Please note that this is part of the presentation from November 2015. Four questions were asked of me, and are addressed separately within this post.
The information contained in this presentation can be overwhelming. We recommend you review its contents more than once, for there is much to understand and much to benefit your health.
How can you determine when you are receiving your best medical care? For a cancer patient, how do you separate brand names and tailored play-on-word scripts…from genuine success. The marketing of cancer treatment has nothing to do with quality…or results. Its audience includes those emotionally traumatized…who feel compelled, almost spell-bound…to listen. Add to this intense dilemma any financial gain influencing those who offer you “the best medical choice.”
Let’s view our Villages past…to present, sorting truth from the swirl of media-induced confusion. Walk with me the streets of time we have traveled, and which direction is safe to go.
Radiation oncology on the Villages campus began over 16 years ago when Gary Morse, the developer of The Vilłages, asked the Robert Boissoneault Oncology Institute to establish a presence. Arriving in June of 1999, we represented our part in the 9% of cancer facilities then accredited across the country by the American College of Radiology. This national board has long been respected by all academic institutions.
But five years ago, Mr. Lee Huntley, then CEO of the Central Florida Health Alliance, changed all dynamics. His agenda to create radiation oncology was with our understanding that the Robert Boissoneault Oncology Institute, our group, would provide professional services for the Villages hospital. We were bewildered that our effort over greater than half a year to plan and consolidate rather led to a duplication of resources.
Do you remember the multi-media barrage consuming The Villages during latter 2010 as you read the following…
Imagine a National Cancer Institute presence on The Villages campus.
- World class doctors coming from Moffitt to The Villages for residents who need care.
- The required technical resources don’t presently exist in The Villages.
- In order to make this happen, $6.3 million must be raised to pay for equipment.
As you recall, every conceivable advertising approach was utilized. In fact, the American Cancer Society was denied use of The Villages for their annual Relay for Life if half the money was not donated to The Villages Hospital cancer facility. But there was no question residents gave financially and emotionally to what was perceived as a justified effort.
The headlines in the Villages newspaper on October 28, 2010, read “cancer center groundbreaking ushers in new era of health care..” as then both CEO of the Central Florida health alliance and CEO of the Villages hospital “promised an absolutely fantastic product and service.”
Villages politics gave an impression….different than the truth. Physicians NEVER came from Moffitt. The series of three wearing the Moffitt name appeared from elsewhere. That arrangement was acceptable to the local hospital administration…as they magnified on the “draw” of the name. Residents…future patients…were being misled…as the train of deception left the station.
“Sold” to residents was the implication that resources were not available in The Villages…that treatment required travel elsewhere. In fact, resources WERE present. Critically important, the Robert Boissoneault Onclogy Institute’s meticulous quality in treatment planning and delivery was directed by four PhD physicists, for a total of 11 physics staff members. Most other academic and private practice programs pale in comparison to our quality assurance and physics staff. This level of sophistication cannot be minimized: in essence, it is the crucial element in radiation as a treatment option. You miss this important step…you lose!
Seeking funds from residents in order to buy equipment is not the standard approach. That..is salesmanship. There was no need to raise any money since part of the insurance payment for treatment covers thecost of equipment. But the fact that you did earnestly contribute should ethically question if YOU now own that equipment?
This one truth still remained unchanged: residents sincerely gave both financially and emotionally to what they believed was a justified effort. As to any relationship between the Villages Hospital system and Moffitt, one can only speculate. An original “draw” for fund raising was the National Cancer Institute presence on the Villages campus. After five years, the Central Florida Health Alliance dismissed that presence.
Because this was the statement released by Moffitt to all referring physicians, including myself. “We are reaching out to let you know that the Central Florida Health Alliance has chosen to end it’s five-year affiliation with Moffitt. The affiliation will cease effective October 15, 2015, including an end to Moffitt provided radiation therapy treatment and radiation oncology follow-up care in The Villages. As such, Moffitt Cancer Center will no longer provide services at The Villages, which may impact your referral of patients for radiation oncology care.”
As indicated earlier, treatment equipment was already present. But by duplicating resources, supply exceeded demand: a result of the local hospital MARKETING cancer care rather than focusing on delivery of care. Thus, the hospital radiation department, even with its Moffitt association, was not financially sustainable. So plans changed. Now, a different means of capturing revenue had to be designed. If a specialty group involved with cancer care could direct referrals, that would become the next approach to be packaged by the hospital….as Moffitt was told to pack up, and ship out.
