According to the National Cancer Institute, an estimated 1,685,210 new cases of cancer were diagnosed in the US in 2016. In fact, approximately 40 percent of men and women will be diagnosed with cancer at some point during their lifetimes. While 600,000 Americans died from the disease in 2016, the overall death rate from cancer has declined steadily over the past 25 years, and by 2024, almost 19 million people will survive a diagnosis of cancer. That will push national expenditures for cancer care in the US to $156 billion a year by 2020.
Cancer, sadly, is a growth industry.
Memorial Sloan Kettering Cancer Center is one of the biggest names to arrive in Westchester, opening a $143 million West Harrison satellite location in 2014.
Healthcare providers typically don’t like to talk about the business side of medicine, but as the intractable arguments in Washington over who should pay for it reveal, the bottom line is as important to monitor as the patient’s vital signs. Here in Westchester County, the business of cancer care is booming, as providers continue to add services and build new facilities to cater to a demand that grows by the day because of an aging population, better diagnostics, and cutting-edge therapies that have caused a dramatic growth in the number of cancer survivors. Those survivors typically require some form of care for the rest of their increasingly longer lives.
In 2016, The Journal News reported that more than $250 million had been spent on new cancer facilities beween 2014 and 2016 in Westchester. Among the biggest investments came from Manhattan-based Memorial Sloan Kettering Cancer Center, which opened Memorial Sloan Kettering Westchester, a $143 million satellite location in West Harrison, in 2014. NewYork-Presbyterian Lawrence Hospital in Bronxville countered with a $65 million cancer center and surgical suite. Meanwhile, White Plains Hospital has doubled the size of its cancer facilities since affiliating with Montefiore in 2015; it opened a new, $50 million, six-floor cancer center in 2016. They and others competing for a share of this market are doing so because the demand is there — and the financials make sense.
The prevailing mantra behind this growth is some variation of “high-quality care, close to home.” Every healthcare organization realizes that saving patients the time, expense, and hassle of traveling to New York City for treatment is a win for all involved. “For us, it really is more about providing services to patients who come from Westchester,” says Dr. Richard R. Barakat, director of the Memorial Sloan Kettering Regional Care Network (of which MSK Westchester is part). “For family members driving [a patient] to the city, or for someone who is working and getting treatment, to make that trip is hard and expensive. When you can go 15 to 20 minutes from home [for treatment], that is so much more convenient.”
It’s also more cost-effective, he says. “Treatment is more expensive in an inpatient setting. We recognized that 20 years ago.” And that is important for providers because of the way they are reimbursed for providing care. Under the Affordable Care Act and other industry trends, providers are moving from fee-based payments — essentially, getting paid for every test, procedure, and patient visit they record — to so-called value-based or outcomes-based care, where they are paid for the results they deliver. “With pressure on healthcare organizations from declining reimbursement, we will see even more push to ambulatory settings,” Barakat says. “We now treat more patients [with radiation] outside of Manhattan than we do in the city, and that will be the same with chemotherapy ultimately.”
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With cures and remissions more common, cancer patients have a changing relationship with their providers. “Care is not just acute episodes anymore — it’s not just a big operation and a few chemo or radiation treatments. It now represents a lifelong commitment of the hospital to its community,” says Dr. Shalom Kalnicki, chair of radiation oncology at the Montefiore Einstein Center for Cancer Care in the Bronx. Obviously, making money goes into the equation for all hospitals. At Montefiore, Kalnicki says, “we believe we are at the forefront of new economic formulations.”
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Montefiore and other large healthcare systems are transforming from localized, urban medical centers into wide-ranging regional players with a central “hub” from which spokes radiate to community-based hospitals and outpatient facilities, creating economies of scale from larger patient bases. “It is a national phenomenon. Cancer care has moved from centers to facilities that partner with hospitals; it is 180 degrees reversed,” from the previous approach, Kalnicki says. “Quality-driven and outcomes-based approaches depend a lot on how many patients are in your database, how you follow them, what procedures you perform on them, and what the result is — that’s how we measure how we deliver cost-effective care.” Building a cancer network with a large number of cancer patients allows healthcare systems to more easily obtain the economies of scale necessary to deliver that cost-effective care. “That is one of our main missions,” Kalnicki adds.
Phelps Memorial Hospital became part of the Northwell Health network in 2015, in part to meet these economic challenges of scale. “As a result of those changes and a variety of economic pressures, we have seen the coming together of very large health systems so that there isn’t disconnected, fragmented care,” says Daniel Blum, president and CEO of Phelps Hospital Northwell Health. “All of this is supposed to drive patients and providers closer together, to make better decisions, eliminate waste and empower patients.”
(Above and above right) White Plains Hospital has doubled the size of its cancer facilities, opening a $50 million, six-floor cancer center in 2016. A new, fully renovated radiation oncology unit will be completed this spring.
