Partnering with hospital?

[DrProtonX]

Hi all, i was wondering if anyone has ever done partnership with a hospital. There’s small rural hospital close to where I want to live after residency. I’ve noticed that they don’t have an oncology program. I was thinking to contact the hospital and see if they would be interested in starting an oncology program but I don’t really know how to approach it, when to conctact them, how the partnership would even look like etc. Any insight would be greatly appreciated.

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[Reaganite]

Wouldn't give the hospital any ideas LOL. Are there any oncology specialists in town? Call them to get the lowdown on radiation referrals, volume, etc.

 

[medgator]

Wouldn't give the hospital any ideas LOL. Are there any oncology specialists in town? Call them to get the lowdown on radiation referrals, volume, etc.

Yep. If anything partner with the local med oncs and surgical specialists

 

[DrProtonX]

I don’t think there is any oncologist in town. There are couple OBGYNs and a Urologist that see some oncology patients but no radonc/medonc/surgonc

 

[Reaganite]

population size?

 

[Bequerel]

I just saw your username and was wondering if you were planning on asking the small rural hospital to partner in a proton program 😂?

In all seriousness…it would be a dream scenario to partner with a hospital and build a program from scratch and reap the benefits of hospital based professional and technical reimbursements..just not sure how realistic that would ever be, especially straight out of residency. It would require significant 7 figure capital and a very non-traditional hospital administration team.

 

[DrProtonX]

population size?

About 15k

 

[drowsy12]

Start an arthritis center there, with only a 15k population, seems to be like you need to be in the business of bones to keep the lights on and thriving

 

[OTN]

About 15k

Too small

 

[Reaganite]

Too small

Yup. Every geography is different and overhead can vary widely among centers, but I'd estimate 10k seniors is an absolute minimum to just meet overhead for even the most cost efficient center.

 

[OTN]

Yup. Every geography is different and overhead can vary widely among centers, but I'd estimate 10k seniors is an absolute minimum to just meet overhead for even the most cost efficient center.

I've heard 60k population is needed

 

[medgator]

I've heard 60k population is needed

Can do it with less imo but the demographics really need to be favorable (55+ community, retirement Central etc).

A great place for a rad onc center is not a great place for a newly-minted peds or obgyn practitioner

 

[DrProtonX]

When I was working with a PCP, in 4 weeks we had 3 new diagnosis (unfortunately one was a kid). Many of his patients had history of cancer whom were treated in the past 10 years. I just looked up the demographic, looks like about 40% over 45 and 15% over 65. The closest radonc is 50 minutes away.

 

[fiji128]

A catchment area of 15,000 is not large enough to support an entire rad onc department. That size population maybe enough for 4 or 5 PCP's to give some idea for comparison.

 

[DrProtonX]

A catchment area of 15,000 is not large enough to support an entire rad onc department. That size population maybe enough for 4 or 5 PCP's to give some idea for comparison.

Thanks. It’s such a shame. It seemed like a pretty unique opportunity specially location wise and the fact that there is no other oncologist so I could get all the referrals

 

[evilbooyaa]

No one who is not an oncologist will routinely be referring their oncology diagnoses directly to a Rad Onc. They will mostly come from surgeons and med-oncs. So if a place doesn't even have med-onc, I think it will be very tough sledding to establish a new RO department.

It is an immense amount of risk to put the funds towards a new RO department (forget CON rules, etc.) and whipping up enough patients to establish solvency even in a populated environment, let alone in a small town (village?) of 15k people.

 

[TheWallnerus]

I've heard 60k population is needed

Classic Blue Book metric was one rad onc per 100K people

And that was back in the day when cancer incidence was significantly higher than now (and any given rad onc probably handled twice more patients under beam on average!)

 

[MidwestRadOnc]

I once identified a great area for a new center and contacted the hospital there to explain the opportunity and inquire about their interest in partnering. I never heard back and 2 years later they had built their own center.

I have heard of joint ventureships with hospitals in the past in areas difficult to recruit, but nothing recently.

Also, the town of 15k isn't the only factor. It's the draw from nearby communities. A 15k town in rural Wyoming with literally nothing for 200 miles in any direction (there was a center in Elko, NV that tried this and failed -- literally nothing else there) is not the same as a 15k town in rural Tennessee.

 

[DrProtonX]

Classic Blue Book metric was one rad onc per 100K people

And that was back in the day when cancer incidence was significantly higher than now (and any given rad onc probably handled twice more patients under beam on average!)