Thus, as we learned in the Orlando Sentinel newspaper, the radiation equipment, designating the Central Florida Health Alliance as stewards for your contributions, was recently sold to Florida Cancer Specialists (FCS) for an undisclosed amount.
The hospital has enrolled FCS to assume radiation oncology: the group now owning the equipment oversees referrals…to themselves. But these doctors, medical oncologists (or chemotherapists), were never trained in radiation. They were trained in the use of pharmaceuticals. The hospital is well aware of this fact. But the hospital’s motivation is to have patients receive radiation treatment in the hospital since that becomes a source of revenue. The hospital assumes that medical oncology, or chemotherapy, doctors control when and where referrals for radiation go…kind of like a gatekeeper. And if patients don’t do their homework, the open gate to avoid bias…becomes locked.
Buzz phrases like “providing total care under one roof” or “comprehensive” have been routinely used to justify such arrangements. Protection of a patient’s choice is a responsibility each physician should uphold with the highest ethical regard. At a time when an emotional connection is sought, decisions for treatment take on value for both patient and physician, a commitment that should not be influenced by maximizing hospital profit. Objectivity in the decision process becomes compromised. Finances cloud hospital approaches to care. The patient’s “choice” is unknowingly swayed.
Studies from Medicare and the Government Accountability Office. indicate that specialists who gain from directing treatment choices recommend those options up to eight (8) times more often than if they were not invested: this is based on an initial 2002 study, subsequently reported in 7/08. Their conclusion…was that a specialist’s investment adversely influences medical judgment.
Hospitals who want referrals preferentially directed…to themselves…are aware of the financial wind-fall by capitalizing on an incentivized approach. But this has become a slippery slope for two Florida hospital systems. Fines of almost 70 million and 122 million have been imposed upon the Broward Hospital System and the Seventh Day Adventist (better known as Florida Hospital) System for violation of federal self-referral laws. In their case, one must question motivation. I provide these real-life events as illustrations of a self-serving mindset: they are in no way accusatory in nature.
But care can become analogous to a court room…without a judge…without a jury…and with one attorney representing both sides of treatment, because he/she has been placed in a position to influence both sides of treatment.
Let’s look at “the journey to create a comprehensive center” described in The Villages Daily Sun on October 11, 2015, and more recently January 24, 2016. The CEO of the Central Florida Health Alliance, stated, “We’ve been very grateful to the Moffitt Cancer Center for the services they did provide. But they reached their high-water mark and they told us they couldn’t go further than what they were currently providing, which was the doctors for the radiotherapy service.”
Mr. Henderson indicates he started a “dialogue with them (Florida Cancer Specialists) and they told us, ‘we think we can provide a comprehensive center such as the one you are looking for’.”
How is this new comprehensive cancer center different from what has previously been in place? In essence, there were already medical oncologists from Florida Cancer Specialists in the Sharon Morris building. These same FCS medical oncologists previously referred a number of patients to our practice for years, in spite of their presence in that building.
The convenience of having the offices of both FCS and radiation oncology close together already existed…in the same building. Now, the same medical oncologists provide services…under one roof, or separate. No doctor came into or left the community. From inception the chemotherapy, or medical oncology, doctors saw no need for their services to be duplicated, since they would have been out of a job. In essence, nothing for medical oncology was ever designed to change.
There is still one radiation oncologist. Why now would the radiation physician be overseen when the physicians overseeing have no knowledge of radiation oncology and never served that function in the past? Certainly not at Moffitt. Is the hospital having a radiation oncologist hired into a medical oncology group somehow now “comprehensive?” Could the word have more financial implications?
So what in the new contract now makes the present situation…better? You see, moving remaining FCS physicians into one building does not change your care.
The CEO of Florida Cancer Specialists indicated in the same article of October 11, 2015, that now “patients don’t have to drive to Tampa or Orlando to receive the most advanced and comprehensive cancer care available.” But the hospital was already providing the exact same care with medical oncology delivered by their FCS physicians, radiation oncology delivered using the same doctor…with the exact equipment you purchased…all under one roof. And if Moffitt stayed, the hospital would not have lost the National Cancer Institute or the American College of Radiology accreditation, since those benchmarks now leave the local hospital and return to Tampa.
