Beginning this month, CoxHealth’s insurance company ended in-network coverage with its longtime oncology care provider.
Oncology-Hematology Associates of Springfield MD PC and its patients using Cox HealthPlans LLC were notified of the change in a letter sent April 20, said Amanda Hedgpeth, vice president of clinical services at CoxHealth. The change went into effect May 1.
Approximately 25 patients actively receiving cancer treatments will continue with OHA, Hedgpeth said. Another nearly 200 OHA patients will now be out of network – out of thousands served by the nearly 40-year-old company, said OHA Administrator Beth Gann.
Hedgpeth said those patients have the option to switch providers to Cox’s newly formed CoxHealth Medical Oncology or pay the out-of-network price.
“We want to be very cognizant of the trying time that this is for patients,” Hedgpeth said.
Gann said the independent oncology provider has leased space in Cox’s Hulston Cancer Center on South National Avenue since the early 1990s.
“We’ve partnered with CoxHealth for years as the sole provider for oncology care,” she said. “We are on the physician panel with CoxHealth network, so any insurance plan that’s contracted through them, we are on their provider panel – except for Cox HealthPlans.”
Gann said the change only affects patients with insurance through Cox HealthPlans. She declined to disclose the financial impact of the decision, but said OHA will remain open and retain all of its 65 employees.
Over the past few years, Hedgpeth said CoxHealth developed its own oncology department on the fifth floor of the Hulston Cancer Center. OHA occupies the sixth floor of the building.
Cox’s oncology team is led by two physicians, Ray Lobins and Srikant Nannapaneni, ready to accept patients from OHA, Hedgpeth said.
“This department has been up and running for a little over a year, so Cox HealthPlans decided not to renew its contract with OHA, who is a vendor that has been providing services for our patients,” she said.
Gann said after decades of working closely with Cox to care for cancer patients, she doesn’t understand why the decision was made.
OHA was not given a reason for the change, she said.
“I can’t speak for them, but it was probably a business decision based on driving patient care to their integrated oncology group,” she said.
Gann also said she’s concerned about patient care in the transition.
“Caring for an oncology patient is a unique experience, and change increases stress and anxiety. This is a care journey,” she said, pointing to OHA’s six specialized physicians led by board President Dr. Dushyant Verma.
“You work and develop this relationship, and it’s based on trust.”
Gann said she’s received numerous calls from patients in tears and anxious about the change.
Terry Penner was diagnosed with breast cancer at 40 years old in 2011. She said she received treatment at OHA and continues care with follow-up appointments.
Because she is not in active care, Penner won’t be able to continue receiving an in-network price at OHA.
“This isn’t just a doctor who checks you for a sore throat; this is a cancer doctor,” she said. “This doctor knows your problems. … It’s an earth-shattering thing when you find out you have cancer.”
Penner said she’ll likely continue with her care at OHA and pay the out-of-network cost, adding she had a previously scheduled follow-up this month.
“I feel like I’m being attacked by my own insurance,” she said. “I’m going to have to pay more money to stay with the doctor I want.”
Penner said she had to switch doctors once before, and it was a stressful experience.
“I probably could have wrapped my head around this a little bit more if I would have had more notice and known I would have had this switchover,” she said.
Penner said she grew close to the physicians, nurses and fellow patients at OHA and considers many of them friends.
According to the Community Oncology Alliance, a Washington, D.C.-based nonprofit advocacy group, since 2008, some 1,500 community-based clinics have closed, representing a 121 percent increase in closures.
Additionally, there has been a 172 percent increase in community practices being acquired by hospitals in that time.
Dr. Gil Mobley and his immediate care clinic are not among the closure trends across specialties. He’s operated Dr. Gil’s Immediate Care independently for 20 years in Springfield, and he plans to remain that way.
“Hospitals are inherently clumsy, inherently cost inefficient. They’re burdened with the nonpayers especially,” he said.
Mobley said private operators, such as his urgent care, workplace injury and pre-employment care clinic, generally can provide service with more focus and efficiency.
As a result of specialty clinic closures, the cost of patient care has risen, according to Xcenda, a health economics research division of AmerisourceBergen Corp. (NYSE: ABC).
A study Xcenda released in September shows a 20-39 percent cost increase to patients receiving chemotherapy treatments in a hospital outpatient setting, versus a community oncology clinic.
Michael Merrigan, a clinical assistant professor at Missouri State University, said he’s observed that reductions in competition increase patient costs. But, he said, Springfield has competition among CoxHealth and Mercy.
“For Springfield, having both entities kind of going toe to toe with each other, it keeps health costs down,” Merrigan said.
However, in a community with only one health system, it’s additionally more difficult for independent providers to stay open with fewer health care workers and increased regulation.
“I don’t think this integration is going to go away; it’s just going to get stronger,” he said. “For southwest Missouri itself, I think it’s going to be really hard for private, especially rural, hospitals to survive.”
At CoxHealth, Hedgpeth said the changes are designed to improve continuity of care, especially for the complexities of treating cancer.
“Cox HealthPlans has a preference to coordinate care through Cox physicians as they have established common practices, policies and even a common medical record,” she said. “This facilitates better coordination of care.”
O’Reilly Development Co. is building a continuum-of-care community with 83 independent living units, 46 in assisting living and 16 in a memory care division.
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