One rad onc per 100k seems impossible. The closest place to the town i’m talking about has 40k popultion and 3 rad oncs. There is another one an hour away with 60k population and 5 rad oncs

 

[medgator]

One rad onc per 100k seems impossible. The closest place to the town i’m talking about has 40k popultion and 3 rad oncs. There is another one an hour away with 60k population and 5 rad oncs

I think we retx more often now plus the advent of SRS/SRT etc

 

[DrProtonX]

I once identified a great area for a new center and contacted the hospital there to explain the opportunity and inquire about their interest in partnering. I never heard back and 2 years later they had built their own center.

I have heard of joint ventureships with hospitals in the past in areas difficult to recruit, but nothing recently.

Also, the town of 15k isn't the only factor. It's the draw from nearby communities. A 15k town in rural Wyoming with literally nothing for 200 miles in any direction (there was a center in Elko, NV that tried this and failed -- literally nothing else there) is not the same as a 15k town in rural Tennessee.

Makes sense. I don’t think the area would be easy to recruit. It’s one of those places that if you saw it in a job posting your first reaction would be “that’s an actual place? I didn’t know!” But I grew up in the city closeby that my family also live so location wise is very ideal for me. I looked up Elko, NV and there’s literally nothing around. The county that this town is in has 50k population (no rad onc in the county either)

 

[yesmaster]

It depends on what area of the country. In the desert southwest, a population of 15k truly is 15k. In New England, if the town is 15k, the surrounding townships and burrows can double or triple that.

I’d say population 50-100k per rad onc is about right. I don’t see how you’ll make it work without a med onc, generally you’d want at least 2 med onc’s per rad onc at your practice.

 

[OTN]

I once identified a great area for a new center and contacted the hospital there to explain the opportunity and inquire about their interest in partnering. I never heard back and 2 years later they had built their own center.

I have heard of joint ventureships with hospitals in the past in areas difficult to recruit, but nothing recently.

Also, the town of 15k isn't the only factor. It's the draw from nearby communities. A 15k town in rural Wyoming with literally nothing for 200 miles in any direction (there was a center in Elko, NV that tried this and failed -- literally nothing else there) is not the same as a 15k town in rural Tennessee.

The story makes sense. All we can bring to the table in discussion with a hospital about a partnership is the initial idea. Once they have that, why partner? If I were hospital admin, I would just build the center and staff it.

 

[Reaganite]

I've heard 60k population is needed

I don't disagree...us population is about 18% over 65 y/o so my estimate of 10k seniors to meet overhead would translate to over 50k assuming usual population distribution.

 

[Reaganite]

One rad onc per 100k seems impossible. The closest place to the town i’m talking about has 40k popultion and 3 rad oncs. There is another one an hour away with 60k population and 5 rad oncs

Would depend on population make up. Cancer incidence in seniors is like 10x non seniors. A population of 60k seniors would be a huge source of cancer referrals. I've come up with a very rough estimate of 3 new pts per week per 10k seniors based on internal and insurance data I've seen.

 

[DrProtonX]

It depends on what area of the country. In the desert southwest, a population of 15k truly is 15k. In New England, if the town is 15k, the surrounding townships and burrows can double or triple that.

I’d say population 50-100k per rad onc is about right. I don’t see how you’ll make it work without a med onc, generally you’d want at least 2 med onc’s per rad onc at your practice.

Is having med onc vital if I can get referrals directly from PCPs? The town has 11 PCPs, 8 of them works for the hospital so I’m assuming the hospital would encourage them to refer all patients to me since i would be the only in-system oncologist

 

[Reaganite]

I think you need to figure out the current referral dynamics. Don't be another Elko 😅 You can't assume you are going to get every single referral.

 

[MidwestRadOnc]

Is having med onc vital if I can get referrals directly from PCPs? The town has 11 PCPs, 8 of them works for the hospital so I’m assuming the hospital would encourage them to refer all patients to me since i would be the only in-system oncologist

Who is going to be your med onc? PCPs don't give chemo. Where are patients in that town getting chemo right now? If no med onc is driving in, then find a med onc and partner with him/her. Convince the hospital to build a small center with the two of you in a joint venture. You can alternate providing supervision.

The value to the hospital here is the med onc, not you.

 

[Mandelin Rain]

Is having med onc vital if I can get referrals directly from PCPs? The town has 11 PCPs, 8 of them works for the hospital so I’m assuming the hospital would encourage them to refer all patients to me since i would be the only in-system oncologist.

