Oncura Partners, a startup that expects to enable general practices establish oncology practices, may be up and running when it formally introduces itself at the North American Veterinary Conference in Orlando in January 2002.
Among services offered: chemotherapy agents packed in patient-specific, single-dose syringes; online case protocol development, including radiation therapy planning, with board-certified oncologists (including Drs. Neil Mauldin and Phil Bergman); logistical support in developing radiation facilities; nutritional counseling; and related training services.
The company exhibited at the Veterinary Cancer Society meeting in October, where president and chief executive officer Brian Huber, DVM, Dipl. ACVP, described the company’s visions to veterinary oncologists and listened to their concerns.
Below is the complete interview. (Excerpts and photos appear in the December 2001 issue of Veterinary Practice News.
VPN: Tell us what you’re doing?
Huber: Oncura Partners is a company that’s dedicated to veterinary cancer care. We approach it from all angles. From the specialty consult to the veterinarians, the distribution, we set the protocols and distribute the drugs from our partner pharmacy.
What is interesting about it is that we’re going to be able sell the exact dose that’s needed for that patient for this step of chemotherapy delivered to the hospital so there is no inventory for the hospital, there’s no waste of medications, there’s no mixing on site. The chemo safety issues have greatly improved without having onsite chemo therapy issues that many veterinarians don’t want to deal with.
On the per-dose basis we’re going to be able to use some of the newer drugs also that are safer and work very well and have less side effects for our patients to make their quality of life better during the chemotherapy treatments.
With every dose that is shipped we send all the necessary OSHA equipment for the veterinary hospital: that means two chemo gloves, two masks, two gowns, a spill mat goes out with every dose that’s shipped so those supplies are utilized to give that chemotherapy round and then they’re put into the chemo wastebin.
From the standpoint of chemotherapy and protocol assessment, we’re designing a software that works through our Internet that will provide us with the latest and greatest as far as what protocols are out there and what changes could be made based upon higher numbers.
The chemotherapy is one aspect. The radiation treatment therapy, how we work with that is we can work with the client and the doctor explaining radiation treatment. We can do off site with our computer network setup we can do treatment plans which many of the specialists might need in other facilities that we develop through the Internet. It streamlines the efficiency of developing radiation therapy protocols using, like, a CT unit that would diagnose brain cancer, we can do a treatment plan based on that CT-derived picture transmitted through the Internet to our central facility and then sent back to the veterinarian after its approved by a radiation oncologist the appropriate therapy plan. We have the wherewithal, the involvement with Carl and everything, too, that we’re actually in the development of radiation treatment facilities with specialists to get more access to radiation treatment, which is kind of the third arm of cancer therapy.
Wwe basically leave the surgery aspects of this to the local specialist surgeons and the veterinarians. If they don’t have access to a surgeon, we have a section of our site that helps guide them through oncologic surgery principles. They can actually consult with an oncology surgeon regarding a particular surgery for this lesion if that need arises.
The other aspect of our site is nutritional therapy, which a lot of our cancer patients and chronic disease patients need. We have nutritional consultations available. We will be able to develop total parental nutrition compounds and deliver them to the veterinary office if need be. Also, we’ll even be able to develop specialized nutritional formulas on a per-patient basis depending on the disease process, what they’ll eat, what they won’t eat, so we’ll be able to develop those—basically a menu for that patient. That’s going to be kind of a unique option there, too.
Our partners, at this point, in the business plan are as follows: Florida Infusion is a pharmaceutical company in Tampa, Fla., they are a partner with us, an investor and a partner in our development of the per-dose chemotherapy regimen. Norfolk Medical, which is a developer is an investor and a partner in Oncura business. Mike Dalton, the owner there, is the developer of the vascular access ports. The vascular access ports is a product that’s been out now for a few years but not highly utilized in veterinary medicine. We’re going to really push those into the market.
We’re the distributor. Once our business turns on we’re the worldwide distributor for vascular access ports via Norfolk Medical. We’re going to do a lot of training, training veterinarians and staff how to use these, not only for cancer but for chronic illnesses like chronic renal failure where they need lots of IV fluids intermittently. But a vascular access port is kind of a titanium chamber that’s placed under the skin and it’s permanent. So you access this chamber by a special needle and you can give chemo, you can draw blood, you can give total parental nutrition TPN through this port and it lasts the life of the patient. When they’re placed properly, they’ll last basically as long as the patient will. So it’s venous access basically, and it’s very unique. Once they’re placed, the chemotherapy is truly a technician driven service, not doctor driven, but technician driven, just like a human oncology ward nurse. Because they can give the chemo, you basically train and we help with the system of training on our site. There’s a lot of training issues involved with training the staff on OSHA issues, training the staff on human-animal bond issues of cancer and the patient, and how to use vascular access ports. We’ll train the doctors how to do a bone marrow biopsy if they don’t already know and they can order the appropriate bone marrow needle right off the site, click here type of a thing and it’s ordered. So those issues come into play on the site: the training as well as the delivery of the cancer care.
