OBR Daily Commentary

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Physicians May Lose Over $40,000 in 5 Years After EHR Adoption

(Becker's Hospital Review) Mar 4, 2013 - A new study, published in the March issue of Health Affairs, found that the average physician will lose $43,743 over five years after adopting electronic health record systems.

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William McGivney, PhD (Posted: March 06, 2013)

quotesMark Twain would be proud of this publication as to paraphrase him: “The actual financial benefits and savings that were proposed for the implementation of electronic health record (EHRs) systems in practices were greatly exaggerated.” This study published by Adler-Milstein et al. in Health Affairs is a “close to real world look” at the actual financials and financial results from different size and type practices that implemented EHRs with financial support from BCBS of Massachusetts. The takeaway is that plugging in an EHR system requires the provision of significant resources and process management to integrate the program in a practical and somewhat efficient manner. It also requires more than a modicum of systems sophistication. In the setting of this study,implementation consultation was provided at no charge to the practice. Even with the $44,000 federal incentive modeled in, 59% of practices would still lose money. Without the modeled increase, each physician in the practice stood to lose $43,743 over a five year period or just about $6,000 more than the straight one-year tuition charged at Harvard. Smaller practices did not fare as well as practices with six or more physicians. Increased revenue was attributed to being able to see more patients in a small minority of practices and more accurate billing. Savings were attributed to shedding paper based records, eliminating dictation and billing services, and reducing FTE hours. EHRs are the promise and future for a health care system that sees millions of patients, deals with hundreds of millions of patient encounters, and now in the trillions of health care system expenditures. But we have a long way to go. Practices and hospitals still often lack the sophistication and just plain old resources to even come close to maximizing benefit from EHR systems. As that revered health policy icon, Mark Twain, was wont to say: Be careful about reading health books; you may die of a misprint.”! quotes

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Almost One-Third of Chemotherapy Used "Off-Label"

(Reuters) Feb 19, 2013 - About one-third of chemotherapies are used to fight cancers that drug regulators never approved them to treat, says a new study.

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William McGivney, PhD (Posted: February 20, 2013)

quotesI am responding to the article as written and presented not to the scientific publication. The presentation is very confusing and seems to result from a less than complete understanding of the off-label use issue for drugs and biologics in cancer care. There is confusion in the article as to whether off-label is defined simply as off-indication or as off-indication and/or off-approved dose. In some analyses, nonapproved combinations are considered off-label as well. As written, it is hard to figure out how we have 30% off-label use with 14% supported by the NCCN and 10% supported neither by the NCCN nor approved by the FDA. That leaves an important 6% that is off-label and thus must be not FDA approved and not recommended by the NCCN Compendium. Finally, if 10% of the prescribing of drugs and biologics is supported neither by the NCCN nor by the FDA that is surprising given that medical oncologists would be risking denial of payment for one out of every 10 of their patients. quotes

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Shedding Light on the Sunshine Act Final Rule

(ACCCBuzz) Feb 6, 2013 - The Centers for Medicare & Medicaid Services (CMS) just released the much-anticipated final rule on the Sunshine Act, which is designed to illuminate the relationship between providers and drug and device manufacturers.

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William McGivney, PhD (Posted: February 11, 2013)

quotes Enlightened Interpretation of the Sunshine Act by CMS Transparency in activities that ultimately impact clinical decisions about individual patient care is critical and indisputable. Also critical is collaborative interaction between innovator companies and the provider community in order to achieve the effective transfer of the fruits of basic and translational research into therapeutics available to patients in need; hence, the term, Technology Transfer. Pharmaceutical, biotech and medical device companies pay for a substantial majority of the clinical research in the United States (JAMA, 2010. 303: 137-143). Recent years have seen criticism of industry and provider relationships and the imposition of barriers between innovator companies and the provider community. Clearly, some of this distancing was brought on by activities that needed to be corrected. However, a negative consequence has been the significant diminution of the funding made available for continuing medical education (CME). The technology transfer process cannot help but be hurt when the flow of scientific information from the largest supporters and conductors of clinical research is impeded. The February 1 ruling by CMS regarding CME activities and reporting of support and payment to physicians by industry showed recognition of the need for presentation and open discussion in an area, CME, where there is already substantial oversight by independent bodies. In CME activities run by an independent third party where the speaker/presenter is not selected by the innovator company, payment to speakers is considered “indirect” and hence not reportable. Hopefully, the enlightened CMS ruling on this one focused area of technology transfer signals the first step into an Age of Reason in the monitoring of the relationships among all needed constituents of the Technology Transfer process in Medicine. quotes

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