You'd be able to meet them all and tell them you're happy to workup their cancer patients and treat those appropriate for XRT as needed.

I think ultimately this wouldn't be incredibly satisfying as you'd be shipping most patients you see. Even if you took on prescribing all the ADT for metastatic prostate and/or all the TAM/AI for genomic low breast, that doesn't give you/the hospital ROI on a new Linac/Vault.

 

[DrProtonX]

I think you need to figure out the current referral dynamics. Don't be another Elko 😅 You can't assume you are going to get every single referral.

I know, that’s why I’m trying to gather information and see if anyone has any experience with something like this. First I need to figure out the logistics and then figure out how the partnership would actually look like since I have 0 experience right now. It seems like a big hassle but thanks to our great leadership our field has such an AMAZING location flexibility that I don’t wanna pass up this opportunity if there’s a way to make it work.

 

[medgator]

I think you need to figure out the current referral dynamics. Don't be another Elko 😅 You can't assume you are going to get every single referral.

Cannot overstate this enough. Sometimes your biggest competitor isn't even another scrappy small practice in town, it might be a large health system (sometimes partnered with an NCI center, or paying MDACC etc for the name/networking of their cancer center which they can market to your patients) an hour or two away.

Having a captive market with a solo practice isn't as much of an advantage as you might think if a lot of docs/patients are looking for options outside of town. Your job will be to market yourself as the competent local oncology practice where referrings and patients can feel safe and secure regarding the care they will receive.

 

[DrProtonX]

Who is going to be your med onc? PCPs don't give chemo. Where are patients in that town getting chemo right now? If no med onc is driving in, then find a med onc and partner with him/her. Convince the hospital to build a small center with the two of you in a joint venture. You can alternate providing supervision.

The value to the hospital here is the med onc, not you.

The closeby centers that are 50-60mins away. Well i don’t know how easy it would be to find a med onc to come to such location since they’re currently are in much higher demand (than rad oncs) in better locations

 

[DrProtonX]

Cannot overstate this enough. Sometimes your biggest competitor isn't even another scrappy small practice in town, it might be a large health system (sometimes partnered with an NCI center, or paying MDACC etc for the name/networking of their cancer center which they can market to your patients) an hour or two away.

Having a captive market with a solo practice isn't as much of an advantage as you might think if a lot of docs/patients are looking for options outside of town. Your job will be to market yourself as the competent local oncology practice where referrings and patients can feel safe and secure regarding the care they will receive.

One of the centers in the nearby city is partnered with the big NCI center but the hospital in this town is not afaik

 

[medgator]

One of the centers in the nearby city is partnered with the big NCI center but the hospital in this town is not afaik

Part of your research will be to find out where the cancer cases are going now. This data is available to hospitals (paid)

 

[TheWallnerus]

Classic Blue Book metric was one rad onc per 100K people

One rad onc per 100k seems impossible. The closest place to the town i’m talking about has 40k popultion and 3 rad oncs. There is another one an hour away with 60k population and 5 rad oncs

I’d say population 50-100k per rad onc is about right.

Sorry, the Blue Book metric was one linac per 120K people.

This is a metric from 1991 when the US population was 250m, and there were 2500 rad oncs... 1 rad onc per 100K people.

Now there are 5000 rad oncs for 330m US people... 1 rad onc per 66K people.

(In America, there is 1 linac per 85K people. In the UK, there is 1 linac per 137K people.)

 

[Mandelin Rain]

This all sounds like the setup for a new Jordan Peele horror joint. Run away man.

 

[Radonc 2013]

One rad onc per 100k seems impossible. The closest place to the town i’m talking about has 40k popultion and 3 rad oncs. There is another one an hour away with 60k population and 5 rad oncs

I would bet that these towns with 40k and 60k people, are not likely supporting 3 and 5 full time rad oncs respectively. The hospitals are likely listing all the physicians that practice there (e.g. a group of 3 or 5 rad oncs providing rotating coverage at that center equivalent to 1 FTE).

 

[DrProtonX]

I would bet that these towns with 40k and 60k people, are not likely supporting 3 and 5 full time rad oncs respectively. The hospitals are likely listing all the physicians that practice there (e.g. a group of 3 or 5 rad oncs providing rotating coverage at that center equivalent to 1 FTE).

That makes so much sense, thanks. I was very shocked to see that many rad oncs were listed in those locations.