By Tracey Drury – Reporter, Buffalo Business First
Sep 30, 2022
Just a few years ago, local residents with a referral for cancer treatment and services could expect to head to a hospital for care.
Patients will still find treatment, surgery and specialty services at sites such as Roswell Park Comprehensive Cancer Center, Buffalo General Medical Center and Erie County Medical Center. But more and more, that’s changing.
Outpatient care away from hospital walls has increased, including the expansion of infusion care sites and regional practice sites that give patients more access closer to home.
Part of that growth comes from shifts in funding and reimbursement, but also in response to patient demand on where and how they want to be seen – factors that are changing clinical care models for providers.
“We’re visioning out where we came from 10 years ago, where we are now and where cancer is going,” said Jeffrey Walker, executive vice president of operations and transformation at Roswell Park. “We’re really looking at the spectrum from diagnosis and treatment to survivorship and/or end of life and really beginning to re-establish our care model with an understanding of the way the environment is changing.”
Offering flexibility will be important as incidence rates continue to grow. According to the American Cancer Society, the U.S. is projected to have 1.92 million new cancer cases in 2022, including 118,830 in New York, with female breast and prostate cancer leading the way. That's compared to 1.64 million new cases that were projected nationwide a decade ago in 2012, and 109,440 in New York.
Other trends:
• Cancer remains the second most common cause of death in the U.S., second to heart disease. But more people are living longer with cancer: The five-year survival rate for all cancers combined is 68% for white patients, and 63% for Black ones, up from 39% and 27% respectively in the 1960s.
• The cost of cancer, including direct medical costs and indirect costs, such as lost earnings due to missed work from illness or premature death, is estimated to grow to $246 billion by 2030, a 34% increase from 2015 based on population growth and aging.
Shifting care
Walker said addressing those trends will shifting more care to telehealth, which was barely even a consideration pre-pandemic. Other solutions include more screening and early detection, with providers using more artificial intelligence to sift through data and identify people who are more at-risk.
“How do we intercept patients before they become patients?” he said. “Right now we do a lot in the diagnosis space, but we want to move further upstream.”
Ultimately, Roswell's downtown campus could be reserved for surgeries and more advanced treatments such as cell therapy and bone marrow transplants. More routine care like imaging, infusion, labs, education and consultation would take place at the off-campus, suburban sites.
In addition to its flagship hospital downtown, where total beds increased by 18% to 157, the $1.14 billion Roswell Park has been expanding community-based operations. A $23 million outpatient ambulatory center for diagnostics and infusion is expected to open next year to replace an existing site, joining operations in Orchard Park and Niagara Falls. In October, Roswell Park will launch the state’s first lung cancer screening mobile unit.
The provider also reaches across the state through a care network that includes providers in Utica, Watertown, Ithaca, Schenectady and Long Island, using telehealth for consults and training and to reach people in remote areas.
Walker, who previously chaired the Alliance of Dedicated Cancer Centers, said the same trends are underway at the nation’s top cancer centers.
“We can’t just be bringing everyone down to the campus," Walker said. "Patients are becoming much more savvy, much more focused on their experience and certainly about the care they get."
The same type of transition is happening for Great Lakes Cancer Care, a collaborative that includes Kaleida Health, Erie County Medical Center and five physician groups and specialty providers.
“Our intent is to be more out in the community,” said Victor Filadora, president. “The patients we see tend to want to be seen close to where they live. They also want to be seen outside the acute care hospital setting.”
Like Roswell Park, Great Lakes is adding partners at community-based sites, including breast cancer surgeons and gynecologic oncology surgeons practicing in Orchard Park and Niagara Falls. This summer, a dermatology practice joined the collaborative, bringing offices in Lewiston, Amherst and Depew.
That’s led to volume growth in several areas, including infusion care, where patient volume has doubled since 2018 when the collaborative was formalized, going from 6,517 visits in 2017 to 13,040 last year.
Great Lakes Cancer Care is also working on a strategy to identify regional hubs in the Northtowns, Southtowns and in Buffalo to make access to community-based sites more convenient for patients, a process that should be completed later this year.
Hospitals remain important
That’s not to say patients aren’t still going to hospital settings for care. ECMC treated 23,273 patients at its on-campus Center for Cancer Care in 2021, up from 19,632 in 2019. Andy Davis, chief operating officer, said the oncology service line has grown consistently in the last six years, partly through its head and neck program, but also through expanded services for breast, plastic surgery and cardio-thoracic lung cancer.
