Independent oncology practices are facing unprecedented operational strain as reimbursement pressures, cybersecurity obligations, capital needs, and staffing challenges converge.
For many, the default response has been consolidation into larger hospital systems or academic medical centers. That trend has reshaped the oncology landscape, particularly in rural regions where travel distances, workforce shortages, and local economic conditions complicate access to care.
Amid these pressures, independent oncology practices are reassessing how to remain viable without relinquishing autonomy.
To meet the needs of these community centers, we are implementing a new approach that combines nonprofit governance with shared, cloud-based IT infrastructure.
This operational model offers a stable framework for sustaining local cancer care, improving efficiency, and strengthening long-term access.
Independent oncology practices face growing pressures
Radiation oncology, in particular, has been vulnerable to margin compression and capital burden. Maintaining multiple specialized information systems, planning platforms, and cybersecurity safeguards demands both financial and staffing resources.
Replacing linear accelerators and supporting IT infrastructure typically requires multi-year planning and significant reserves. When reimbursement shifts occur or local staffing gaps emerge, organizations with limited scale have minimal buffer.
The result is a narrowing of strategic options. Closure and acquisition have become common pathways, not because they serve community needs, but because they appear to be the only viable models in the current environment.
A nonprofit alternative
Four independent radiation oncology clinics in Alaska chose a different path: nonprofit consolidation.
Though the sites had collaborated informally in the past, they operated under distinct tax structures, maintained separate software environments, and negotiated individualized vendor contracts.
Forming a single nonprofit foundation enabled shared governance, coordinated capital planning, and pooled administrative resources, while preserving local clinical leadership and community identity.
The model also strengthened the role of community oncology. By consolidating technology systems into a unified cloud environment, each clinic gained access to the same treatment information, scheduling data, and planning tools, available around the clock at every site.
This reduced workflow variation, supported continuity when patients moved between locations, and ensured that care remained close to home in a region where travel can be a significant barrier.
These changes created capacity for investments that individual centers could not have undertaken on their own, including equipment upgrades, expanded staff support, and patient assistance programs.
Technology consolidation becomes the operational backbone
Nonprofit governance alone does not alleviate technology debt or operational fragmentation. To support long-term sustainability, the Anchorage Radiation Oncology Center, Mat-Su Valley Cancer Center, Peninsula Radiation Oncology Center, and Southeast Radiation Oncology Center migrated from four disparate environments to a unified, cloud-based oncology software platform.
Federal initiatives aimed at advancing early detection, strengthening prevention, and reducing the financial burden associated with cancer care depend on local treatment availability. Community oncology practices, particularly in rural markets, play a critical role in supporting these goals.
The decision eliminated recurring hardware refresh cycles—previously costing approximately $300,000 per site every four years—and reduced the administrative complexity of multiple vendor relationships and upgrade schedules.
Early results demonstrated meaningful performance improvements. Standardized scheduling and workflow optimization contributed to an approximate 20% reduction in scheduling delays, and automation tools supported a roughly 15% increase in staff efficiency.
Despite challenging bandwidth conditions in much of the state, the platform maintained approximately 99.9% availability after go-live, without treatment disruptions tied to system downtime.
Those gains enabled staff to focus on clinical operations and patient engagement rather than system maintenance.
Reinvestment and access expansion
Operational efficiencies translated into expanded community support.
The foundation funded upgrades to radiation oncology equipment and established a patient assistance program that has provided support to more than 225 individuals, including transportation, lodging, nutrition assistance, and other treatment-related support. In its first full year, Aurora Integrated Oncology Foundation, the Alaska nonprofit, directed roughly $500,000 toward community health programs, including screening initiatives and direct financial grants for patients. The subsequent year saw more than $300,000 committed to similar efforts.
As barriers to in-state care diminished, patient volume across the network increased by nearly 30%. Today, the foundation supports radiation oncology services for an estimated 85% of Alaskans living with cancer, reducing reliance on out-of-state travel and improving continuity of care in a geographically complex region.
Expanding the nonprofit model beyond Alaska
Following the implementation, a second nonprofit collective comprising 14 independent radiation oncology practices was established in the continental United States.
Participating sites sought to maintain local autonomy, address succession planning challenges, and avoid being sold to larger systems. The shared model provided access to enterprise-level cybersecurity, standardized documentation and compliance processes, and centralized support functions such as oncology social work and locum coverage.
Importantly, each center retained its community identity and patient relationships, while participating in a platform designed to sustain independent oncology practice under increasingly complex regulatory and financial conditions.
Intersection with national cancer policy
This model aligns with national efforts to expand equitable access to cancer care, strengthen the community oncology workforce, and modernize digital infrastructure.
Federal initiatives aimed at advancing early detection, strengthening prevention, and reducing the financial burden associated with cancer care depend on local treatment availability. Community oncology practices, particularly in rural markets, play a critical role in supporting these goals.
Additionally, cybersecurity expectations for healthcare providers continue to increase. Many smaller practices lack the scale to meet those requirements independently. Shared, cloud-based systems can address this gap more efficiently than isolated, hardware-dependent environments.
Future considerations
Independent oncology practices will continue to face pressure from capital cycles, workforce constraints, and reimbursement volatility.
The nonprofit structure, paired with shared technology infrastructure, represents a potential pathway for sustaining access and clinical autonomy without relying on divestiture.
While this model may not be appropriate for every organization or market, early results demonstrate its potential to preserve local cancer care capacity, expand community benefit, and support alignment with national cancer equity and value-based care objectives.
Jacob Welkley serves as vice president of information technology at Radiation Business Solutions, where he leads enterprise architecture, cybersecurity, and technology modernization initiatives across community oncology practices. He has overseen the consolidation of multiple legacy IT environments into scalable, cloud-based systems, including the deployment of Elekta’s oncology software platform to support unified workflows, reduce infrastructure overhead, and strengthen operational resilience. His work has produced measurable gains in efficiency and cost savings, including a 35% reduction in infrastructure overhead and significant decreases in system downtime and security risk.