Let me go into some of the other unique aspects that veterinarians need to be aware of. Through our site, once we give them the right protocol for cancer, our site will take care of all the reminder system to the veterinary office. We will send a reminder not only to client about, they need to remember ‘Mrs. Jones, Fluffy needs to go in for her CBC blood count in two days. If you haven’t heard from Dr. Smith or have made an appointment, please call.’ At the same time, a reminder will go to the veterinarian through the Internet, Oncura Partners, to their hospital file about that same issue, so we’re going to keep the client as well as the veterinarian informed about the protocol and remind them all the way through this as when the next step is due and what needs to be done.
That’s going to be a very positive thing for veterinarians, too, because they don’t have to worry about the reminder setup for all these long, drawn-out protocols. We’ll take care of all that.
The other thing we’re going to provide is an automatic estimator of costs for the veterinarian, which is a very big plus. The veterinarians I’ve spoken to and our investors also are a lot of general veterinarians, they like the fact once they have gone to the Oncura web site when you sign up initially you will enter in all your hospital charges in a secured site. So you put your price for radiographs, urinalysis, blood count, chem 20, chem profile, things like that, so we know what your hospital charges. Then you tell us how much you want to mark up the drug prices that the OP will send you, how much you would like to mark up the price of a vascular access port. Once those things are programmed, then when you have a patient come in that you feel has a lymphoma tumor and you want to give the estimate to the client, give him some idea of what they’re looking at. In about 30 seconds, you put the weight of the patient in and the species—dog, cat—and how much it weighs and prints out an estimate that includes the diagnostic steps, the staging and two months of the protocol costs based upon your costs, your real-time hospital costs. That’s a huge benefit when you consider how long it takes to generate one of those estimates now because a lot of times there’s a lot of waste involved with the packaging for humans of these chemotherapeutics, and you’ve got to charge out that waste, too. You have to figure that into your costs. So that’s going to be a real plus. It’s a real smooth transition for the veterinarian to be able to get in there and do that and not have to spend 30 or 40 minutes calculating out a protocol.
The nice thing, also, is that they can rest assured that whatever protocol we put out there will probably be the best protocol our board of oncologists feel right now is available for that type of cancer therapy. Some of these treatments will encompass surgery and chemo, some of them will encompass surgery, chemo and radiation therapy, and some of them may just be radiation therapy depending on the type of tumor and location, too. We’re able to give that whole package to the veterinarian, which he passes on to his client, of course. We’re really working as specialists with the veterinarians, and then they can deal with their patients and their client as they want to keep them there. A lot of people don’t have the access to the specialists they that need.
VPN: Is that all?
Huber: We’re going to have a little section on there, too, which is called the counseling corner. For clients, they can access information on euthanasia, children and euthanasia, issues of cancer and euthanasia. We will eventually, it may be kind of a phase two, second edition, but within a few months of opening we’ll have access to where they can have basically a one-on-one counseling session with a trained counselor about decisions of euthanasia or treatment. A lot of those really hard decisions that have to be made based upon cost factors, quality of life for the pet, and sometimes people just want some extra input there. So we’re going to have that available, too, through our site for the clients. I think that would be a big help too, because the veterinarians can send them to this area and know that somebody’s supervising the quality of what’s going through there.
VPN: Will the trained counselors be Oncura personnel?
HUBER: No, at this point, we’re looking at options there. We’ve talked to some people. Certainly with the availability of how this works via the Internet they don’t have to be our employee. That may be a separate line item cost: The client enters in their credit card number for 30 or 40 minutes whatever for however much. This person, which we’ll screen and know that they’re not a flake, will help deal with those issues for that medium. They may go to a phone conversation too with that counselor. There may be a number of options there.
VPN: When do you launch?
Huber: Our launch is really scheduled for North American in January. We got in there, got a booth, so we’ll be there. Hopefully, we want people to go visit the web site and hear and read more about us. Oncurapartners.com is the web site. On the web site there’s an issue where they can sign up for more information. So we’ll give them updates, provide e-mail updates about what’s going on, and kind of get that going there.
VPN: As far as opening for business?
Huber: Hopefully a January timeframe, the same time we’re there. We hope to have the live site up. It just depends. It’s in programming right now and things are moving well, but sometimes you never know. We want to have it beta-tested too before we get out there. We’ll be there and showing the site and be able to have enough to show how it works and how it helps them. Our goal is to have it up, running as an entity and doing business for sure by the end of January, hopefully by mid-January.
VPN: How critical is the web site to the company as a whole?