Though ECMC doesn’t operate any brick and mortar community-based sites, patients can find consults, screenings and other services off-campus at partner sites through Great Lakes Cancer Care in community sites such as the 11 locations of Western New York Urology Associates.
“Some patients will choose to go to certain places because of geography where they live, which is fine. It’s what our strategy has been in working with the Great Lakes collaborative," Davis said. "It takes them closer to where they live.”
Moving into 2023, Davis expects to see more providers join the collaborative, including medical oncologists, who will provide services embedded in primary care practices. Those partnerships give patients the chance to find care closer to home, while also spreading the business across multiple providers.
Dr. Paul Pizzella, president of Southtowns Radiology Associates, said the practice is seeing growth at its outpatient imaging centers in Orchard Park, West Seneca and Hamburg, as well as more visits for its specialists working with partners that include Roswell Park and Great Lakes Cancer Care.
“Our goal is to support these specialists with the ability to keep their patients close to home for all imaging needs,” he said. “If a patient can see the doctor in Orchard Park, but they have to travel 25 miles for routine scans, it's still a burden and a barrier to care.”
The practice considers itself a part of the team, providing MRI, CT and other scans for biopsy, surgery and to help surgeons better understand where disease has spread through the body.
“Our model is to be partners on this team, knowing that patients need high quality, reliable resources close to where they live and work,” he said. “We've found that many are concerned about how far their patients will need to go and we can help ease that challenge for them.”
Batavia and Niagara Falls
In Batavia, a new campus is under development by United Memorial Medical Center and its parent, Rochester Regional Health, that will include specialty services for gynecologic oncology and gastroenterology. It’s an expansion of services started in 2016 when RRH opened an extension site of its Lipson Cancer Institute in Batavia, giving patients the ability to get care nearby instead of traveling to Rochester or Buffalo.
Daniel Ireland, president of United Memorial, said easy and early access to primary and specialty care is fundamental to early identification of cancer.
“This has increased patient compliance with care and follow-up and offers better success in improving outcomes of those patients," he said.
Niagara Falls Memorial Medical Center has been expanding oncology services at the main hospital campus and the Summit Healthplex outpatient site in Wheatfield in partnership with Roswell Park.
Joe Ruffolo, president at Niagara Falls Memorial, said a new 3T-MRI will allow more work in cardiac MRI as well as prostate and breast MRI, complementing the work started two yeas ago on campus by Roswell Park at the Golisano Oncology Center. There, the hospital has seen 2,100 patients, most for breast cancer but also lung, lymphomas and blood cancers.
Though it’s not a major service line, oncology has become an important area of business for Niagara Falls Memorial as a newer clinical care area, helping to supplement revenue declines from volume losses that have not returned to pre-pandemic levels.
It’s also filled a gap in access, especially for low-income patients who had to take multiple buses to get to downtown Buffalo for care. The ability to stay closer to home means they’re more likely to show up for treatment.
“Clearly, this has addressed health disparity issues in terms of ease of access for preventive care and ease of treatments among the African-American and Native American population, but also the special needs population and behavioral health patients as well,” Ruffolo said. “It really has been a well needed service for the western part of Niagara County.”
Innovation in treatment
While new locations in the community are important, new treatment methodologies such as cell therapy and immunotherapy are also changing how and where patients receive cancer care.
These therapies are not yet approved by the FDA for solid tumors in the breast and lung, but they are making a big difference for patients with lymphomas, leukemia and other blood cancers, said Dr. Renier Brentjens, deputy director at Roswell Park.
It’s expected that these types of therapies, including Car T cell therapy pioneered at Roswell Park, could one day allow patients to be treated with just one dose. That’s compared to months or even years of treatment using chemotherapy and radiation.
“That doesn’t mean that everyone that gets Car T cells is cured, it’s the first iteration of this therapy, but there are laboratories working on making this better," he said.
The new therapies are at least five to 10 years in the future, but they’re a lot closer than they used to be, with hundreds or thousands of labs doing the work versus a dozen or two a decade ago, Brentjens said.
In the future, that will probably have an impact on treatment facilities, but it will be awhile before hospitals and other cancer providers can assess that. They’re only available in academic cancer center or hospital settings right now, but that could change too.
“While it’s possible that at some point, community hospitals or maybe one day the doctor’s office could give these therapies, currently it still remains a type of therapy you need to find a specialized center to receive,” he said. “We call them Car T and we have a Model T Ford now, and what we need is a Ford Mustang.”
