May 9, 2011 | last updated March 25, 2012 10:18 am
QUANTITY OF CARE

How Many Cancer Centers Is Too Many? | Proposed center at St. V's would be sixth in Central Mass.

When Saint Vincent Hospital in Worcester recently announced that it would build a new $21-million cancer center, some in the area may have felt a sense of déjà vu.

Just last month, Marlborough Hospital unveiled plans for an $11.7-million cancer treatment wing. Less than two years ago, the $14-million Cancer Center at Harrington opened in Southbridge. Two years before that the $25-million Cancer Center at Milford Regional Medical Center — a partnership among the medical center, the Dana-Farber Cancer Institute and Brigham and Women's Hospital — opened its doors.

Supply And Demand

The proliferation of cancer centers undoubtedly reflects a growing effort by health care institutions to bring services like radiation treatments close to the patients who need them. There's also no doubt that these services are typically good sources of income for hospitals — the kind of medical area where competition among institutions can be fierce.

Critics argue that, in general, the state should offer more oversight as hospitals expand and offer new services to make sure that health care costs aren't being driven up needlessly. But the hospitals where these centers are located say there's no oversupply of cancer care, and, in fact, they expect to be struggling to handle a growing number of cancer patients in coming years.

Ed Moore, president and CEO of Harrington Hospital, said that when he joined the hospital in 2007 it was offering chemotherapy and infusion treatments, but radiation therapy wasn't offered anywhere between Worcester and Springfield.

The distance was particularly significant, Moore said, because patients often need 20 to 30 radiation treatments, and they take only 15 minutes or so.

"You go in, you change, you get positioned and you get done very rapidly," he said.

So Harrington joined with Radiation Therapy Services Inc., a for-profit company based in Florida, and with UMass Memorial Medical Center, whose physicians provide expertise in radiation oncology, to bring radiation treatments to Southbridge. At the same time, it consolidated its other cancer services into the new center.

The move Saint Vincent is now making doesn't involve any new services — it already has a radiation oncology program housed at its former campus on Vernon Hill — but it mirrors what Harrington did in bringing various services into a single location. Saint Vincent spokesman Dennis Irish said it's a matter of offering the convenience for patients that is becoming standard in the health care industry.

"The new model for cancer care is a comprehensive one-stop location," he said.

Marlborough Hospital, which is part of the UMass Memorial Health Care system, also touted the idea of offering patients care close to home in announcing its new center. Like Harrington's the Marlborough center adds radiation therapy to the cancer treatment options already available at the hospital.

Billable Services

Attractive cancer care options also make sense for hospitals from a financial perspective. Moore notes that cancer treatments are "reimbursed adequately or well," particularly if a hospital can keep patient volume reasonably high.

But how many multimillion-dollar buildings filled with state-of-the-art equipment can be built in Central Massachusetts before it stops being a sensible way for the health care system as a whole to spend its money?

Eric Linzer, spokesman for the Massachusetts Association of Health Plans (MAHP), said he doesn't know, but that in itself may be a problem.

MAHP is pushing for an expansion of the state's determination of need process, which evaluates plans for major new hospital developments based on the potential demand for their services. State approval is only required for projects over $25 million, but MAHP wants to see that threshold reduced.

Gov. Deval Patrick has also proposed changes that would require new hospital projects to comply with a state health plan, which would expressly indicate what areas are under- or over-served. That would be a return to a system the state used until it was eliminated by Gov. William Weld in the 1990s, according to Brian Rosman, research director with Boston-based Health Care For All.

Linzer said expanding state oversight would help stop high-priced teaching hospitals from setting up new operations in areas that are already well served by more affordable community medical centers.

But Irish said the Saint Vincent cancer center is actually doing just the opposite of that. Besides serving the hospital's current cancer patients, he said, it expects to draw from those who would otherwise seek care at more expensive hospitals to the east, or at UMass Memorial Medical Center.

Irish noted that, thanks to pressure from the state and employers, as well as individuals' budget concerns, more and more people are enrolling in tiered network plans. Many of those put Saint Vincent in their preferred tier and charge lower co-pays for patients who go there, while putting UMass in the pricier tier.

"Simply on the basis of the new calculus in health care around value, we expect that we're going to take some services away from our competition," Irish said.

But Michael Blute, director of the UMass Memorial Cancer Center, said his system is actually well positioned for coming changes to health care finance. The UMass center is not simply a stand-alone facility, he said, but the heart of a cancer care network. The new Marlborough cancer center, the Simonds-Sinon Regional Cancer Center at UMass's HealthAlliance campus in Fitchburg and the Harrington center, through its partnership with UMass, are all connected with the main Worcester campus. That means patients at any of the sites can get conventional types of treatments or be part of clinical trials that allow them to get new treatments before they're available at most community hospitals.

"If you go and receive cancer care at HealthAlliance or at Marlborough, you're essentially walking into the UMass Cancer Center of Excellence," Blute said.

Blute said that makes the UMass system a model for accountable care organizations, the unified patient-care systems that both state and federal health finance reform efforts are betting on to help reduce costs.

Regardless of the payment system, you could certainly question whether the new cancer centers will add up to too much capacity for cancer care in Central Massachusetts — too many radiation machines, too much staff, too many spots for chemotherapy treatments. Blute says the answer is certainly, though unfortunately, no.

"There's going to be an explosion in the diagnosis of malignancy with the Baby Boomers entering into their 60s now," he said. "We're going to be challenged to meet the demand for cancer care in the future. We're not going to be challenged by having too much equipment."

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