Huber: It’s very important because our target audiences are veterinarians that have high quality practices, that can possibly do ultrasound or have access to ultrasound, that can do a bone marrow biopsy or learn how to do that, that will have enough case load that they’ll see cancer and the quality of clients who will want to treat. A lot of veterinarians that have good quality practices in smaller metropolitan areas all over the country and the clients have no access to specialists that will treat cancer or even an oncologist or particularly a board-certified oncologist. But our web site is the first step of what we’re doing. It’s very important because we’re designing the software and the workings of the web site to make it quick and easy and we’re trying to keep the veterinarian to the web site for immediate downloads of current information on this type of cancer they can hand over to the client. So it’s very important. The web site is a very critical factor and the first step of what we’re providing. It’s really the meat and potatoes of getting the consults appropriately and quickly, getting the information, and getting the ordering for the drugs and keeping the chemotherapy protocol in line, is all tied to the web site business structure.
VPN: Who’s on your board of oncologists?
Huber: Right now, the two primary ones are Phil Bergman with AMC. He’s an internal medicine oncologist, Ph. D., and then Neal Mauldin, who’s at LSU, is double boarded in medical and radiation oncology. Those two are the medical directors of Oncura. They’re the ones who dictate the protocols. We have some other oncologists that we’re talking with right now that give us some input. I haven’t really signed anything on with them, so I’m not really going to put any names out there. But these two guys really are the core point of focus for us to get where we’re headed with the protocols and everything we’re trying to put together for the medical side.
VPN: And the protocols are developed on a case-by-case basis?
Huber: Yes. The interesting thing, what’s going to happen with this is this, which is exciting because with the volume of cases that we should be able to run through here, we’re going to develop real-time information on a lot of case responses, not just a few, 20 or 50, we’ll have hundreds of cases of cancer to look at and truly determine if the protocols we have are as good as we think they are or better. The value to this is that not only that it’s a revenue generating very good medical stream of income for a quality hospital to tap into, and they should be because their patients are getting older and they see this all the time, but we’re going to get some very valuable clinical research data out of this that will really help the oncology world with determining what protocols are best truly on a high number basis. We’ll also be able to access certain clinical trials based upon the hospitals we have in our network once we establish a quality line of hospitals. It may be 200, it may be 500, who knows? When we identify those hospitals that provide us with quality feedback of information and they’re on top of their cases, then we can establish a clinical trial network that will allow us to put into clinical trial different drugs, different protocols, things like that that are coming out even now in the human world that veterinary medicine has an influence in: new drugs, like I said, the protocols that really even for veterinary medicine a lot of our protocols can get. The more numbers we have to support them, the more critically we can evaluate their effectiveness. That’s always been a problem with veterinary medicine is the number of responses to a protocol that we can sit down and say, ‘Okay, we don’t have 50 now, we have 500 which makes a big difference. Or we have 1,000, which makes a big difference. So that’s another existing part of this. The clinical trials is another entire branch of our business that we’re developing even now with the contacts we’ve made in the pharmaceutical world. There’s a lot of interest in what we can put together on a nation-wide scale of quality hospitals. We’re focused on that also as part of our business development.
VPN: Is there a plan in place to share that information?
Huber: Yes. Basically, our plan is that certainly with our lead oncologists and medical directors on board, we’ll be able to go work with universities or other specialists that want to put into play a clinical trial of a drug or a protocol. We will utilize our network of hospitals to hopefully get that started for them. They can have the research data back, put their name on and publish. All of this is going to be shared, you bet. It makes a big difference in ultimately the quality of cancer care, what’s right and what’s wrong, but even some of the early phase trials that will develop into hopefully some valuable information for humans, too.
VPN: Have you signed any hospitals yet?
Huber: Right now we haven’t really promoted any opening sign up type of issues. Right now we’re in the early stages of sitting down with some hospitals and some of the other larger groups of hospitals to show them the product and talk about how it could work for them and kind of put things together. I have probably spoken to, in the Dallas-Fort Worth area during the funding days, I mentioned that Norfolk Medical and Florida Infusion, our investors and partners. The rest of our business plan has been funded by general practitioners in the Dallas-Fort Worth area who have listened and read it and understand the value to their practice. They’re the ones who have put a lot of money into this thing. They truly understand the benefit. Over the last three years in the Dallas-Fort Worth area alone, probably I’ve talked to over 200 individual veterinarians. Not one of them has said, ‘This won’t work.’ They haven’t said, ‘This is a bad idea.’ They understand the value to them on a day to day basis. Now not every veterinarian is going to take our site and treat cancer. They don’t feel comfortable. Even with everything we provide them, we don’t want them to do it if they don’t feel comfortable doing it. There’s a learning curve involved. We take care of a lot of the issues of why they don’t do in now in the quality hospitals because of the stocking issues, the inventory. You want to know you’re on the latest and greatest for these clients, because that’s what they want. This is how it will be updated. It will be ongoing, a work in process forever, day by day we’ll make changes when we see fit based upon the information that’s out there of updating information for the client and for the veterinarian about this form or that form of cancer. So we’ll be hopefully even ahead of the textbook curve by about a year on what’s the latest and greatest and what protocols we might want to pick now that might be more appropriate than what we’ve been doing over the last six months. With the data that we’ll have back from our site from the veterinarians and from the clients on the quality of life issues of pets with cancer, we can also adjust protocols to make sure that we have minimal discomfort for the pets but higher effectiveness of controlling or curing the cancer.