Cancer providers look to a future with less hospital-based care - Buffalo Business First (bizjournals.com)
Sep 30, 2022
Just a few years ago, local residents with a referral for cancer treatment and services could expect to head to a hospital for care.
Patients will still find treatment, surgery and specialty services at sites such as Roswell Park Comprehensive Cancer Center, Buffalo General Medical Center and Erie County Medical Center. But more and more, that’s changing.
Outpatient care away from hospital walls has increased, including the expansion of infusion care sites and regional practice sites that give patients more access closer to home.
Part of that growth comes from shifts in funding and reimbursement, but also in response to patient demand on where and how they want to be seen – factors that are changing clinical care models for providers.
“We’re visioning out where we came from 10 years ago, where we are now and where cancer is going,” said Jeffrey Walker, executive vice president of operations and transformation at Roswell Park. “We’re really looking at the spectrum from diagnosis and treatment to survivorship and/or end of life and really beginning to re-establish our care model with an understanding of the way the environment is changing.”
Offering flexibility will be important as incidence rates continue to grow. According to the American Cancer Society, the U.S. is projected to have 1.92 million new cancer cases in 2022, including 118,830 in New York, with female breast and prostate cancer leading the way. That's compared to 1.64 million new cases that were projected nationwide a decade ago in 2012, and 109,440 in New York.
Other trends:
• Cancer remains the second most common cause of death in the U.S., second to heart disease. But more people are living longer with cancer: The five-year survival rate for all cancers combined is 68% for white patients, and 63% for Black ones, up from 39% and 27% respectively in the 1960s.
• The cost of cancer, including direct medical costs and indirect costs, such as lost earnings due to missed work from illness or premature death, is estimated to grow to $246 billion by 2030, a 34% increase from 2015 based on population growth and aging.
Shifting care
Walker said addressing those trends will shifting more care to telehealth, which was barely even a consideration pre-pandemic. Other solutions include more screening and early detection, with providers using more artificial intelligence to sift through data and identify people who are more at-risk.
“How do we intercept patients before they become patients?” he said. “Right now we do a lot in the diagnosis space, but we want to move further upstream.”
Ultimately, Roswell's downtown campus could be reserved for surgeries and more advanced treatments such as cell therapy and bone marrow transplants. More routine care like imaging, infusion, labs, education and consultation would take place at the off-campus, suburban sites.
In addition to its flagship hospital downtown, where total beds increased by 18% to 157, the $1.14 billion Roswell Park has been expanding community-based operations. A $23 million outpatient ambulatory center for diagnostics and infusion is expected to open next year to replace an existing site, joining operations in Orchard Park and Niagara Falls. In October, Roswell Park will launch the state’s first lung cancer screening mobile unit.
The provider also reaches across the state through a care network that includes providers in Utica, Watertown, Ithaca, Schenectady and Long Island, using telehealth for consults and training and to reach people in remote areas.
Walker, who previously chaired the Alliance of Dedicated Cancer Centers, said the same trends are underway at the nation’s top cancer centers.
“We can’t just be bringing everyone down to the campus," Walker said. "Patients are becoming much more savvy, much more focused on their experience and certainly about the care they get."
The same type of transition is happening for Great Lakes Cancer Care, a collaborative that includes Kaleida Health, Erie County Medical Center and five physician groups and specialty providers.
“Our intent is to be more out in the community,” said Victor Filadora, president. “The patients we see tend to want to be seen close to where they live. They also want to be seen outside the acute care hospital setting.”
Like Roswell Park, Great Lakes is adding partners at community-based sites, including breast cancer surgeons and gynecologic oncology surgeons practicing in Orchard Park and Niagara Falls. This summer, a dermatology practice joined the collaborative, bringing offices in Lewiston, Amherst and Depew.
That’s led to volume growth in several areas, including infusion care, where patient volume has doubled since 2018 when the collaborative was formalized, going from 6,517 visits in 2017 to 13,040 last year.
Great Lakes Cancer Care is also working on a strategy to identify regional hubs in the Northtowns, Southtowns and in Buffalo to make access to community-based sites more convenient for patients, a process that should be completed later this year.
Hospitals remain important
That’s not to say patients aren’t still going to hospital settings for care. ECMC treated 23,273 patients at its on-campus Center for Cancer Care in 2021, up from 19,632 in 2019. Andy Davis, chief operating officer, said the oncology service line has grown consistently in the last six years, partly through its head and neck program, but also through expanded services for breast, plastic surgery and cardio-thoracic lung cancer.
