"The first thing is there has to be a rigorous, disciplined focus on becoming cost-effective and generating value in the sense of quality over cost—true clinical value and cost-effectiveness. That has to be embedded into the way they do their work," he says. "The other is reevaluating their affiliations and alignment models. That may mean affiliations or mergers or acquisitions. But the cancer center needs to be assured that there is a primary and a specialty referral source that is durable."
While healthcare reform and market pressures will create challenges, Ziskind says they will also produce opportunities for high performers, particularly specialists.
"Under healthcare reform and payment reform and accountable care, the ideal is that the patient should go to the right place at the right time for the right treatment by the right people," he says. "That will tend to favor the highly specialized treatments, like bone marrow transplants or stem cell transplants or potentially proton therapy. What it will discourage is routine cancer care being delivered at the freestanding cancer center—things that can be done locally."