VPN: Did you prelaunch at the Veterinary Cancer Society meeting in October?
Huber: Yes we did. We did an initial launch to give the information about our business plan to the Veterinary Cancer Society and the group of specialists there. We were just there, kind of letting people come by and read about it and see what they think. We had some good responses and we had some that were a little more concerned. Overall, I think what we were able to show them by going to them first and not launching it to the general public is that we’re serious on wanting to work with them through this. There’s 99 of them in the whole country and there’s just not enough access to the general population to oncologists at this point in time. We also with that in the clinical trials and some of the other things we’re going to be able to do will be able to work with these oncologists on a first line basis for many of these things. We’ve already got some other corporations involved at looking at using us as directing certain therapeutics that are coming down the line for cancer and access to certain technologies that may be utilized for treatment of cancer.
VPN: What were the specific concerns?
Huber: We had just a couple responses of concerns about sending the chemotherapy to the veterinarian. Understandably so. Our target audience is not all veterinarians in the country. We want the good quality veterinarians who understand what they’re getting into and we explain that to them on the site, that you’re embarking on a treatment of cancer is a significant undertaking and a commitment to the client and the patient and you’ve got to do it right. Throughout our site we have sections of drop down lists of referral facilities for surgery, for MRI, CT access, for oncologists. When they log on our site the site’s going to pop up with the nearest board-certified oncologist to say if you aren’t comfortable, here’s the nearest one to you based upon their zip code. And that’s the first they’re going to see. We’re going to load all of them in there. It’s basically a locator. What that’s going to do is it gives the client the option, the doctor the option ‘Okay, here’s one. Maybe we ought to call them up if you would like.’ Or a lot of these people just don’t have the time and their schedules won’t allow them to drive three or four hours and when you start chemotherapy protocols it’s a once a week at least or twice a week issues for the first few months many times in monitoring. There’s a lot of travel time involved in some cases. For some clients that’s not an issue, and that’s great. But what we’re trying to do is work with the specialists that are out there and hopefully expand even the base of what’s going on with cancer and that the need for access to treatment I think will be expanded when we do our normal marketing, not just for the veterinarian, but we’ll eventually have the general public side of this thing up and running to access the public to find the appropriate information on treating their pet for cancer and where to go get it. That’s the second step, the general public side. But let’s step back and talk about VCS.
We had a lot of oncologists at first saw it, sat down and talked to us, and if I couldn’t talk to them for at least 15 minutes or more, then I couldn’t really impart everything that we’re doing because there’s a lot of issues that are involved with this. Most of them were very positive about it, thinking that ‘Well, you know, there’s a lot of need out there.’ At least I think we’re doing it right. We’re not going about it in the wrong fashion. Maybe some of the concern was that we’re sending the chemotherapy to the veterinarian. It’s not a difficult step. The monitoring is the big issue, and that’s why our software is so tied in to the routine e-mail reminders and monitoring from the standpoint of the client side as well as the veterinary side. We provide the OSHA safety gear and we’re going to make sure they know how to use it, basically. Make sure they are using it. We’re not going to have any need for mixing on site, so we’re trying to deal with these issues as much as possible so there’s no, we’re trying to decrease the potential for problems on the site of the veterinarian in his hospital. The main concern that we got in those few instances was that we shouldn’t be sending per-dose units to veterinarians. That’s where it really bottom-lined out at. Unfortunately, the demand is there and on a nationwide basis, there just isn’t enough access to oncology care. And a lot of veterinarians that are doing a little bit of it already will do a better job with us because now they can get better drugs and better protocols and we’re going to help them guide that patient through the protocol, and hopefully get better service and better remission times because we’re doing the right protocol instead of the cheaper, lower, easier one to do. You know, ‘Well, Mrs. Jones, we’ll do this one just because this is what I’ve done before. It should be okay, it’s something.’ We want to give the options, of course, to the clients to pick the best or at least a second alternative, but we also want to make sure we’re trying to impart the best care, and that includes the safest drugs, some of the newer drugs that are very expensive will now be much more affordable based upon an individual dose for that patient size vs. buy the whole bottle because it’s packaged for a human. We had some good responses from a number on oncologists too.
Invariably most of the oncologists we talked to were not slow, they weren’t hurting for business already, let’s put it that way. That may be too broad of a statement, but in most cases that’s a reality. There’s a lot of internal medicine specialists that are out there doing cancer care and do a very good job, but we feel we can step in and help them streamline their practice even more on cancer care. Because when they get trained to use a port and once a port’s placed, then all the oncology care is really a technician-driven service. All the rechecks and all the blood draws, everything, is a technician-driven service. The veterinarian doesn’t have to be involved with the actual procedure. They have to be involved with the examination and the evaluation of the blood results on certain things. We’re really generating another specialty area for technicians in veterinary hospitals that we feel they should be highly utilized in this aspect.
