Patient-First, Physician-Led: The Case for Independent Community Oncology

My path to oncology began the summer before I started medical school. A few weeks before I graduated from college, my mother was diagnosed with head and neck cancer. Watching her navigate that diagnosis, the initial fear, the debilitating side effects of intensive chemotherapy and radiation therapy, and eventually the hope of survivorship, I came to understand what a profound impact an oncologist can have on a patient and a family. That experience led me to do what I do today.

Years later, her cancer returned, and by then I was a practicing radiation oncologist, helping to manage her care from across the country. Her physicians were technically excellent and genuinely caring. I have great respect for them and deep gratitude for the compassion they showed her. Yet her care was fragmented in ways that mattered enormously when she needed it most. As her symptom burden grew, we were forced to rely on an outside hospice agency to provide palliative care rather than the care team she knew and trusted.

On several occasions as I watched her suffering, I found myself wishing she could have been treated at my practice, Compass Oncology, a dedicated oncology practice built precisely to prevent this type of fragmentation. As a member of The US Oncology Network (The Network), Compass, like most community practices, provides the seamless, comprehensive support my mother did not receive. Because cancer care is all we do, our entire organization is purpose-built to serve patients with cancer. By putting key specialists with a shared vision under one roof, we offer an integrated approach that is more than a convenience—it is a proven model that delivers better patient experiences¹ and outcomes² at significantly lower costs.³

The Economic Realities of Independent Community Practice

Unfortunately, the community oncology model that serves more than half of all patients with cancer⁴ in the neighborhoods where they live is under siege from converging financial and regulatory pressures. In my specialty, radiation oncology, Medicare has reduced reimbursements by 25% over the past 10 years,⁵with outpatient freestanding clinics like mine absorbing deeper cuts than hospital-based practices.⁶ These policies are not merely inconvenient; they structurally favor one site of care over another, shifting patients toward higher-cost hospital settings and away from community care.

Couple those cuts with postpandemic staffing costs, and the financial reality for independent practices is becoming unsustainable. We are locked into fixed payer contracts and cannot—nor would we want to—pass those costs to patients already burdened by the financial strain of a cancer diagnosis. For practices without the infrastructure to absorb these pressures, the choice is often consolidation or closure.

Leveraging Strategic Support From The Network to Protect Our Independence

This is exactly why our alliance with The Network, supported by McKesson, is so essential. There is a common misconception that The Network owns member practices or dictates clinical decisions. That is simply not true. When I walk into a patient’s room, I am the one making clinical decisions, along with the patient and their family members. Our relationship is a strategic alliance, not an ownership structure, built on one explicit purpose: protecting our independent practice of medicine.

What that looks like in practice is less abstract than it sounds. Independent oncology practices face ever-increasing operational complexity to keep their practices running: prior authorization requirements, revenue cycle management, managing pharmacy inventories, complex value-based care arrangements, and an increasingly volatile regulatory and reimbursement landscape, to name just a few. The Network’s administrative infrastructure and shared expertise help absorb much of that burden. When capital-intensive technologies, such as the linear accelerators we use to treat patients and artificial intelligence–enabled tools that are changing the way we practice medicine, become necessary to remain competitive, The Network helps us access and implement them. Without that support, our physicians would spend significant portions of their working hours navigating regulatory and administrative complexities instead of caring for patients.

That partnership has allowed Compass to remain independent for more than 2 decades. Navigating today’s regulatory and payer environment as a standalone practice is, for most, no longer viable. Our relationship with The Network does not compromise our independence. It is, in many respects, the reason we still have it.

Measurable Excellence in Value-Based Care

As participants in the Enhancing Oncology Model (EOM) and its predecessor, the Oncology Care Model, Compass and other practices across The Network have consistently delivered Medicare savings and quality outcomes above national averages. High-quality care and cost efficiency do not have to be in tension; our performance demonstrates they can coexist.

Part of what makes this possible is the clinical infrastructure The Network provides. Evidence-based pathways from the National Comprehensive Cancer Network are embedded directly in our electronic health records, ensuring every patient receives care aligned with current standards. At the same time, our physicians retain full clinical autonomy: We treat patients off pathway when the clinical situation warrants it, following review by our Pharmacy and Therapeutics Committee. Protocols inform decisions; physicians make them.

Programs like the EOM are operationally complex by design. Navigating them successfully requires data infrastructure, analytics capability, and compliance expertise that most independent practices cannot sustain alone. Our ability to perform at this level depends on the operational leverage and expertise The Network provides.

