Collaboration in Cancer Care: Navigating Hospital-Community Practice Partnerships

Community oncologists and their practices are an integral part of the cancer care continuum, caring for 50% to 80% of patients diagnosed with cancer.^1,2

However, the growing complexity of cancer care—combined with a transition from volume-based to value-based cancer care—means that a majority of care involves partnerships between community oncologists, local hospitals and health systems, and academic centers.

Hospital and community practice partnerships can take many shapes. Blood Cancers Today spoke with several oncologists about the types of partnerships and the benefits and drawbacks to each.

A Local Partnership

Independent practices are often unable to provide access to all the resources necessary for patients to receive the full continuum of care, thereby fostering the need for care partnerships, according to Stephen “Fred” Divers, MD, a practicing oncologist and hematologist at Genesis Cancer and Blood Institute in Hot Springs, Arkansas.

Dr. Divers said that these partnerships or collaborations often take one of two forms. The first is a contractual relationship that is compliant with the Federal Trade Commission (FTC). Other partnerships are those that exist or are born “out of necessity or limited resources.”

His practice has a partnership that is borne of the latter, with a footprint covering approximately 20 to 25 counties throughout Arkansas. Although the practice interacts with numerous hospitals, depending on the location of some of its satellite services, its largest partner is CHI St. Vincent in Hot Springs and Little Rock.

“There is no legal or binding contract,” Dr. Divers said. “It has been a patient-centric path forward where we try to streamline who has access to which resources and fill the gaps when it comes to patient care.”

Dr. Divers provided an example of the cooperative effort required to provide appropriate care for patients. Pathologists, medical oncologists, and urologists are employed by his clinic. The hospital employs surgeons and radiation oncologists, while diagnostic and interventional radiologists are independent practitioners.

Both sides benefit from this symbiotic relationship. The hospital avoids the cost of employing full-time oncology providers and $100 million per year in pharmacy expenses, while having access to a complete oncology service line. As the hospital’s non-contractual preferred referral provider for oncology services, Dr. Divers’ practice avoids the expense of radiation build-out and has access to the hospital’s multispecialty support.

“The independent oncologist is laser-focused on the oncology aspect of care, and any hospital has a myriad of objectives it is trying to accomplish; it has orthopedic service lines, cardiology service lines, in addition to the emergency department, surgery, and more,” Dr. Divers said.

The oncology practice needs the hospital for its services, but the hospital needs the oncology practice to continue cancer care outside of the hospital setting, he said.

“This is where being good partners and being respectful of the ways one center creates revenue and creates risk is important,” Dr. Divers added. For example, he said he tries not to order next-generation sequencing until a patient is 14 days out of the hospital. Otherwise, the hospital, which is paid on a set fee per day, is stuck with the expense of that test.

Tension occurs, he said, when revenue drivers overlap, creating competition. This can be especially true between independent groups and large health systems in metropolitan areas.

Expanding Reach

Mutually beneficial working relationships also exist between community-based oncology practices and academic medical centers. One strong example is the collaboration between New York Cancer & Blood Specialists (NYCBS) and Memorial Sloan Kettering Cancer Center (MSKCC).

“MSKCC patients typically undergo surgeries and procedures in the city, with follow-up oncology care provided both at MSKCC’s main Manhattan campus and its satellite locations,” explained Gurmohan Syali, MD, co-chief medical officer at NYCBS. “Chemotherapy, radiation, and imaging services are also delivered by MSKCC physicians at these sites. However, MSKCC doctors generally do not round at the local community hospitals near their satellite locations. To maintain continuity of care, NYCBS physicians step in to manage MSKCC patients admitted to local hospitals, creating a true partnership between the two practices.”

With more than 40 locations across New York, NYCBS delivers comprehensive cancer care, including chemotherapy and radiation therapy, and provides hospital coverage at nearly all major facilities on Long Island. When MSKCC patients are admitted to these local hospitals, NYCBS physicians manage their care while staying in close, real-time communication with the MSKCC teams. This creates a seamless experience, ensuring patients receive high-quality, coordinated care every step of the way.

“MSKCC needed a partner to cover these hospitals,” Dr. Syali said. “NYCBS fulfills that need because our providers are already embedded in these facilities. With access to MSKCC medical records, we’re able to provide care that’s informed, connected, and efficient.”

Beyond inpatient care, NYCBS also supports MSKCC in areas such as dedicated hematology and palliative care services.

“There are also times when a patient reaches out to MSKCC but finds the center isn’t in-network with their insurance,” Dr. Syali noted. “In those cases, MSKCC can confidently refer patients to NYCBS, knowing we already have a strong working relationship. This is especially important when distance or coverage creates a barrier to timely care. We step in to ensure patients still receive prompt, quality treatment.”

This collaboration laid the foundation for the two organizations to open a co-managed, state-of-the-art cancer center in Brooklyn’s Flatbush neighborhood.³ The center blends MSKCC’s academic depth with NYCBS’s community reach, bringing world-class cancer care directly into the heart of the borough.

Dr. Syali acknowledged the learning curve at the start of the partnership. “Early on, there was concern in our group that referring patients to MSKCC might mean losing them permanently,” he said. “But over time, it became clear that patients move freely between our practices. There’s mutual trust, and we know they’ll come back to us for their ongoing oncology care.”

Partnership Challenges

Despite these two examples of working relationships, both Dr. Divers and Moshe C. Chasky, MD, FACP, an independent hematologist-oncologist at Alliance Cancer Specialists, part of the US Oncology Network, acknowledged that not all partnerships between community oncology practices and hospitals or health systems are seamless and successful.

Dr. Chasky trained at a National Cancer Institute–designated cancer center but decided to join an independent community oncology practice that operated as part of a local hospital.

Soon after, the market around his practice started to consolidate, driven in part by the growth of Jefferson Health. After Jefferson took over the local hospitals, Dr. Chasky and colleagues were told that their practice would be allowed to remain independent. However, that turned out not to be the case; they were kicked off staff and eventually filed a lawsuit.

Part of the incentive for health systems acquiring these hospitals and practices, Dr. Divers said, is the 340B Drug Pricing Program. Established in 1992, the 340B program provides eligible safety net providers with substantial discounts on outpatient drugs, while also ensuring full reimbursement from private and public insurers. Eligible hospitals might include certain Medicare disproportionate share hospitals, freestanding cancer hospitals, rural referral centers, or sole community hospitals.⁴

An unintended consequence has been the incentive for 340B-participating hospitals to purchase community practices “that have the greatest opportunity to benefit from dispensing medications acquired through the 340B program, including practices in oncology, ophthalmology, and rheumatology.”⁵ This is aided by site neutrality, a parameter of the 340B program that qualifies all hospitals within a certain distance of the 340B site to qualify for the discounted pricing.

On the opposite end of the spectrum, Dr. Divers discussed examples of health systems that are letting go of oncologists and oncology practices because they don’t want to bear the burden of employing them in a non-340B environment.

“This has really been the downfall for many independent oncologists,” Dr. Chasky said.

Now, Dr. Chasky has a thriving independent practice in Bensalem, Pennsylvania, and is once again able to successfully collaborate with a local hospital. Maintaining his independent practice was not an easy choice, he said. It took courage and a lot of hard work.

“There are definitely some hospitals out there that have decided to employ medical oncologists because of these financial incentives,” Dr. Chasky said. “There are others out there like MSKCC that have instead chosen to be collaborators.”

Regardless of the level of independence or collaboration chosen, Dr. Divers emphasized that it should ultimately come back to the patient and what is best for their cancer care.