By Brian J. Huber, DVM, ABVP

Oncology is one of the most profitable medical revenue centers in any hospital, however, there must be a desire to grow this area of medicine and these higher end services for your patients. Why is this disease so impactful to my practice? Oncology touches routine diagnostics (CBCs, Chem panels, UAs), extensive diagnostics (radiographs, ultrasound and advanced imaging), often surgery, pathology services (cytopathology and histopathology), specialized testing (immunohistochemistry, PAAR, Flow Cytometry, Mast Cell Prognostic panels, etc.), Pharmacy (cytotoxic therapies, supportive therapies (Cerenia, Denamarin, Antibiotics), and long term patient management (paraprofessional staff).

We see an average of 33-40% of a practice’s patient load as senior and geriatric pets. The arena of chronic conditions and diseases is the future of medicine for our practices. Oncology is a chronic disease, just like heart disease, diabetes, hypothyroidism, liver disease, renal disease, etc. The key is earlier diagnosis for the appropriate discussions with the pet parents BEFORE it is a euthanasia discussion. We often see patients “Living with Cancer” and maintaining a good quality of life.

Additional medical services that directly impact how pet parents perceive your level of care is a very positive practice builder. These services will bond clients to your hospital and staff. The discussions around palliative therapy protocols is powerful and unfortunately still underutilized in veterinary medicine.

The Oncura Partners, online cancer management system, allows your hospital the confidence and specialist oversight to manage many of these cases in your facility. Thus, providing the owner a choice to decide whether referral is their best option at this time (offer the choice and you will be amazed how many clients will prefer to stay right there).

Cancer Care and Practice Profitability
(Good Medicine Always Equals Better Revenues)
Oncura Partners has developed proformas for hospitals based upon the income and expenses of cancer care. Use of the OCMS removes many management issues from the day-to-day needs within your hospital. In Table 1, Oncura Partners has provided an example of a cash flow chart that demonstrates a two- to three-doctor hospital performing cancer care. These financial projections were generated from a member hospital in Texas. Oncura has projected a three-doctor practice performing an average of one new case of lymphoma a month. This practice will also generate an average of 0.5 cancer cases for a single-agent doxorubicin protocol. This practice will assume an average of 0.25 cases for an advanced Mast Cell disease treatment protocol. The assumptions are based upon the fee structure of a member hospital. Oncura is happy to provide a complete proforma analysis upon request. The treatment protocol and long-term care that is generated from proper cancer management is a technician- driven service revenue, which makes even more economic sense to the hospital’s bottom line. The vast majority of technicians appreciate the chance to expand on their knowledge base and increase their own productivity through patient care in cancer management. Oncura Partners is there every step of the way to assist your hospital in providing a high-quality cancer care service. You can immediately differentiate your hospital from others in the area by providing a more complete cancer care system with Oncura Partners supporting you and your staff.

Key areas of differentiation within this Oncura Partners business model are the following: Please be aware that estimates of cost discussions below are NOT exhaustive. We deal with hospitals all over the nation and we all recognize that certain regions have much different ACT’s for all categories of services.

Why does the OCMS model work for many hospitals?
Consider all aspects of patient management; we have oncology specialists reviewing and making all therapy decisions, selecting appropriate protocols (always at least 3 options), setting all doses and reviewing all submitted lab tests. The specialist can switch protocols at any time during the management if side effects or efficacy issues are in question.

1) You or your staff will NOT, be managing inventory (drugs, Chemo support products), be mixing and/or storing cytotoxic therapies on site (no need for the proper Class II chemo hood).
a. Chemotherapy Administration gear for 2 people is sent with every injectable order
b. The Closed Administration System – PhaSeal is included with all injectable orders
c. Our Unit-Dosed Chemo means the exact dose is provided for the patient – no waste.
d. We work with you to achieve OSHA compliance – spill kit, safety gear and MSDS
e. We coordinate all pick up and disposal of byproducts from chemo administration

2) Due to the above workflow steps – we often see Veterinarians adding in a modest charge on top of the delivered charge for the chemotherapy medications, OR passing the direct cost onto the pet parent with no markup (due to #1 above).
a. We see an additional $50 -$75 added (again there has been minimal effort on internal staff workflow to get this product to the door)
b. We DO recommend that the billing system be set up for the following items.
i. Chemotherapy Administration – a charge of $45-$75 for any admin
ii. Hospital Supplies fee – a charge of $15-$45 for this line item
iii. Hazardous Waste fee – a charge of $25-$65 for this line item

3) Consider specific package pricing for your oncology patients. Your chemo patients are going to keep your practice busy so consider package pricing for them. A typical lymphoma protocol will include 20+ CBCs over a 6 month period. Plus your ancillary charges such as IV Catheters, minor hospitalization, Cerenia, and recheck exams, etc. at each administration visit. a. The ability to create an Oncology Blood Monitoring package price has created value for both pet parent and hospital revenues. b. The cost of Cancer Care is significant – there are only so many ways to trim the dollar amount.

4) Additional revenue is also generate by conducting regular oncology consultations. Patient specific oncology consults are an invaluable tool to add to your practice. A typical consultation charge generates $50-$100 per consult. Utilizing this feature will drive your clinic’s oncology cases. Offering oncology consultations with a board certified oncologist is a service our pet parents appreciate and are willing to pay for.

5) Client loyalty – Cancer can be scary and our pet parents want to stay with a DVM they know and trust. By offering theses services in your clinic you ensure that you are not referring away your loyal client and the associate revenue. The leading cause of death in pets over 10 is CANCER. If you are doing regular ultrasounds and diagnostics, you will find cancer. Brining oncology into your clinic makes practical and fiscal sense, as well as adding value in the eyes of your clients. Pet cancer is no longer a death sentence. You now have the ability to make the discussion about treatment in house, instead of about referral or end of life care.

About the Author
Brian Huber has acquired over 28 years of experience in the practice of small animal Veterinary Medicine and the Business of Animal Health. His experience has dealt with advanced medical and diagnostic therapies and investigational products/devices. He has had the opportunity to work with veterinarians from across the U.S and Canada. A graduate of Kansas State University, College of Veterinary Medicine – 1986, He is a Founder/Partner of the Animal Hospital of Rowlett & Diagnostic Center, founded in 1988, and a Founder/Partner of the Animal Hospital of Heath, founded in 2005. His practice has been AAHA certified hospital since 1990. He has been certified by the American Board of Veterinary Practitioners in the Canine and Feline Specialty, since 1994. He and his partner have been Members of Veterinary Study Groups - VMG4 since 2001. He founded Veterinary Diagnostic Imaging in 1991 – the first mobile Ultrasound and Endoscopy service in Texas, which operated until 1994. He was a National Speaker/Educator for Luxar CO2 Lasers in small animal surgery, from 1996-2000. He is the President and Founder of Oncura Partners – an online cancer management system for small animal practitioners. Founded in 1999. He was the Chief Medical Officer and Consultant for Strategic Pharmaceutical Solutions from 2002 thru 2005. He had been the Chief Medical Officer for VetSource from 2003 thru 2011. He was the current Chief Medical Officer for Stason Animal Health, from 2008 - 2012. He is a partner and Chief Medical Officer in BioPharma Products, LLC since 2009 and currently holds this position. Most recently he is a current Partner in Oncura Partners Holdings, Inc. and Oncura Partners Diagnostics, LLC.