Editorial: Avoiding a shortfall of cancer treatment facilities
The state Department of Public Health has called for the construction of at least eight radiation treatment centers in the state to meet an anticipated increase in cancer cases by 2010. The state’s population is aging, and as it does, is becoming more susceptible to cancer. Massachusetts cancer cases are expected to increase to more than 38,000 in 2010, an 18% increase over the baseline year of 2000. Without the new centers, the state says, patients could wait dangerously long for treatment or have to travel much farther to get it.
It’s a "soft ask" - the DPH isn’t requiring hospitals to build anything. The question, though, is who’s going to build them, and where. The DPH is looking to the market to determine which parts of the state seem to be underserved in terms of radiation treatment. The DPH doesn’t develop its own regional numbers. The burden of proof is on the applicants for new centers to prove that their target market is either farther than 30 minutes from an established center or have to wait more than seven days for treatment.Anecdotal evidence of the growing demand for radiation treatment isn’t hard to find. Half of all cancer patients undergo radiation therapy as part of their treatment. Worcester County now has seven radiation treatment centers, and many of them are going straight out. For example, the treatment center in Fitchburg’s Burbank Hospital, opened in August 2002, was designed to treat 25 patients a day, but now treats 50 to 60 patients a day.
In July, the DPH loosened the rules to widen the applicant field from hospitals and companies with existing units, to any company or hospital that can project a caseload of at least 250 patients annually and can demonstrate need based on proximity and availability. The new law also opens up the radiation oncology field to community hospitals. But those hospitals have tight profit margins and given the hard investment cost in setting up a center they’re proceeding with caution.
Harrington Memorial Hospital in Southbridge is an example. HMH is wrapping up a feasibility study for a radiation treatment center, but CEO Richard Mangion says HMH would have to partner with two other hospitals in order to achieve the required annual patient volume. So right now, there’s no easy answer as to whether our region’s cancer patients will be adequately served by 2010.
Because of the $6 million to $10 million cost of building a treatment center, there’s no motivation for applicants and their investors to oversaturate the market.
The entities that pay for health care - insurers and employers - are watching closely. Payers note that increases in the availability of services often leads to an increase in utilization - and therefore, cost. Payers express the hope that "good science" will drive the medical selection process. The increasing transparency of medical records and evaluation of physicians should help accomplish that, but we still need somebody to build the centers that both the state and the medical profession say are needed.
We hope that the loosening of regulatory constraints will bring the needed entrants into the market - entrants who can provide good technology at an economically feasible cost. The DPH - and many of the state’s hospitals - appear to be hoping that market forces will provide the needed antidote to unmet medical needs, while keeping the side effect of cost increases to a minimum. If market forces don’t begin to fill that need in the near term, the state may have to be more proactive as a catalyst in getting those centers up and running.
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