Phelps had been associated with Memorial Sloan Kettering, “But there wasn’t a true integration of care,” he says. Their partnership with Northwell Health, based on Long Island, has been critical for patients with cancer. “When a patient comes with a cancer diagnosis, generally more than just the cancer needs to be addressed. Integration of other providers, including the patient’s primary-care provider, surgeons, subspecialists, et cetera, is very important to the overall care of the patient,” Blum says. Because the Northwell network is so large and treats a high volume of patients, Phelps is able to “adopt practices [from the Northwell Health Cancer Institute] on our campus,” he explains.
The hospital invested upwards of $10 million, Blum notes, to repurpose some of its space and to bring on new technology and additional clinicians. “We now have medical oncology, radiation oncology, and all the support programs around oncology,” he says. He also touts a natural advantage: “Our infusion center overlooks the Hudson River. It’s a pastoral environment,” he says. “Some have to pay to recreate that scene. For us, it’s a window.”
Nurse and patient at White Plains Hospital.
Montefiore’s Kalnicki adds another way all this growth in cancer services both helps patients and drives down costs: “Failure to cure cancer is the highest waste of economic resources in cancer care, because the expenditures of cancer treatment for a recurrent cancer are close to six times what we spend the first time around, and cure rates are more than eight times lower,” he says. “The largest amount of money that Medicare spends on cancer is in the last 18 months of life. That’s about two-thirds of all costs. To us, curing cancer is the best way of eliminating costs, and they are horrible costs in terms of outcomes, quality of life, everything.”
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Westchester Medical Center has spent the past several years developing a regional health network that now comprises 10 hospitals across eight Hudson Valley campuses. “Our goal is making sure we have the best cancer care in Valhalla and in more rural areas, making sure we provide good access to infusion, chemotherapy, radiation, survivorship programs — all the things you want to have if you are living with cancer,” says Joshua Ratner, senior vice president for network strategy, WMCHealth. The hospital network has several major infrastructure projects underway, in Westchester and at their other facilities, which include capital investments in new technology for radiation and chemotherapy treatments. That means bringing on new physicians and support staff. “Over the past two or three years, we have hired three additional oncologists, including myself,” says Dr. Michael Fanucchi, network director of oncology and infusion services at WMCHealth. WMC has also hired a thoracic radiologist and a thoracic surgeon for an expanded lung cancer program and staffed a new lung cancer screening program. “We have become an ACR-designated lung cancer screening center, so we can establish a comprehensive program for early detection and patient navigation,” says Inderjeet Sandhu, vice president of oncology services.
Who Pays for All This Cancer Care?One ever-looming cloud on the horizon of cancer care in Westchester County is that intractable debate in Washington over insurance coverage. No one knows where that debate will go or who will win, and, as one executive said, if you aren’t worried about reimbursements, you shouldn’t be in healthcare these days. “You have to plan for every eventuality,” says Dr. Richard R. Barakat, director of the Memorial Sloan Kettering Regional Care Network. “Right now, it is business as usual, but you can’t have your head in the sand. We have bright and talented people looking at different [payment] models, so we will be prepared.”Healthcare execs typically don’t like to mix the harsh reality of business with the compassionate art and skill of healing, at least not in public. “You have to be thoughtful about the economics. You don’t want to go out of business,” says Daniel Blum, president and CEO of Phelps Hospital. “But when you are in the position of caring for someone who is concerned whether they will live or die, what their quality of life will be, to boil it down to dollars and cents is disconnected from the mission we signed up for.”Susan Fox, president and CEO of White Plains Hospital, agrees. “We make decisions based on our patients, not on what’s coming out of Washington. The business and science go hand in hand, and to be successful in any business, you need to be successful in your product, which for us is healthcare. Our business is about providing the best product. This is an interesting environment, with many unknowns around reimbursement and legislation, but at the end of day, we are here to care for patients.” —DL |
The future of cancer care, many believe, lies in what’s being called precision medicine, in which an individual patient’s cancer cells are profiled for their specific genetic makeup and then targeted with therapies that are designed to treat that particular genome. In 2016, WMCHealth partnered with Philips IntelliSpace Genomics to integrate genomic sequencing analysis with patient data, to tailor cancer treatment in the Hudson Valley. Such cutting-edge technology also opens the door for more clinical trials, Fanucchi says, which will in turn keep patients in the 914 area code.
White Plains Hospital is looking to serve these patients, as well. “There is a lot of competition in the county, with new and different organizations coming here, and for us, it is making sure we provide a level of excellence better than our competitors,” says Susan Fox, president and CEO. Its cancer center doubled in size, to about 70,000 square feet, in 2016. Chemotherapy infusion chairs now number about 36 (up from eight), and a fully renovated radiation oncology unit, with new, cutting-edge stereotactic radiation surgery technology, will be completed this spring, Fox says. They have added cancer surgeons in thoracic and other specialties, as well as supportive services. “Another horizon is our partnership with Montefiore Cancer Center, which is National Cancer Institute-designated and allows us to expand the clinical trials we can provide here,” she says. “We can also connect and consult with their specialists on rare, complicated cases.”