Physician-Led Innovation and Clinical Research

One of community oncology’s most underappreciated strengths is its ability to bring clinical research directly into the communities where patients live.

Through The Network’s collaboration with Sarah Cannon Research Institute, a global leader in community-based oncology research,⁷ we can offer local access to a broad portfolio of clinical trials. Our patients do not have to travel to a large academic center or leave the state to access novel therapies. For some disease sites, we offer trial options that our local university competitors cannot match.

We have worked to build a culture of research within our practice through an initiative called “Just One More”—a standing commitment to consider trial eligibility for every patient before a treatment plan is finalized. It keeps that question top of mind at every visit and has meaningfully changed outcomes for individual patients. For us to fully realize the promise of today’s medical breakthroughs, it is essential that we make sure they are available to patients in their communities.

Ensuring Patient Access and Financial Sustainability

The patients we treat at Compass represent the full spectrum: uninsured, underinsured, Medicaid, Medicare, private insurance. We treat all of them the same way. Support from The Network allows us to maintain wraparound services, including patient benefit representatives who help underinsured patients navigate coverage and financial assistance, social workers who help them manage the complexity and cost of treatment, and physical therapists who help them manage the side effects of cancer treatment. When independent practices face financial pressure, these services are typically the first to be cut, and their loss is felt most acutely by the patients who need them most.

Legislators are rightly focused on the cost and accessibility of cancer care. What they must understand is that community oncology is part of the solution, not the problem. It is the most cost-effective setting for cancer treatment.³ Regulatory trends that continue to drive care into hospital outpatient departments will increase costs and reduce access.⁸ That is not a prediction; it is a story we have seen play out in communities across the country over the past decade.

A Personal and Professional Stake

My mother received her cancer care at a large academic institution with capable, committed physicians. And still, in the ways that mattered most to her—continuity, integration, comfort—the system failed her. That fragmentation was not the result of inadequate individuals. It was the result of a care model that was not built around her.

Community oncology is built around patients. It provides the seamless, integrated care that my mother needed and that every patient with cancer deserves. Preserving it is not a niche policy concern; it is a fundamental question about how we want to care for our fellow citizens when they are faced with this diagnosis.

The physician’s voice is essential in this conversation because we see both sides: the clinical realities at the bedside and the structural pressures that shape how we deliver care. I became an oncologist because I believed that better was possible: for my patients, and for families like mine. Ensuring that community oncology survives and thrives is how we make good on the promise of modern medicine.

Author Information

John Schuler, MD, is a radiation oncologist at Compass Oncology.

References

1. Ho T. Building the optimal patient experience takes planning and effort. Oncology Live. 2022;23(22):48-49.

2. Williams GJ, Thompson JF. Management changes and survival outcomes for cancer patients after multidisciplinary team discussion; a systematic review and meta-analysis. Cancer Treat Rev. 2025;139:102997. doi:10.1016/j.ctrv.2025.102997

3. Tomicki S, Dieguez G, DeStephano D, Chang M, Cockrum P. Costs by site of service for commercially-insured patients with metastatic pancreatic cancer receiving guideline-recommended chemotherapy: comparing community oncology and hospital outpatient settings. Clinicoecon Outcomes Res. 2022;14:653-663. doi:10.2147/CEOR.S373316

4. Nguyen CA, Beaulieu ND, Wright AA, Cutler DM, Keating NL, Landrum MB. Organization of cancer specialists in US physician practices and health systems. J Clin Oncol. 2023;41(26):4226-4235. doi:10.1200/JCO.23.00626

5. ASTRO survey underscores damaging impact of continued Medicare cuts on cancer care; bipartisan ROCR Act offers solutions. News release. American Society for Radiation Oncology. May 19, 2025. Accessed April 29, 2026. https://www.astro.org/news-and-publications/news-and-media-center/news-releases/2025/astro-survey-underscores-damaging-impact-of-continued-medicare-cuts-on-cancer-care

6. LUGPA policy alert – severe reimbursement reductions threaten patient access to advanced cancer care. News release. LUGPA. December 2025. Accessed May 1, 2026. https://www.lugpa.org/reimbursement-reductions-threaten-patient-access-to-advanced-cancer-care

7. Global leader in cancer clinical trials. Sarah Cannon Research Institute. Accessed May 2, 2026. https://www.scri.com

8. Vyas H. Community oncology is at a tipping point thanks to consolidation, policy problems. Oncology News Central. March 21, 2025. Accessed May 2, 2026. https://www.oncologynewscentral.com/oncology/community-oncology-is-at-a-tipping-point-thanks-to-consolidation-policy-problems