Cancer services giant tackles expansion — outside of Florida

While a large portion of the cancer world is focused on research and a cure — for good reason — the gritty urgency of day-to-day treatment remains essential.

That urgency is a driving force within Florida Cancer Specialists.

Consider FCS’s prescription drug program, Rx to Go. “A lot of smaller practices will have to outsource those prescriptions, where the turnaround time is two weeks,” Florida Cancer Specialists CEO Brad Prechtl says. “With our pharmacy, our turnaround time is one to three days, and FedEx delivers the prescriptions to a patient’s home.”

Physician-owned and a for-profit entity, Fort Myers-based FCS is essentially a statewide conglomerate of oncology and hematology practices. With more than 230 physicians, 220 advanced practice registered nurses and physician assistants and nearly 100 locations statewide, it’s also one of the biggest in Florida. It did $2.1 billion in revenue and collections in 2017, up 14.75% from $1.83 billion in 2016. Officials project $2.45 billion in 2018. FCS will log at least 70,000 new outpatient visits and consults in 2018.

'Getting all of these services and things we do replicated is a pretty big job when you step back and look at it.’ Brad Prechtl, Florida Cancer Specialists

While not ignoring the research side — “We have clinical research comparable to a medical center,” Prechtl says — FCS, behind programs such as Rx to Go, operates on a continuous improvement mission. It also operates with the belief it provides world-class cancer treatment, on par with noted centers in Houston or Los Angeles, anywhere it has an office, from Tallahassee to West Palm Beach.  

Now Prechtl and his FCS team are in the early stages of one of the biggest moves it’s made since Dr. William Harwin and his wife, Marilyn, founded it in 1984: going national.

It’s an ambitious plan to build efficiencies through volume, just like it did with FCS in expanding across Florida. Says Prechtl: “We believe this will be as big or bigger than Florida Cancer Specialists within five years.”

The route there is through American Oncology Network, a for-profit entity FCS formed in late 2017 with $8 million in capital from a group of FCS physician-owners. The plan mirrors FCS’s model: AON will partner with oncology and hematology practices in a series of states. The practices will keep their name, under doing-business-as agreements with AON. The administrative and executive functions for AON will be run from the FCS Florida headquarters.  

Practices in Arkansas and Louisiana were the first to join AON. A Virginia practice has since joined the network, for 14 physicians so far. Officials project more than 40 doctors will join AON in 2019 from five states, including Ohio, North Carolina and Arizona. “Our goal,” Prechtl says, “is to replicate everything we do at Florida Cancer Specialists within AON.”

In addition to Rx to Go, a differentiating service at FCS is the FCS Drug Development Unit, run out of Sarasota in partnership with the Sarah Cannon Institute in Nashville. The focus there is to get new treatments to patients while minimizing red tape. And it works. Company officials say half the new FDA-approved cancer drugs in the past five years were studied with FCS participation.

Another core part of FCS is its Central and Pathology Labs, in Fort Myers. Company officials say that department is a national model for streamlining patient care, where blood and tissue tests come from across Florida, and technicians talk with doctors immediately about the results. This eliminates the time and expense many independent oncology practices spend on third-party evaluations. FCS labs, says Prechtl, handles some 13 million lab tests each year.

Beyond programs, Florida Cancer Specialists traces its growth, in large part, to massive shifts in how much the federal government pays for Medicare reimbursements — particularly with prescription medication. Earlier this decade, prescription payments to cancer practices were slashed by more than 80% in some cases.

“It forced a lot of practices to close their doors or join a hospital or an organization like our group,”  Prechtl says, “because they were bigger and able to handle the cuts better.”

Achieving scale with the national expansion, like FCS did in Florida, is both motivating and challenging for Prechtl. That includes everything from finding the right practices to navigating the maze of different state rules and regulations. “Getting all of these services and things we do replicated,” Prechtl says, “is a pretty big job when you step back and look at it.”