OBR Daily Commentary

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Novartis Wants Japan To Link Drug Price To Patient Outcomes

(Nikkei Asian Review) Oct 5, 2017 - Swiss drugmaker Novartis seeks to bring a cutting-edge cancer treatment to Japan under a pricing model linked to patient outcomes, asking for payments from only those who benefit from the therapy.

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Thomas Marsland, MD (Posted: October 05, 2017)

quotesThis is an interesting concept. Although this sounds good it may not in the long run hold down drug costs. If a producer knows that 20% (40,50 whatever %) of the treatments are not effective then what is to prevent them from just adding 20% to the initial cost of the drug knowing that they will have to refund that 20%? This indeed is a proposal that should be studied and indeed was discussed in the ASCO white paper on drug costs but is really needed is transparency on how drug prices are developed in the first place. quotes

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Proposed Changes to 340B Program Would Hurt Nonprofit Hospital Margins, Moody’s Says

(COA) Oct 4, 2017 - Hospitals will continue to pay more for inpatient drugs, though Moody’s predicts the pace will moderate due to pharmaceutical scrutiny.

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Thomas Marsland, MD (Posted: October 04, 2017)

quotesSo clearly less is less..... but less for some maybe more for others. The hospitals have used the 340B program to expand their control of cancer care for years. In the Xcenda report discussed in prior OBR daily's it is noted that 75% of the hospital acquired practices come from those with 340B status. So much for that margin providing indigent care... That report also discusses how hospital centered care costs 60% more than the same care delivered in a private practice setting. This amounts to $90,000 a year more per patient. That report also describes a much greater ER and hospitalization rate by hospital based practice. Community physicians have been under the gun with falling reimbursement for years and that has led to improved quality and efficiency's such as the Come Home Oncology Medical home. Another interesting comment in Moody report points out that patients actually will save $180 million dollars a year. It makes no sense to continue to subsidize hospital programs that result in greater cost of care. Hospitals need to learn to reduce their costs as the doctors in private practice learned to do. The 340B program is broken and abused by hospitals to sustain their margins and inefficiency. The playing field needs to be equalized. quotes

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New Study Determines Cancer Care Delivered In Hospital Outpatient Setting Much More Expensive Than In Independent, Community Oncology Practices

(COA) Sept 28, 2017 - Chemotherapy 71% more expensive, physician visits 333% more expensive, and patients have higher rates of emergency department visits when treated in hospital outpatient setting; data consistent across tumor types, including breast, lung, and colorectal cancers.

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Thomas Marsland, MD (Posted: October 02, 2017)

quotesI recently had the opportunity to talk with a group of medical oncologists about MACRA. Many of these physicians are still practicing in small groups or single doctor offices. At the end of the discussion I felt I had to hand out prescriptions for Zolof (a good Napa Cab had already been supplied). They were clearly overwhelmed with the rules and regulations and compliance issues in the new law. These heap additional expenses on already overburdened small practices. This report AGAIN demonstrates the cost efficiency of care delivered in the private practice setting. When physicians control the care delivery, we have continually shown that we can do a better job at cost control than care delivered in a hospital program. Hospitals have a dramatic economic advantage over private practice with things like the 340B pricing and the OPPS. They can give the oncologist greater economic security but at a larger cost for equivalent care. The powers that be must soon understand that the present system is driving doctor out of private practice and that if effort to equalize the reimbursement landscape are not changed there will be no private practices left (I suspect that is their real objective).quotes

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Meet the Editorial Board

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Associate Cancer Center Director, Yale Cancer Center P...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...