But overall I strayed back and forth from your question on the VCS. It was the first time we introduced it. We had some very good comments and we had some, that because like I said it was the first time and they hadn’t been exposed to us yet, they had some immediate concerns but after talking to them and telling them how we’re going to do it, I think they felt much better. It’s kind of one of those things: ‘Well, we’ll wait and see when we’re up and running’ and I said, ‘That’s fine. Just give us that chance.’
VPN: Part of the sense of this venture will expand the number of cases that are actually treated. How many are currently being treated and by how much do you expect to increase that?
Huber: That’s really hard to tell. In our business plan and treatment plan we generate cases about how much cancer is out there, we extrapolated some of the numbers from the human world and based upon 56 million cats and 54 million dogs in the U.S.
What we did, we’re basically looking at increasing life span, we’re looking at some of the ways they calculate this in the human world and we translated that back because there’s no hard, fast figures for veterinary medicine, but some of the other issues that we’ve seen in the textbooks to kind of support what we’re looking at. We based an incidence of about 450 new cases per 100,000 animals on companion animal care and that generates about 237,000 for dogs and about 257,000 cases of cancer in cats a year. This is assuming, of course, not everyone of those is going to be treated, let’s get real here. That’s just an overall number of cases of cancer. That encompasses skin tumors, as well as blood tumors, bad cancers and benign cancers, but just cancer. A lot of those cancers, up to 30 percent, are going to have recurrent disease that needs to be retreated and controlled, so some of those will transition over to the next year and may be cases that are treated for either a year or more in some cases depending on the type of cancer. Most of these cases of cancer that are seen out of this 237,000 and 257,000 are seen at the specialty hospitals and the universities at this point in time. There’s more and more awareness in the veterinary community, as you see through your publication and the meetings that are out there now about veterinarians understanding the need of cancer in their senior pets, in their geriatric client base. They need to deal with it, they need to treat it and they need to deal with it. We’ve seen that going on. It’s the No. 1 concern in pet owners, and the No. 1 cause of non-accidental death in pets is cancer. Over 50 percent of all pets 10 years and older will develop the disease of some form of cancer. You can’t get away from it. It’s more common than chronic renal failure. We’ll treat chronic renal failure and we’ll treat heart disease, which are non-curable, without question. But many times veterinarians will question the treatment of cancer to their client because it’s cancer. We treat diabetes, liver diseases, kidneys and hearts that are not curable; they’re maintainable. Many times we can cure cancer when we catch it and treat it appropriately from day one. That’s a big point there, too. We’re here to make it easier for veterinarians to access the appropriate tools to treat these cases in their practice and hopefully get a broader base access to this type of care for the general public and those pet owners that really need it.
VPN: Financially, how solid are you?
Huber: We’re in good shape. It’s taken us about three years from the start and the inception of this overall project to be where we are today. We feel very comfortable with our financial backing in the situation we’re faced with and the numbers we have. Certainly the last two years and the dotcom crash kind of slowed us down in acquiring certain funds, but with that crash came lower costs of developing—a significant benefit. Everybody wants business. We feel very comfortable with where we are. At this point I’m not real comfortable in throwing specific numbers out there, but I will tell you that we feel we have enough backing and support that we’ll be able to move forward very quickly in developing and keeping this site going. We’re looking at the same time of site and utilizing it on an international basis, too, in other areas where high quality veterinary care exists in other countries. That is definitely a target for us, to look at the international growth potential of what we’re doing, and we’ve already focused on that.
VPN: What’s your time frame for turning a profit?
Huber: We should be turning a profit probably within the fourth quarter of when we turn this thing on. We should be turning the profit we need that we expect to see based on our pro forma. It’s very conservative numbers that we’ve placed. I will tell you that we figured that our member hospitals will use our services twice a month, just two times a month. In my practice particularly, where I have three doctors, and we see a significant referral base but a lot of general medicine, too, we can probably utilize this service easily five to six times a month, based on the cancer cases we see come through here, without any problem. As I’ve talked to some of our investor veterinary hospitals that have two or three veterinarians in them, they feel the same way, that once it’s available and it’s there in the hospital, you can turn around and use it. Man, it’s easy to recommend it and get the oncologist’s professional opinion about these cases for the clients almost immediately and help them make decisions at some point, whether to treat, whether to go forward, what the prognosis is based upon the type of cancer, things like that.
VPN: What about the risk of doctors actually pushing oncology treatment where euthanasia is really appropriate?