Is the hospital indicating that the nine other medical oncologists who are not part of Florida Cancer Specialists, have not provided comprehensive care?
So what has been gained…or lost? Where was the missing piece the Central Florida Health Alliance CEO alludes to that Moffitt could not deliver? In reality…there was no missing medical piece. The change is simply an administrative approach for a financial bailout.
Earlier in my talk, I referred to the eleven physics professionals of the Robert Boissoneault Oncology Institute team. When does that become important? When you become the patient. That behind-the-scenes intensity assures a quality of care meticulously guiding each treatment. And the number of therapists involved in your daily precision treatment? We average three to actively touch your care…every time it is delivered. Each treatment plan is approved by at least two physicians and our physics’ staff. Every step is constantly verified…over and over. The potential for error drops precipitously. We can both sleep better at night knowing the ultimate level of care is provided. Don’t assume that level of protection is available everywhere. Is it really that big a deal?
It was for even the Moffitt Cancer Center when reported in April of 2005 that for the prior year’s time, 77 patients were overdosed with 50% more radiation than planned. Should that repeated error have been caught?…yes! The person responsible “made the same mistake three times.” said Moffitt’s division director of radiation oncology. “They were supposed to have a second physicist independently verify the calibrations of the first physicist,” said Bill Passetti, the Florida Bureau of Radiation Control’s Chief. “It looks like the second verification wasn’t performed.” If this was a survival-affecting mistake at Moffitt in Tampa, to what end should you be guaranteed for your level
What is the responsibility of the specialty of radiation medicine to each patient? Radiation oncology is not a medical component bought and sold under the guise of a machine or a location. It is a profession that requires extensive training…whose performance should be meticulously delivered…by a coordinated and seasoned TEAM. We have always gone to the other extreme of providing endless redundancy to attain perfection. For those invested who don’t practice radiation medicine as a profession, such a level of sophistication and treatment delivery may seem unnecessary: until, of course, they become the patient…or defendant.
Our group, RBOI, has worked with the local medical oncologists for years, and have been impressed with their medical oncology ability, in group settings or solo practice. The hospital’s approach in no way reflects upon a physician’s specialty performance. These are good doctors with whom we have enjoyed providing optimal care together. God knows I hope patient-oriented medicine doesn’t end. But if we are to provide the highest quality of medicine, it will be with respect that each of our teams’ performance has earned, without profiting at the expense of the other. The result of the hospital administration’s actions is to drive a wedge between professional groups whose respected expertise for the patient’s health was seamless and optimized.
The baiting that hospital-orchestrated referral encourages can lead to less than objective health decisions. Plain and simple, the patient has been…and is being misled.
Each of you has the ultimate control over your own health. Cancer treatment is not a one-package deal. You have every right to choose who your surgeon, medical oncologist…and radiation oncologist will be. Further, you can determine where each medical service will be delivered. And there is nothing that stops you from seeing your radiation oncologist…first. I routinely see patient’s first…in order to begin an organized plan of care, whether radiation is part of treatment or not.
Please note…RBOI will CONTINUE to utilize ALL of the same medical oncologists, to include our colleagues of Florida Cancer Specialists, as has been our privilege in the past. We should each ideally serve as a critical…non-incentivized check and balance for one another in the care of our patients.
How will you know when you have found your best medical care?…when you feel empowered to choose who provides EACH component of your care.
We respect deeply that the contributions and effort Villagers gave was for a perceived need. In addition you should have the opportunity to participate in relevant academic treatment resources. But referral to an academic institution, National Cancer Institute affiliated or not, is no further away than a referring physician’s phone or computer. National Cancer Institute studies involving radiation would not routinely have been delivered in the Villages due to protocol guidelines. Your access, however, remains the same, and we refer patients regularly. In addition, an accredited American College of Radiology facility, that is…the Robert Boissoneault Oncology Institute, has been…and is now…present on the Villages campus.
We are here to walk with you as the first step in your evaluation, widely opening gates for each and every medical avenue, while respecting and supporting your decision paths. For that second opinion, for free, call us and schedule that important talk. Your health care deserves nothing less: those who love you will demand it.
The Robert Boissoneault Oncology Institute