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Why Community Oncology Integrated Networks?


Stating the obvious may be redundant, but repetition can help drive the message home. Community oncology, especially small and medium size oncology practices, are swimming upstream without a paddle. These practices are adamant about their independence despite the adversities, because they love their independence more than the augmented revenues of larger practices. This is nothing new in America and should be celebrated, but under current circumstances needs to be assisted.


The attack on independent community oncology started more than a decade ago and was fueled by preferential payment, in the form of enhanced fee schedules, to hospitals and academic centers. The federal 340B was a catalyst in that huge margins from chemotherapy and supportive care drugs stuffed money into the pockets of hospitals, enabling them to generously pay employed oncologists. This created an unfair advantage for hospital practices over already established practices in the community. It has become a systematic hostile takeover of a large proportion of those practices. Restrictive referrals practices by hospitals has been the last nail in the coffin.


It does not stop there, although I sincerely compliment and admire the mega practices since they absorbed and sustained many struggling small and medium size practices. The existing small independent practices are at a disadvantage through preferential pharma and GPO contracts, since upfront discounts and rebates are sometimes higher by several fold for the mega-practices. Pharma, because of the herd instinct and copycat strategy, has encouraged the mergers of practices and small practices to be acquired by larger ones. Yet many of us remain resilient, innovative, and resistant to such a sell out.


In future blogs on this site, I will explain why we need the small and medium size independent practices, but for now we will address what we are doing at Innovative Community Oncology Practices, or “ICOP”. We at ICOP are determined to change the dialogue and policy, a policy that has been misguided. Through our conglomerated size, zeal, and determination we are changing how we think, how pharma thinks, and how GPOs deal with us.


We are working on making contracting with pharma more equitable and expanding the scope of services rendered at our thriving cancer centers and practices. Our clinical and billing data is being sold behind our backs- we will stop that since our data is ours, we generate it, we own it, and if it has value that value is ours. As a bunch of determined oncologists who know what is going on, we will leverage our knowledge and talent to benefit our patients and our practices.

Fortunately for us and the oncology profession, the reception and perception from pharma and GPOs has been positive, and in fact in many cases encouraging and supportive. We are witnessing a change in the paradigm of how oncology is shaping up in the third decade of the 21st century.


I urge all small and medium size oncology practices to join ICOP, it is your ultimate home.


Nash Gabrail M.D.

Gabrail Cancer Center

Canton OH


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Innovative Community Oncology Practices “ICOP” was established in 2021 as an association of small and medium-sized community oncology practices with the aim of promoting our survival in the face of me