Huber: That’s a good point. We’re really going to be watching how these cases are submitted and how they’re appropriately treated. In our case structure, they have to submit certain information before it can move forward. We have stopgap measures that will not allow us to send any more chemo or will interrupt the case if we’re not getting appropriate reports on the blood counts, the chem profiles, we’re not having those filled in—nothing else happens. We’re going to be able to dictate a lot of those issues based upon the quality of submissions of these hospitals. We have no problem telling a hospital that, ‘You know what, it doesn’t appear that you’re quite comfortable with what needs to be done here and we’re going to sever this relationship right now.’ Because that’s not what we’re about. We want to give the appropriate options to the client. With the safer drugs, there’s many times some decent options to move forward. Ultimately the decision of should we treat or not treat is certainly a combination of things. It’s a combination of the client’s wants and desires, their past experiences with cancer in their family many times comes into play in a lot of these decisions, or other pets. The veterinarian that’s examining the patient certainly with the physical exam and the health status of the pet as it is right there is a big factor for us. So when they submit the appropriate information and based upon what we need submitted, they have to put it all in there or it won’t go forward. Then our oncologist has a much better picture of what’s going on and even the patient’s desires to some degree or another are going to be important in that first step of the oncology consult. In treatment of cancer, whether it needs to be treated or not, I guess that’s always a big deal. That happens right now with many diseases, not just cancer. Should we try and stabilize this patient with heart disease that’s having a problem and if they do, how long will they last? That’s a big question. I don’t think that’s as big of an issue as just having access to the actual ability to do the service for the client and know that it’s being done well because of the guidance we’re providing with them and the backing that’s behind them and these steps of treatment. I’m not going to sit here and say we aren’t going to run into some bumps in the road; I’m sure we will. But hopefully we’ll be prepared and have pre-emptively looked at those issues and try to deal with those in a very timely fashion.
VPN: Those ports were primarily in the human market?
Huber: They’d been developed a long time ago for the human market. He developed them for the human market and also a lot of them are used in specialized laboratory animal science, when they need specialized techniques and cannulas for a bioduct or something unique like that. They have been used in laboratory animal medicine for quite some time with great success. Really over the last three or four years they’ve been promoted more into the veterinary oncology field, but we also feel there are other uses for them down the line for some of our patients.
VPN: Are the benefits primarily time-savings?
Huber: It’s huge. No more pokes of the veins to try to get blood for this, that or the other. It’s all done through this one-port access, and it’s much easier on the patient, too. You talk about the overall quality of life issues that once these are placed and you can utilize these on an ongoing basis, the patients have a lot less stress with the chronic therapy issues of cancer. Whether its chemotherapy, whether its recurrent sedation for radiation treatment where you have to keep giving them IV injections on an every other day basis or daily for the duration of their radiation treatment. There’s a lot of ways they really play into the benefit in veterinary medicine.
VPN: Are there any issues as far as Florida Infusion being able to ship to all states?
Huber: They’re able to ship. Legally, that’s not an issue.
VPN: And a receiving hospital would then need to set up a separate chemo waste disposal plan?
Huber: Yes. What we’re going to do when they sign up, they’re going to get shipped to them through our site the waste bin, a chemo waste bin, a 17-gallon waste bin, a spill kit, two pairs of goggles, and a needle sharps container all drop shipped like three day once they sign up on our site. That’s the starting kit. When the waste bin gets full, they get on our site, click, and we will direct a pick up for that through our web site. A pickup company will show up and all they have to do is sign the manifest sheet and its picked up and we’ll automatically drop ship them another container once it’s full. We’re trying to deal with every detail in the day to day potential issues of this oncology care situation. What would be good and bad? What would we have to do in addition to this? I think we have a lot of these things nailed down.
VPN: Where are your revenues coming from?
Huber: Basically we have about $40 a month fee, which is the Internet fee which gives the veterinarian access and they can print off any current information for their client which will have their hospital name as well as Oncura Partners’ name. For instance, they can print off a sheet that talks about mast cell tumors or a sheet that talks about lymphoma and the current information about how we treat them and what the client needs to do. So that’s available once they’re a member on a monthly basis. They can also get into our, on our site, we’ll have pages of emergency medical therapy. We’re going to allow free access to any emergency medical clinic in the country to the emergency oncologic medical therapy pages on our site, which means they can go in there, they can learn quickly about what this thing is in the neck—a port—if they don’t know what it is. They can learn very quickly by entering the weight all the dosages they need to give for this patient based upon the case, if it’s a reaction, or what we call septicemia, a severe reaction because of low white cell count after chemotherapy. We’re going to be able to guide them and give them options to intervene very quickly, without having to go search and calculate dosages and things like that. It’s like an automatic calculator online. So that’s going to be part of our site also, from day one, is how to deal with emergency medicine issues around cancer.
VPN: Other revenue streams?
Huber: The consultation, the medical oncology consultation, runs about $100.
VPN: Is that with Dr. Bergman or Dr. Mauldin?
Huber: Yes, we’ll have other board-certified oncologists involved with this. The protocols will be set based upon the cancer types that we’re going to be dealing with and what we know are the best ones out there. Once the consult is instituted and they’re filled in the proper information, one of our board-certified oncologists will be looking at that and responding back with an appropriate next step. What’s unique is that we’re not going to have five different oncologists with their own great protocols. It’s not going to work that way. We have a set list of protocols based upon what our specialists feel is the best things we need to rule in or rule out as far as effectiveness, and this is what we’re going to provide. There’s going to be consistency across the board with anyone who’s involved with us. Understand that from day one, that’s the way it’s going to work. But they will certainly have leeway in interpreting lab results and concerns about the dosages, if there’s an issue of a patient’s kidney function changing, things like that, then those dosages are automatically adjusted based upon the lab work and the status of the patient.