Though ECMC doesn’t operate any brick and mortar community-based sites, patients can find consults, screenings and other services off-campus at partner sites through Great Lakes Cancer Care in community sites such as the 11 locations of Western New York Urology Associates.
“Some patients will choose to go to certain places because of geography where they live, which is fine. It’s what our strategy has been in working with the Great Lakes collaborative," Davis said. "It takes them closer to where they live.”
Moving into 2023, Davis expects to see more providers join the collaborative, including medical oncologists, who will provide services embedded in primary care practices. Those partnerships give patients the chance to find care closer to home, while also spreading the business across multiple providers.
Dr. Paul Pizzella, president of Southtowns Radiology Associates, said the practice is seeing growth at its outpatient imaging centers in Orchard Park, West Seneca and Hamburg, as well as more visits for its specialists working with partners that include Roswell Park and Great Lakes Cancer Care.
“Our goal is to support these specialists with the ability to keep their patients close to home for all imaging needs,” he said. “If a patient can see the doctor in Orchard Park, but they have to travel 25 miles for routine scans, it's still a burden and a barrier to care.”
The practice considers itself a part of the team, providing MRI, CT and other scans for biopsy, surgery and to help surgeons better understand where disease has spread through the body.
“Our model is to be partners on this team, knowing that patients need high quality, reliable resources close to where they live and work,” he said. “We've found that many are concerned about how far their patients will need to go and we can help ease that challenge for them.”
Batavia and Niagara Falls
In Batavia, a new campus is under development by United Memorial Medical Center and its parent, Rochester Regional Health, that will include specialty services for gynecologic oncology and gastroenterology. It’s an expansion of services started in 2016 when RRH opened an extension site of its Lipson Cancer Institute in Batavia, giving patients the ability to get care nearby instead of traveling to Rochester or Buffalo.
Daniel Ireland, president of United Memorial, said easy and early access to primary and specialty care is fundamental to early identification of cancer.
“This has increased patient compliance with care and follow-up and offers better success in improving outcomes of those patients," he said.
Niagara Falls Memorial Medical Center has been expanding oncology services at the main hospital campus and the Summit Healthplex outpatient site in Wheatfield in partnership with Roswell Park.
Joe Ruffolo, president at Niagara Falls Memorial, said a new 3T-MRI will allow more work in cardiac MRI as well as prostate and breast MRI, complementing the work started two yeas ago on campus by Roswell Park at the Golisano Oncology Center. There, the hospital has seen 2,100 patients, most for breast cancer but also lung, lymphomas and blood cancers.
Though it’s not a major service line, oncology has become an important area of business for Niagara Falls Memorial as a newer clinical care area, helping to supplement revenue declines from volume losses that have not returned to pre-pandemic levels.
It’s also filled a gap in access, especially for low-income patients who had to take multiple buses to get to downtown Buffalo for care. The ability to stay closer to home means they’re more likely to show up for treatment.
“Clearly, this has addressed health disparity issues in terms of ease of access for preventive care and ease of treatments among the African-American and Native American population, but also the special needs population and behavioral health patients as well,” Ruffolo said. “It really has been a well needed service for the western part of Niagara County.”
Innovation in treatment
While new locations in the community are important, new treatment methodologies such as cell therapy and immunotherapy are also changing how and where patients receive cancer care.
These therapies are not yet approved by the FDA for solid tumors in the breast and lung, but they are making a big difference for patients with lymphomas, leukemia and other blood cancers, said Dr. Renier Brentjens, deputy director at Roswell Park.
It’s expected that these types of therapies, including Car T cell therapy pioneered at Roswell Park, could one day allow patients to be treated with just one dose. That’s compared to months or even years of treatment using chemotherapy and radiation.
“That doesn’t mean that everyone that gets Car T cells is cured, it’s the first iteration of this therapy, but there are laboratories working on making this better," he said.
The new therapies are at least five to 10 years in the future, but they’re a lot closer than they used to be, with hundreds or thousands of labs doing the work versus a dozen or two a decade ago, Brentjens said.
In the future, that will probably have an impact on treatment facilities, but it will be awhile before hospitals and other cancer providers can assess that. They’re only available in academic cancer center or hospital settings right now, but that could change too.
“While it’s possible that at some point, community hospitals or maybe one day the doctor’s office could give these therapies, currently it still remains a type of therapy you need to find a specialized center to receive,” he said. “We call them Car T and we have a Model T Ford now, and what we need is a Ford Mustang.”
Cancer providers look to a future with less hospital-based care - Buffalo Business First (bizjournals.com)
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