Community Oncology Alliance Urges Curbs on Consolidation
The Community Oncology Alliance (COA), a nonprofit advocacy group for community oncology practices, has developed a five-part legislative framework designed to help stabilize the U.S. healthcare system, with a focus on curbing consolidation.
Addressing hospitals and health system consolidation, the COA claims that hospitals have been permitted to consolidate into monopolistic mega "nonprofit" systems that raise costs, reduce provider choice, and limit competition. It says that reform must begin with site-neutral payment policies to ensure fairness in reimbursements, an overhaul of 340B to ensure patients are benefiting as Congress originally intended, an examination of what a "nonprofit" institution means, and restrictions on aggressive debt collection practices.
COA also urges Congress to address insurance and pharmacy benefit manager (PBM) consolidation and market dominance, stating that insurers and their increasingly owned or operated PBMs wield disproportionate power, inflating costs, and limiting access. Transparency in PBM operations, accountability for formulary practices, and protections against prior authorization (PA) delays are critical, according to COA. Laws must prevent PBMs from steering patients toward affiliated pharmacies or imposing mandatory mail order requirements, the report says.
The COA Prescription for Healthcare Reform also recommends addressing physician reimbursement and workforce shortages, ensuring access to oncology therapies, and modernizing structural CMS Medicare policies.
"Our healthcare system has reached a critical tipping point as Americans pay more than ever for health care that is becoming increasingly out of reach. Consolidation, administrative burdens, and skyrocketing costs are hurting patients and providers alike," said Debra Patt, M.D., Ph.D., M.B.A., president of COA, in a statement. "As stewards of our cancer care system, we feel it is our duty to provide Congress with a blueprint for meaningful reform that protects independent community medical practices and the millions of patients they care for," added Patt, a practicing breast cancer specialist in Austin, Texas, and executive vice president at Texas Oncology.
COA notes that although the framework is rooted in the experience of community oncology practices, the systemic issues it addresses—consolidation, inequitable payment structures, workforce shortages, escalating costs, and access barriers—are universal across all of healthcare. Oncology serves as a lens for broader reform because it is one of the most multifaceted areas of health care, encompassing complex care delivery, diverse treatment modalities, and interactions with every aspect of the health care system, the advocacy group says.