Revenue streams is the oncology consult is the main one. There will be a revenue stream from the standpoint of the ports, even though the cost is the same as what they buy now. There’s some revenue built in there in the revenue stream of the port sales. Other than that, we are not marking up drugs or anything other than getting the best price we can from Florida Infusion. There’s a minimal fee based upon shipping through the network and recovering our costs of development of the network and that’s where there’s a minimal fee through the drugs.
Realistically between the medical consults, the radiation consults, the nutritional consults, that’s our bulk. That’s really where we’re going to run our revenues, through those three issues. Because of the software and how we kind of streamlined this in the development of making it easier on the oncologist to provide good quality information in a very timely fashion, we’re going to be able to do a lot with a smaller group. That’s the way we’re looking at this, from that standpoint. So that’s where are primary source of revenue is. The facility development, which is the next step, is another source of revenue, too, because we can work with the financing of these facilities, we can do certain ventures of basically a profit-sharing type of issue, franchising options are available, I don’t really want to call it franchising, but that’s an option, that type of a setup to get the facilities in place. That’s really Carl’s specialty also , he’s kind of bringing that with him on board, on the development of facilities.
VPN: Are there any goals as far as number of facilities developed per year?
Huber: At this point, not really. Our target goal is within 48 months to have at least 2,800 and 3,000 hospitals working with us through the Internet, Oncura Partners basically. I think we can meet that goal. I feel comfortable that if we provide the quality of service that we set out to provide, this has been.
The unique thing about this is that this whole business was derived from the standpoint of a good quality general practitioner’s frustration on a day-to-day basis of dealing with cancer. It was not built by specialists to hand over and say ‘Here guys, use this site. This will make your life easier.’ It was built from the standpoint of a good quality general practitioner on a day-to-day basis seeing cases coming in and out, how busy they are, how much time they have between cases. It’s really trying to streamline that and really focus on maximizing the technical services of your hospital. Good quality technicians can really deal with these cases tremendously for the veterinarian and free him up on a lot of these issues. That’s part of our training aspect, to get the veterinary technicians involved in a significant level.
VPN: What level of training do those technicians need?
Huber: They need to understand the issues of the drugs they’re handling, even though there’s no mixing involved, they need to understand what ports are and how to give them, or they need to understand how to put in a good cephalic catheter and sterilely do these procedures. Some of these things they do already, very similar. Port placement is something that we’re going to train the veterinarians and I think there’s a number of high quality technicians out there that can learn how to put vascular access ports in also, basically. But right now its mostly done by the surgeons or technicians, and we’re working on streamlining that technique of placement to make it easier and quicker for those who are trained to do it, to do it a much smoother procedure. The technicians, a lot of the good ones out there already have the desire and ability to do this. At my hospital, we have basically two technicians that will do it. One’s basically a supervisor and does most of the cases, and they do a great job. They know how to access the ports, they know they have to sterilize them first, they wear the gloves, the chemo gear, they know what they’re giving, they already know if they need to give infusions of saline afterwards or give drugs preemptively to these cases. Those issues are easy to deal with, and we’re going to provide those answers for them. Our focus is that we’re going to do a lot of training, not only for veterinarians but to the technician groups and societies and schools. We want them to come out understanding what importance they are to the overall care of cancer in pets because they really do drive a lot of revenue, of good quality medical revenue, for the veterinary hospital when dealing with cancer patients. It’s very significant, and they enjoy it. It’s a challenge, it’s a new level of care that they get to be involved in than many times they don’t have a lot of experience with. We’ve had nothing but positive responses from technicians we’ve trained and have dealt with these cases because they see improvement and many times it makes them feel good, too, about the therapy of these patients.
VPN: Are there any concerns as far as consulting over the Internet, particularly the legal gray issues?
Huber: That’s a concern, and we certainly are looking at those issues and trying to deal with them preemptively. There’s a lot of that going on already in certain respects. Internet-related information is out there. It’s happening on a day-to-day basis. In the human world with telemedicine and in the veterinary world with telemedicine, it is very gray. At the present time with how we’re dealing with a doctor to doctor consult, that’s really where it stops. We provide information to the pet owner about cancer, but no direct response from our oncologist without going through the veterinarian who’s the primary caregiver. It’s really a doctor-to-doctor driven service. At this point in time, we haven’t had to deal with any major issues involving that.
VPN: Even though the Oncura consultants will be more involved than the typical consult?
