Guest Column: Cancer patients are getting state-of-the-art health care |

Guest Column: Cancer patients are getting state-of-the-art health care

Laurence J. Heifetz

Regarding the Gene Upshaw Memorial Tahoe Forest Cancer Center, on Sept. 26, in the Sierra Sun, Dr. Mark Spohr, candidate for the hospital board, expressed righteous indignation with our cancer program, listing four “problematic” issues in his letter, “We need access to affordable health care.”

As Shakespeare wrote, “Thou protesteth too much.”

He stated that Measure C only approved $134,000 for a chemotherapy suite. This is a complete falsehood. Please read this link to the Measure C documents ( Feel free to download PDFs of the actual bond resolution and the community surveys summary. Become secure with the functions of the Citizens Oversight Committee. There is absolutely no mention of limiting the cancer program to a chemotherapy suite.

On the contrary, the Measure C campaign literature stated, “The current cancer center is too small to accommodate all patients. A new and larger treatment center will be built to provide additional treatment options for our patients.” The staff and our Community Advisory Committee saw the inclusion of radiation oncology as one of our highest priorities from day one of the conceptual design. It was never off the table. Measure C was the vehicle to enable that service.

Dr. Spohr listed 2,894 doctor visits by cancer patients in 2013, and stated that the national average for four oncologists should be 15,392. His expertise at spinning data to meet his preconceived notions is quite transparent here. The national average per medical oncologist is 3,848. We have three medical oncologists, not four, and one of us, myself, is only working 50 percent in patient care. That leaves 2.5 medical oncologists.

Dr. Spohr also failed to include chemotherapy visits. When our infusion room visits are added in, our total visits were 4,458. Granted, this is below the national average of 9,620, but it is by design, our design. As contrasted with the national average of harried physicians scheduling patients every 15 minutes, we have scheduled 30-minute follow-up visits and one-hour new patient consultations, enabling much needed time for a more satisfactory experience for both the physician as well as the patient.

He also takes issue with pharmaceutical pricing. As explained clearly to the public and the Board of Directors, the hospital’s pricing is completely in line with all hospital-based outpatient cancer centers. It is less than Renown, St. Mary’s and Carson-Tahoe.

What he fails to understand is that there are only two systems in the United States for oncologists to practice in — free-standing, physician-owned private facilities, or institutional facilities. The reason CMS and the private insurance companies allow for this pricing system is that the institutional practices must achieve ongoing quality performance goals that ultimately result in improved and more appropriate outcomes.

Those performance standards include but are not limited to clinical trial accrual, evidence based decision-making, and the appropriate utilization of both diagnostic and therapeutic modalities. Non-institutional practices are not held to those standards. As a rule, physicians in non-institutional practices earn 40 percent more than those in hospital-based practices. That differential is true for our group as well.

If Dr. Spohr wishes to redesign the American models for caring for cancer patients by addressing this seeming collusion between big pharma and big insurance companies, let him run for congress and fix it at the source. I will support him in that endeavor.

However, to score a point at the expense of the over 2,100 patients that we have cared for since the inception of this program in 2006 is unconscionable.

The implication is that patients are choosing to go elsewhere for their cancer care due to this pricing. Let me be completely clear about this. We see everyone. That means everyone. Approximately 18 percent of our patients are under-insured with Medi-Cal, Covered California (Obamacare), or no insurance at all.

We see them side by side with retired Silicon Valley CEOs. No one else will. No one in Reno or Carson City will. Our commitment is to this entire community, and we have delivered on that.

Dr. Spohr’s expertise is in analyzing big data and consulting with international agencies including the World Health Organization for the design and implementation of health systems in the developing world. I applaud him for that necessary work.

But we are in America, not the third world. Our patients deserve state-of-the-art care and they have been getting it. Rolling that back would be analogous to asking the people fighting the current King Fire to do it with a bucket brigade.

For those of you interested, please check out the citizen website focused on the facts (

Laurence J. Heifetz, MD, FACP, is medical director of the Gene Upshaw Memorial Tahoe Forest Cancer Center and a clinical professor of medicine at UC Davis School of Medicine.