Doctors already removed one of Carol Dehlinger’s kidneys, performed emergency surgery after cancer spread to her spinal cord, put her through radiation treatments and prescribed a chemotherapy drug.
So the 61-year-old City of Tonawanda woman cried when she recently received a letter from Independent Health telling her it was dropping her oncologist from its network.
“I don’t need the stress,” said Dehlinger, a mail carrier who took disability retirement when she became too sick to work. “The cancer stress is enough for me.”
Nearly 600 patients now receiving treatment from CCS Oncology learned the insurer would drop the practice’s 22 oncologists from its network of providers as of Jan. 1.
Other patients are affected, too, like the 1,400 people who are in remission and return only for follow-up appointments, or who only went in for an initial consultation.
Dehlinger, who uses a walker, has been a patient of CCS since last summer, after the surgery, and she deeply appreciates the care provided by her doctor, the chemotherapy nurses and the billing staff.
“I just love going there – it’s like family,” Dehlinger said. “That is like their motto: ‘Don’t worry about it, just concentrate on getting better.’ ”
Cynthia DeMarco’s breast cancer is in remission, after her third and latest bout with the disease.
The 80-year-old Town of Tonawanda woman said she has come to trust and rely on her oncologist and the rest of the staff at CCS Oncology after her chemotherapy treatments, surgery in January and post-surgery radiation sessions. DeMarco returns every six months for follow-up visits.
That’s why DeMarco said she was disturbed to find out about Independent Health’s decision to drop the CCS oncologists.
“I was furious, simply because I think so highly of CCS,” she said.
Finding a new practice will add stress on those being treated for cancer. Their options are finding a new oncology provider, switching to an insurer that includes CCS in its network or staying with Independent Health and paying higher, out-of-network costs to keep their oncologist.
After she learned of the decision, Sharon Suriani, 66, a retired teacher from Cheektowaga, called Independent Health and told the company “you’re not taking into consideration that these are people that have a serious disease, cancer, that they’re going through enough already. And now you’re cutting them off from their doctor that they know and respect.”
Suriani, a CCS patient since 2013 whose breast cancer is in remission, added, “I said it’s all about money, that’s all it’s about. It’s not about patient care – don’t give me that – which is sad, very sad.”
Independent Health said in a statement last month that it was working with its CCS patients to help them transition to new medical providers.
Other area oncology providers, including Roswell Park Cancer Institute and Cancer Care of Western New York, said there are more than enough oncologists in the region to absorb every oncology patient who chooses to leave CCS Oncology.
“We have adequate capacity,” said Dr. Marc Ernstoff, chair of the department of medicine at Roswell Park Cancer Institute.
The other providers can’t absorb all of the hundreds of patients “tomorrow,” said Ernstoff, but the early Independent Health notification gives enough time for an orderly transition before Jan. 1.
Roswell Park is a designated comprehensive cancer center with an academic and research mission that also has a network of community cancer practices.
Western New York Urology Associates and Cancer Care of Western New York are part of Kaleida Health. In addition to Cancer Care’s oncologists, the vast majority of Western New York Urology Associates’ 24 urologists treat urologic cancers, said Dr. K. Kent Chevli, president of the combined practices.
“The oncologic community in Western New York is very diverse,” Chevli said.
The other oncology providers said they understand the deep personal connection patients have with their oncologists. But they said the region has a bounty of skilled oncology providers and there is more than enough room for CCS patients.
New payment model
Independent Health said it made the decision to exclude CCS Oncology from its network because it could not reach agreement with the oncology practice on a new, value-based reimbursement method to replace the traditional model that pays a fee for each service provided.
The decision followed at least 18 months of negotiations over the insurer’s attempts to rein in spending at the practice.
After those talks broke down, Independent Health in mid-June notified the 22 CCS oncologists that the insurer would not renew their status as in-network providers as of Jan. 1. The decision doesn’t affect the 51 doctors in the umbrella CCS Healthcare group, which provides other medical services.
CCS officials said normal operations continue at both CCS Oncology and at CCS Healthcare.
CCS previously said Independent Health incorrectly accused the practice of providing costly care and attempted to impose punitive reimbursement cuts.
While CCS said it balked at Independent Health’s terms for value-based reimbursement, both Roswell Park and the combined Western New York Urology/Cancer Care practices said they have value-based payment arrangements with the insurer.
The model is growing in popularity with commercial and government payers.
In Western New York Urology/Cancer Care’s case, the arrangement involved a switch from payments based on volume to payments based on meeting specific targets for patient satisfaction, for example, or post-treatment complication rates.
“Generally speaking, it liberates you,” Chevli said.
While Dehlinger and other active CCS patients received notice from Independent Health, about 1,400 inactive patients did not.
Independent Health said it notified patients who came up in its records as having received a treatment between January and June of this year.
Dr. Thomas J. Foels, the insurer’s chief medical officer, said Independent Health relies on claims records and there could be a lag in the filing of some claims. The insurer will continue to notify active patients each month through the end of the year.
Foels said the insurer will adjust its criteria to include any CCS patient whose cancer is in remission in future notifications.
“Obviously [it was] not ever our intent to not inform them, and we wanted to give as much advance notice to people who were in active treatment,” Foels said.
CCS Oncology set up a patient hotline last week. Of the first 110 patients or their family members who called the number after a Buffalo News article on the decision, 35 said they hadn’t received a letter, said Paul Slater, a CCS marketing representative.
Facing a choice
The CCS patients have several options now that Independent Health will drop CCS Oncology, one of the region’s largest oncology providers, from its network.
Staying with Independent Health and CCS on an out-of-network basis would be the most costly option. Many insurance plans don’t offer out-of-network coverage, and those that do typically require patients to pay a percentage of the cost of the service or drug – which quickly can get expensive.
The patients then are left with the more likely choices of staying with Independent Health, but switching oncology providers, or staying with CCS but switching insurance companies.
Sorrentino said he doesn’t want to have to switch to a new provider.
Sorrentino credits CCS doctors and nurses for their “bedside manner, and explaining things thoroughly to you, and putting you at ease.”
DeMarco and Suriani, who have Independent Health Medicare Advantage plans, said they will consider changing to another Medicare Advantage plan. But they won’t know until the fall enrollment period which other insurers will include CCS in their networks for 2017.