Lawsuit pending over cancer treatment

UPDATED: Dr. W. Sam YI, M.D. explains why legal action is necessary.

CCS Oncology tells 7 Eyewitness News that it plans to file a lawsuit in NYS Supreme Court over Independent Health's decision to drop 22 CCS oncologists from its network starting January 1, 2017.

"To me, that is putting money over cancer patients.  To me, that is absolutely unacceptable," said Dr. W. Sam Yi, MD, CEO and Executive Medical Director of CCS Oncology.

Dr. Yi said the decision has impacted over 500 active cancer treatment patients and threatens to reduce choices for those who are diagnosed with the disease in the future.

"These patients are fighting for their lives and now they have to fight the insurance company," said a CCS staff employee who added that she is fielding calls from tearful patients.

Independent Health said the decision was necessary to control rising cancer treatment cost.  The health insurance company said it was helping patients find new oncologists and took steps to provide longer-than-required notice.

CCS Oncology plans to file the lawsuit within the next two weeks.  The medical groups is launching a media blitz to inform the public of what is happening.  It has also created a hotline to answer questions (716) 932-7779.

The following is a statement released by Independent Health on the dispute:

BUFFALO, N.Y., November 8, 2016… “In June, Independent Health notified 22 oncologists at CCS Healthcare (CCS) that it will not renew its contract with them, effective Jan. 1, 2017. This non-renewal does not apply to the 51 other non-oncology providers at CCS, including primary care physicians and other specialists.

“Our action was the result of a strategic decision to move away from the inefficient and costly fee for service payment system toward a network of select oncology specialists who have agreed to a value-based reimbursement model. This move is in line with national and local trends in the health care industry, driven in large part by the Centers for Medicare and Medicaid Services (CMS), to move away from a fee-for-service model for reimbursing providers. We have been able to partner with other oncology providers in the community in this regard but, unfortunately, we have not been able to agree on such an arrangement with CCS, which negotiates on behalf of its affiliated physicians.

“We did not take this action lightly, and we certainly understand this decision may be unsettling to some members who have been receiving oncology services from these CCS physicians, which is why we have provided affected members with 6-months’ advance notice instead of the usual 90-day notice. Depending on their plan, members in the midst of an ongoing course of treatment may have a 90-day transition period to continue receiving coverage for oncology care from these CCS oncology providers after Jan. 1, 2017. As of April 1, such care for these members will no longer be covered, although some members may continue to have coverage if their plan has an out-of-network benefit.

“In keeping with our award-winning customer service, Independent Health began in June to assist members affected by this network change to help ensure access and a smooth transition to another oncologist in our network of oncology group partners that includes Buffalo Medical Group, Cancer Care of WNY, Roswell Park Cancer Institute, and other community oncologists.

“The health care industry and CMS are rapidly moving to value-based payment models which are designed to improve the quality and lower the cost of care by reimbursing physicians for the efficient use of services, reducing errors, attaining clinical excellence, and improving care outcomes.

“The CMS has set a timeline to tie 50 percent of Medicare payments to a value-based reimbursement model by the end of 2018; because CMS is the largest health care payor in the country, this is resulting in a sea-change for this new payment model. A recent national survey found 80 percent of insurers are moving to value-based payment models.

“It is reported the U.S. spends as much as $127 billion on cancer care in a year, and that number is expected to grow to between $158 billion to as much as $210 billion by the end of the decade. The use of value-based care is essential to improving quality and reducing the unsustainable growth trend of health care costs, in particular the skyrocketing cost of cancer care.

“Here in Western New York, Independent Health and some forward-thinking, high-performing physician practices are on the leading edge of moving toward these alternative payment models. These programs, which provide enhanced reimbursement to the group for meeting and exceeding national and local benchmarks of quality and efficiency, are working.

“Independent Health members affected by this network change have been notified. Members should contact Member Services (the number is located on their ID card) where a member service representative is available to answer questions and case managers are available to help them with the transition to a new oncologist.”