Huber: Yeah, you bet. But that’s actually a good thing because some of the problems that have arisen through Internet consultants is the fact that the consultants have not been intimately tied with the knowledge of that case. That’s where the problems have occurred. Basically you get on a little message board: click click click, this is what’s going on. Yet they don’t have consistent laboratory values, they don’t have the complete urinalysis, they don’t have possibly a radiographic interpretation from a radiologist hasn’t been entered in; they don’t have that information. That may misguide the consultant much more than how we are setting it up to make sure that information is imparted before it moves forward at all. And if we don’t get it, guess what, that’s where it ends. That’s why it’s going to frustrate some practitioners because we’re going to demand they do quality care. We’re going to demand that they do a full blood profile, a full urinalysis. They’re going to have to do a differential under a microscope. We don’t believe every blood count in-house counter. We want you to look and have a technician or somebody knowledgeable to do a white blood cell count under the microscope. Those are issues of reality, of quality of care. That’s where we’re focused on: We’re not focusing on every Tom, Dick and Harry hospital in the United States. We’re welcome to work with anybody, but when they come to our site and get on and work with us understanding the complexity of what we’re dealing with, they have to be prepared to perform to a level that we can assure some kind of quality control on both ends. Our specialists that are involved with us are not involved with us without great thought, and they want to see how we were putting this together. Let’s put it that way. They’re involved in putting it together intimately. Their comfort level is such that they chose to be involved with this because really they saw it was going to be done right compared to what’s been done to this point.
VPN: And those two specialists provide a great deal of credibility.
Huber: That’s very interesting. It was interesting at the Veterinary Cancer Society to see that the past president and the current upcoming president of that Veterinary Cancer Society are our two main people. That lends credibility to the fact we’re doing something significant, important and we’re going to do it right. We have some very credible people involved; that does lend credibility, yes. That’s the bottom line.
VPN: I bring that up I wasn’t suggesting that you’re not credible.
Huber: I know. That’s important. If it was an internal medicine person out here doing this that wasn’t a board-certified oncologist, that would be bad. If it was Joe Blow Brian Huber out here doing it, who’s ABVP but not an oncologist, that would be bad. I’m not involved with the medical decision process. I’m here because I know the business side of what it takes to get this out to a point of good business flow for the veterinarian on their side of the coin and to make their life easier and provide good quality service for the countless number of patients that they’re going to see and they see every day with cancer. There’s a huge number of metropolitan areas that may be 200,000 or less that have no access to specialists at all. It’s a realism of life and there’s just not enough of these guys around right now to keep up with the demand of the growing aged population that we have and the amount of cancer that we see. It’s a very timely thing, and we’re trying to do it right. We’ve actually placed patents on the process that we’ve instituted. They’re not given, they’re not provided patents, but we actually went into and looked at the U.S. and international patents on the processes that we developed for delivering this type of chemotherapy and this type of service. The whole process, not just one arm of it but the whole thing, has already been submitted for patent. Will it or will it not hold, I do not know. But I think it’s unique enough to spend the money to kind of get in enforced and put it in there and see if it’s important enough to be a significant change in the veterinary community then it’s probable invaluable enough to remain patented as far as the overall process, everything that’s encompassing what we’re doing. That’s hard to explain in a few minutes.
VPN: How is this going to change your life? Are you going to keep practicing?
Huber: No. I’ve been dual career for about two and a half years. I am full time on Oncura Partners as of November 1. I’ve stepped away from my practice. My existing partner and my other staff are very well capable of maintaining what they need to do to keep it running, so I’m really focused on this full time.
VPN: So you’re now a businessman instead of a veterinarian?
Huber: Basically, that’s right. I still can show somebody how to put a vascular access port in, do a bone marrow biopsy, do an ultrasound and all this stuff, but that’s not my focus. My focus is really working on this to continue bring it to the veterinary community here and anywhere else we think is appropriate and just trying to continue to bring newer and better techniques to veterinary oncology, to develop and get to clinical trial is a real viable business arm of this which I think will happen very quickly. Those are the aspects, it’s really focused on the Oncura cancer care and the arms that it brings to veterinary medicine, the different branches of business opportunities there. I’m constantly looking and already have potential ways to work with what’s already out there, too. We’re not reinventing the wheel. There’s a lot of issues centered around some of these other existing businesses out there that we’re looking at now is trying to work associations with. But that’s for another time.
VPN: Final comments?
Huber: We’re in the development phase, as I told you our opening date is in January, hopefully by North American. I think we’re going to provide a very valuable service. The general public side of this information service will probably be the second phase, hopefully within a few months after we start with the direct veterinary service, we’ll have the general public service open which will give the general public good quality information. It will explain to them about different aspects of cancer: diagnostics, treatment, vascular access ports. It will train them a lot before they even walk into the doctor’s office hopefully about what they expect and what they hope to be able to get from their veterinarian along with hopefully working with us in many cases or the local oncologist. It’s really the information that people need about the treatment of cancer and the fact that it’s not all gloom and doom.
4-15-2004Oncura Partners Aims To Expand Oncology MarketOncura Partners Aims To Expand Oncology MarketOncura Partners Aims To Expand Oncology MarketOncura Partners Aims To Expand Oncology MarketStartup Aims To Broaden Oncology MarketOncura Partners, a startup that expects to enable general practices establish oncology practices.