OBR Daily Commentary

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Doctors Without Appointments

(Forbes) Mar 29, 2019 - Why is it so difficult for Americans to make doctors’ appointments?

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Thomas Marsland, MD (Posted: April 01, 2019)

quotesThis particular article hit close to home on two fronts. I can share the author's frustration about primary care since I have recently had to go through the experience of "changing my primary." I received multiple letters from several different entities claiming to be my insurer, completely unclear who the actual insurer is. These letters offer several different panels and availability. Clear as mud as they say. Now also from the side of doctor providing care, I am extremely frustrated by ongoing delays experienced by my patients when I try to refer to another provider for additional insights, and learn that often they are given the "next available " appointment many times months away. Clearly that does not result in good quality care. Usually I can short circuit this with a personal phone call (begging) my colleague to see if they could possibly get my patient is a little sooner (and again to my frustration it usually isn't just one phone call but multiple episodes of phone tag).... texting is somewhat quicker but again often don't have the doc's personal cell and even then am limited by privacy concerns about what I can actually say in a text...) quotes

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21st Century Oncology Cancer Docs Sue Company For 'Monopoly' Practices

(Fort Myers News-Press) Mar 18, 2019 - Four radiation oncologists for 21st Century Oncology, including a company co-founder and the son and daughter of another founder, have filed a federal lawsuit alleging the company maintains a monopoly on certain cancer treatments in Southwest Florida.

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Thomas Marsland, MD (Posted: April 01, 2019)

quotesAlthough certainly onerous non-competes have been around for a long time. Also over the years I have labored in numerous different programs and systems and they all expect you to "support the team." The critical issues are whether personal compensation becomes a factor in driving referrals. When it does that could ultimately result in reduced access to care for some patients.quotes

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Association Between Reimbursement Incentives and Physician Practice in Oncology

(JAMA Oncology) Jan 3, 2019 - Question: Do the financial incentives within oncology reimbursement affect physicians’ practice patterns?

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Thomas Marsland, MD (Posted: January 22, 2019)

quotesFinancial incentives have and always will drive healthcare. There is no free lunch. This report focuses on treatment practices by physicians depending on the financial incentives. First I strongly believe doctors choose what treatments to recommend depending on what is best for our patients. When efficacy and toxicities are equal then the economics definitely come into play. There are systems where using more expensive therapies are chosen as well as systems where less expensive therapies maybe chosen if there is a financial incentive to do so. Many of the newer models are based on these concepts. Also I would like to point out that that comment about financial incentive clearly applies not just to physicians. Payers also have programs that alter treatment choices due to the economics (prior auths, step therapies, fail first, and more). Gee, bet the PBMs never look at the economics of the treatments they mandate. So let us all agree patients come first and that we need to continue to work to assure that financial incentives work to the benefit of all.... quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

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Debu Tripathy, MD

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

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H. Jack West, MD

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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
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Jeff Patton, M.D.

CEO Tennessee Oncology...

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Jennifer Levin Carter, MD, MPH

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

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Michael G. King Jr.

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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

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Ted Okon

Executive Director Community Oncology Alliance...

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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

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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...

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Winston Wong, PharmD

President, W-Squared Group...