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NYP Lawrence Hospital’s new cancer center, which opened in November 2016, includes a radiation therapy suite for advanced medical imaging; a new infusion center, with community, semi-private, and private treatment areas; state-of-the-art surgical equipment, including a video-
integration system for use with robotic and laparoscopic surgeries; a pharmacy; lab; medical offices; and exam rooms. There are support programs, which incorporate disease-management teams, a surveillance clinic for high-risk individuals, a clinical-survivorship program, and patient navigation from screening through diagnosis and treatment. The hospital even added a rooftop garden that is accessible to both patients and visitors.
“This center allows us to provide all the services our patients need under one roof in their community,” says NYP Lawrence Hospital president Michael J. Fosina. “With multidisciplinary disease-management teams in place in Westchester, working in collaboration with the NCI-designated Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, patients can be treated close to home yet have access to additional services for complex surgeries and clinical trials.”
Montefiore Einstein Center for Cancer Care was the first hospital in New York to treat patients with the Radixact Treatment Delivery System, shown here by Wolfgang Tome, PhD, director of medical physics at Montefiore.
Montefiore Einstein Center for Cancer Care was the first hospital in New York to treat patients with the Radixact Treatment Delivery System, shown here by Wolfgang Tome, PhD, director of medical physics at Montefiore.
While this is all good news for cancer patients and their families, and competition is generally good for consumers, are providers oversaturating the cancer-care market? Along with all the Westchester players, providers in Connecticut, New Jersey, and farther upstate are also beefing up their cancer services. Stamford Hospital has upgraded its cancer center as part of a $450 million expansion campaign, and Memorial Sloan Kettering is expanding in Monmouth and Bergen Counties, as well as in Westchester. Some industry experts are even warning of a “bubble” in healthcare.
“There is going to be a point where we are oversaturated with services,” predicts Phelps’ Blum. “The metro-New York area has a robust complement of healthcare providers. I don’t know what the intersection points of need versus overbuilding are, but I do worry about it.”
Barakat, of MSK, doesn’t see a bubble bursting with his company. “People know the quality of the Memorial [Sloan Kettering] brand,” he says. “After one year, our Monmouth facility exceeded expectations — it was at 90 percent above projections for cheomtherapy and radiation oncology. We are already going to opening on Saturdays and extending hours on weekdays [to meet demand]. We see robust growth in all our ambulatory facilities.”
At White Plains Hospital, Fox says the level of competition is “probably at its maximum.” But she feels that people should have choices. “This is our community, so for us it is about providing the right care and, frankly, keeping our patients here.”
WMCHealth’s cancer-care team includes (l to r) Dr. Michael Fanucchi, network director of oncology and infusion services; Inderjeet Sandhu, VP of oncology services; and Joshua Ratner, SVP for network strategy.
“Our goal is making sure we have the best cancer care in Valhalla and in more rural areas, making sure we provide good access to infusion, chemotherapy, radiation, survivorship programs — all the things you want to have if you are living with cancer.”
—oshua Ratner, Senior Vice President for Network Strategy, WMCHealth
Westchester Medical Center’s Ratner says, “Unfortunately, there is plenty of current demand [for cancer services], and there will be more demand in the future. And there are many patients who still choose to leave the area for care, so there is plenty of opportunity.” There are also opportunities in preventive care, as with WMC’s lung cancer screening program; follow-up care for longer-living cancer survivors; lifestyle education programs; research and academic programs and more. “We have all the services needed, from prevention to diagnosis to surgery and therapy and follow-up care within the community, at the medical center and our other sites,” Sandhu says.
Dr. Maureen Killackey, director of clinical cancer services at NYP Lawrence Hospital, agrees that demand is, unfortunately, high and growing. “Currently there are an estimated 54,000 people living in Westchester who already have a history of a cancer. Among those people, approximately 25 percent over age 65 and 11 percent under 65 will develop a second cancer,” Dr. Killackey says. “Addressing the needs of this significant segment of the population, which is is expected to grow, poses a challenge to the entire healthcare community. As the population ages, we need to have supports in place, close to home, to treat the expected increase in cancer cases.”
The infusion center at NewYork-Presbyterian Lawrence Hospital.
“I don’t see [a bubble] happening,” Montefiore’s Kalnicki says. “If all the checks and balances of centralized processes and the economics of the market play out well, what I think will happen is the reliance of certain New York City institutions on the migration of Westchester patients to them in search of perceived higher quality of care will be significantly reduced. The reason everybody is retooling in Westchester is that the outmigration of cancer patients has been a phenomenon lasting three or four decades. Now, all analyses indicate that patients want state-of-the-art treatment in
their communities.”
Right now, all signs indicate that cancer patients are getting just that — and the healthcare companies operating here are poised to continue meeting this patient need for cutting-edge treatment in convenient locations.
Freelance writer David Levine is a frequent 914INC. contributor.
