F. Anthony Greco, MD
Tennessee Oncology was a relatively small practice until 1992, which is when F. Anthony Greco, MD, left Vanderbilt University Medical Center to become its fourth partner. Greco came with the then-radical idea that he could perform more trial work at a private practice than he could at a larger institution, such as an academic hospital. His vision not only made Tennessee Oncology a key player in many oncology studies, but also precipitated its 25 years of rapid growth.
By 1996, Tennessee Oncology had hired its 15th physician, current CEO Jeffrey Patton, MD. Today, after a trio of mergers and sustained organic growth, the practice has 81 physicians who provide care in 30 locations in central and east Tennessee. This growth has made Tennessee Oncology the dominant provider of cancer care across its service footprint. It has also fulfilled Greco’s original vision: Tennessee Oncology does significantly more work on clinical trials than the only big competitor it still faces, Vanderbilt Ingram Cancer Center.
“We have more patients in clinical trials than any other private practice in the country, and when you look specifically at phase I trials, we’re the second busiest drug development unit anywhere in the world. We have been the venue for more than 100 first-inman trials,” said Patton. “We are very proud of this trial work, both because it gives our patients options that they could not get elsewhere and because it advances the state of cancer care for patients all around the world.”
Tennessee Oncology conducts this work across an extremely varied service area. It is based in Nashville, a middle-income state capital of just over 650,000 people that lies at the heart of a booming metropolitan region with 1.8 million inhabitants. The practice’s footprint spreads far beyond that region, however, across more than a dozen rural counties, all the way to Chattanooga, a middle-income city of 175,000 just north of the Georgia border. Cancer incidence rates exceed the national average throughout most of this region.1
State officials report that Tennessee ranks 19th nationally in per capita cancer incidence and third in per capita cancer deaths.2
Many factors contribute to this problem, especially tobacco use. About 22% of Tennesseans3
(compared with only 15% of Americans4
) smoke cigarettes, according to the Centers for Disease Control and Prevention. As a result, Tennessee’s annual lung cancer death rate of 56 per 100,000 individuals far exceeds the national average of 43 per 100,000.5
The exact size of the problem varies greatly across Tennessee Oncology’s service area. In the wealthy suburbs of Williamson County, the lung cancer death rate is just 41 per 100,000, but many other health metrics exceed national averages. In rural Polk County, the annual lung cancer death rate of 103 per 100,0006
is just one of many serious public health problems.
“Different parts of our service area differ in just about every way you can imagine, but our operations are the same pretty much everywhere, except that offices are smaller in less populous areas and some of them operate fewer days per week,” said CFO Ron Horowitz. “Despite the overall demographics of a particular area, you get all sorts of patients at every office, so you have to be able to deal with different cancers and different financial situations and different everything at every office.”
The real challenge in covering Tennessee Oncology’s service area isn’t so much the differences from place to place as it is managing the growth of the practice. “When you’re growing from a local to a regional practice, you have to be careful not to outrun your support,” Horowitz said. “It’s easy for technology to give the impression you can open an office anywhere you can get an Internet connection, but oncology requires physical support. If you have an office that’s 200 miles away from any other office, you can’t get staff there to cover unexpected absences or medicine when your refrigerator breaks. Offices need to be close enough to support each other when the need arises. Otherwise, you don’t get the benefit of running a network rather than a series of independent offices.”
Although primary care providers, public health officials, and others probably have more ability to reduce the state’s elevated cancer incidence rates and get patients with cancer diagnosed earlier, Tennessee Oncology is continuously testing new strategies for improving outcomes once patients are diagnosed. The practice’s ongoing participation in clinical trials is an example, but the group has also spent the past few years testing new care delivery models and gradually implementing them across its practice.