Dr. David Eagle: The Hospital Squeeze

DC EKG with Joe GroganDC EKG Ep 140 | Joe Grogan &amp; Dr. David Eagle: The Hospital SqueezeGuest: Dr. David Eagle, Vice President, American Independent Medical Practice AssociationEpisode DescriptionJoe Grogan sits down with Dr. David Eagle, Vice President of the American Independent Medical Practice Association and board-certified hematologist oncologist from New York Cancer and Blood Specialists, to discuss the collapse of independent oncology practices in America. Dr. Eagle explains how hospital consolidation through aggressive acquisition strategies, combined with punitive reimbursement policies and the 340B drug pricing program, has devastated independent community oncology practices. He details how independent practices declined from 85% of cancer care in 2000 to roughly 45% today, the "uneven playing field" created by 340B, and how policy changes under the Inflation Reduction Act are accelerating the crisis. The conversation covers Medicare payment systems, facility fee exploitation, reimbursement pressures, and the future of cancer care delivery when independent practices disappear. Dr. Eagle also discusses promising advances in cancer treatment including CAR T cell therapy, personalized vaccines, and precision medicine—innovations that may be lost if the healthcare system cannot maintain community-based oncology practices.Key Timestamps0:54 Joe Grogan welcomes Dr. David Eagle from New York Cancer and Blood Specialists1:44 Why independent medical practice is important for oncology and the healthcare system3:38 Current state of independent oncology practices in America3:42 In 2000, community practices were 85% of cancer care; now roughly 45%5:04 How hospitals create artificial competition by setting up practices nearby6:02 The transition when Dr. Eagle's practice was acquired by a hospital system6:08 How hospitals exploit facility fees while patients pay higher copays7:11 Medicare Modernization Act 2003: The ASP system shift that squeezed independent doctors10:18 IRA drug pricing: How add-on payments shrink as negotiated drug prices fall10:51 2025 physician fee schedule: The grim economic reality for independent practices12:29 Why independent community oncologists aren't valued by policymakers15:51 Jeff Faserka: CEO of New York Cancer and Blood, previously in FDA commissioner contention26:18 340B playbook: How hospitals have spent 15 years acquiring independent practices<strong style