# Debra Patt at COGC 2026: Scale, Integration and the Squeeze on Independent Oncology

> OncoDaily reports Texas Oncology's Debra Patt arguing that scale is becoming a condition of survival for community oncology. What she said, why it matters to independent practices, and what to watch.

iPMS Practice Desk · 2026-10-04 · https://blog.myipms.app/debra-patt-at-cogc-2026-scale-integration-and-the-squeeze-on-independent-oncolog

OncoDaily published a feature on October 4, 2026, by Eliz Baloyan, MD, summarising remarks by Debra Patt, a medical oncologist and Executive Vice President at Texas Oncology, at the Community Oncology Global Congress (COGC 2026), which OncoDaily organizes [1]. Patt argued that independent community oncology practices in the United States face financial, administrative and technological pressures at once, and that consolidation is changing where cancer care is delivered [1]. In her words, "scale is becoming the price of survival for community oncology practices in the United States" [1].

## What Patt described

- Over the past five years, she said, the small independent practice model has eroded under regulatory complexity, growing administrative overhead, the need for leverage with payers, and more demanding revenue cycle and technology work [1].
- She described clinically integrated networks, groups such as the U.S. Oncology Network, OneOncology and Navista that supply affiliated practices with technology, revenue cycle management, group purchasing and clinical pathways, as increasingly important to practice survival, alongside private equity investment and vertical integration by payers [1].
- Commercial value-based contracts remain limited relative to what many expected ten years ago, and the Oncology Care Model has been succeeded by the smaller Enhancing Oncology Model, with participation falling over time [1].
- Falling reimbursement, continued physician fee schedule cuts, lower radiation oncology payment despite inflation and shrinking drug margins are compressing margins, which she said can force choices about keeping locations or radiation facilities open, particularly in smaller or rural communities [1].
- She linked growth of the 340B program, which she noted was first meant to support vulnerable patient populations, and consolidation into hospital systems to a broader meaning of community oncology that now takes in hospital-based outpatient facilities, a shift she said matters because the site of care affects cost [1].

## Advanced therapies need infrastructure

Patt cited CAR T-cell therapy, bispecific antibodies that may need step-up dosing and careful monitoring, and radioligand therapies with specific infrastructure requirements [1]. Delivering CAR T outside the hospital, she said, requires capacity for high-acuity patients, specialised nursing and pharmacy teams, toxicity-management protocols, capital and payer agreements on site of care [1]. Her point was that having a therapy is not the same as being able to deliver it safely [1].

## Integration is the barrier

On technology, Patt said interest in artificial intelligence is not what holds practices back; the constraints are capital and interoperability, meaning the ability of separate tools to work together [1]. Stacking platforms with different interfaces, she warned, leaves patients and staff with noise [1]. She named revenue cycle work, where authorization gaps, coding mismatches and denied claims add effort and contribute to burnout, as one area where digital tools may help, while holding that treatment decisions belong to clinicians and patients [1]. She added that small and mid-sized practices may lack the capital or connected systems to adopt clinical decision support on their own, and said that is one reason network affiliation can become attractive [1].

## Why it matters

For owners of independent oncology practices, the remarks set out what Patt considers necessary to compete: technology, purchasing power, clinical pathways and the capacity to deliver complex therapies, all of which she said networks supply [1]. Her remarks addressed oncology only, and the source does not discuss other specialties [1]. She framed the open question as whether greater scale ends up strengthening the delivery of innovative cancer care in the settings where patients already receive it [1].

## What to watch

- Whether the further consolidation Patt called likely occurs in community oncology [1].
- How payers approach site-of-care agreements for outpatient CAR T [1].
- Participation in the Enhancing Oncology Model and any change in commercial value-based arrangements [1].
- Whether fee schedule and radiation reimbursement pressure leads smaller or rural sites to close [1].
- Whether AI tools arrive integrated with existing systems or as more separate platforms [1].

## Limitations

The source is one executive's conference perspective, written up and published by the organization that runs the congress, and it presents no data, figures or studies quantifying the trends described [1]. It identifies Patt by her role at Texas Oncology but does not describe that practice's size or affiliations, so her assessment of scale should be read as informed opinion rather than measured evidence [1].

## References

1. oncodaily.com. Debra Patt at COGC 2026: Community Oncology Is Changing Fast – Can Practices Survive?. Accessed October 4, 2026. https://oncodaily.com/dialogues/debra-patt-600354