of the regional independents was large enough to provide a comprehensive range of treatments, so patients with unusual tumor types often needed to drive more than 4 hours west for care, over the Cascade Range, to one of the Seattle area’s large hospitals.
Since then, CCNW has increased its market share in eastern Washington to more than 75% and achieved similar dominance in northern Idaho and part of western Montana. That patient volume supports 12 medical oncologists, 8 oncologists, 8 radiation oncologists and 7 surgical oncologists—many of whom specialize in particular tumor types. Together, they can provide patients with every mainstream cancer treatment except proton beam therapy and autologous stem cell transfer, all in a region where the largest city has just over 200,000 residents.
“We still bleed a few patients over to the west side [of the Cascades], but not many. There simply isn’t much they can do in Seattle that we can’t do here. Not only do we offer all the treatments, we also get the patient numbers we need to develop expertise in providing those treatments,” said practice president Jason Call, MD, a radiation oncologist who treats patients at CCNW’s North Spokane Clinic.
The practice that is now CCNW began operations in 1975, when a single medical oncologist named Turner Woods hung his shingle in Spokane, Washington. Woods took on a handful of partners over the following decade, all of them medical oncologists, and then joined the organization that became US Oncology, a Texas-based company that provides management and back-office services to cancer practices. It was during those years that the practice consciously decided to become a comprehensive cancer care provider. It first added 3 radiation oncologists and its first linear accelerator. A few years after that, it added a surgical oncologist and the gynecological oncologist, both of whom had been operating in independent practice in Spokane.
About a decade ago, the partners in the practice decided they could improve their business by becoming truly independent, so they left US Oncology and hired Warren Benincosa, MPH, to run the operation. However, Benincosa’s tenure as CEO nearly turned out to be very brief. Soon after he arrived, hospital chains around the country began snapping up independent oncology practices and the 2 local chains reached out to CCNW and expressed a strong interest in purchasing the practice.
After 14 months of negotiations, Providence Health and Services and Community Health System both came through with serious offers, but the partners ultimately decided against selling. Their analysis of the market suggested they could become the region’s dominant cancer care provider without backing from any hospital. Their strategy: help the practice by helping all types of patients. During the US Oncology years, CCNW used a complicated algorithm for ensuring that treatment of patients without adequate insurance was kept to a minimum. The US Oncology algorithm was so conservative that the practice turned away a substantial percentage of potential patients. This engendered ill will and ended up hurting the bottom line.
“One of the first phone calls I received when I came to work here was from a primary care physician who said he would never refer another patient to us. He wanted to partner with oncologists who would care for all of his patients, so if we wouldn’t take the poorly insured patients, then we weren’t going to get the well-insured ones either,” Benincosa said.
“Shortly after I reported the conversation,” Benincosa added, “the partners decided on a fundamentally different approach. We have since gotten the algorithm down to a single question: do we treat this patient’s condition? If the answer is yes, we accept the patient, regardless of ability to pay. There was some concern initially that such a policy could bankrupt the practice, but extra business from well-insured patients has offset extra business from uninsured patients, and we are thriving financially.”
Because patients who don’t have appropriate insurance can constitute a drain on practice finances, CCNW employs financial navigators who work to obtain government assistance, charity care, and drug subsidies that bridge the gap between what patients can and can’t afford. These counselors cannot find enough dollars to fully cover every patient—CCNW contributes about $1 million in charity care per year—but a high percentage of uninsured patients do qualify for enough financial aid to cover the cost of caring for them and prove the old algorithm wrong.