Independent Health has decided to drop CCS Oncology from its provider network as of January 1, 2017. The change in coverage has left some 560 members looking for a new cancer physician.
Independent Health Chief Medical Officer Dr. Thomas Foels says the insurer did not take this decision lightly, but it is in the best interests of members. He says Independent Health had been in talks with the CCS for 18 months and could not come to agreement on moving toward a new value-based reimbursement model, instead of the pay-for-service model currently used by the physician group.
"The entire healthcare industry is moving rapidly toward a new type of payment, called value-based payment, and it rewards outcomes and quality rather than traditional fee-for-service payment," Foels says. "In fact, the federal government, Medicare, is moving in this direction. One-hundred percent of physician payments in the next few years will be moving toward value-based payments."
Foels says members were notified last month that the 22 oncologists at CCS will no longer be covered and have been helping find new care. Other CCS specialists are not affected by the coverage drop.
"We have a very comprehensive care of oncology providers in the community, including the Buffalo Medical Group, Cancer Care of Western New York, Roswell Park, so we don't anticipate any problems with our members continuing with high-quality care," Foels says.
CCS Chief Medical Officer Dr. Sam Yi says, unfortunately, the patients have been caught in the middle a financial disagreement. He says patients going through cancer treatment are in the most stressful time of their lives and cancer care is typically very expensive - "in the six figures."
"There was absolutely no question about the quality of care we provided and all of a sudden they start analyzing a bunch of data specifically looking at the cost and they keep coming back to us saying we are a lot more expensive than our peers," Yi says.
"Without telling us how we can improve, by maybe ordering less tests or doing less of therapy," Yi says. "They would just give us a bunch of statistics saying, 'Oh, you guys are much more expensive.'"
Yee disputes Independent Health's claims, saying the insurer was "comparing apples and oranges" in its "flawed" analysis. He says his oncologists follow the national guidelines of its credentialing organizations.
"They're not just doing this to us. They've been going around town targeting different specialists, whether oncologists or cardiologists or orthopedic physicians, etc.," Yi says. "They've been doing this for a number of years and, unfortunately, because none of practices or the doctors felt they were big enough to defend themselves and challenge their Independent Health way of trying to cut reimbursement."