OBR Daily Commentary

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Bundled Payments With Drug Costs Penalize Oncology Practices

(Medscape Medical News) Apr 24, 2018 - Bundled payments were introduced as a means of reining in the high cost of cancer care for Medicare recipients, but a new study suggests that instead of being beneficial, the new approach could be penalizing some oncology practices.

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Thomas Marsland, MD (Posted: April 24, 2018)

quotesClearly the risk for a drug payment bundle could be prohibitive. The variation from practice to practice, or even doc to doc can be significant. Not all cancers were created equal. Even just in breast cancer the differences between someone who treats hormone positive cancer can be dramatically different from someone who treats Her-2 positive or triple neg patients. As one of the authors pointed out the current ICD10 system makes if very difficult to differentiate these sub categories. Historical utilization and risk stratification could be helpful. If someone treats a higher risk population then their "profile" would reflect that and appropriate adjustments could be made. The usage of disease pathways might also make it easier to predict drug cost and bundling. Finally there should be exceptions for outliers. When the DRG system was first introduced to the hospitals, there was a mechanism to deal with outlier populations. Although there really is significant risk there may be a solution if some of these ideas were considered.quotes

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Cancer Risk Rises as Patients Wait for Diagnostic Testing

(Penn Medicine) Apr 10, 2018 - Literature review finds increased risk of cancer, late stage cancer, and mortality with increasing wait time between a positive screening and start of diagnostic testing.

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Thomas Marsland, MD (Posted: April 11, 2018)

quotes This article really hit home with me. As I have transitioned through my career I've had to deal with many changes in the healthcare system. But the one that pisses me off more than any is the delays in diagnosis and treatments in today's health delivery system. I frequently tell my patients that no cancer grows so fast the 1-2 weeks are critical. BUT in today's world that one to two weeks can easily become six to eight weeks from my ordering studies or treatments till the patient actually receives the service. The bureaucratic hurdles that we providers and patients have to jump through to get the appropriate studies or therapies is criminal. I recently read COA is on the hill maybe something good may come in this era of less (sic) regulation..... quotes

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Oncologists Disagree On Use Of Value To Guide Cancer Treatments

(Stanford Medicine/Scope blog) Apr 4, 2018 - A new study found that oncologists have divergent views on how to use “value” to guide cancer treatment recommendations.

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Thomas Marsland, MD (Posted: April 06, 2018)

quotesSo again the "value" question....I share my dear friend Ted Okon's comments about sample size of this study. 31 oncologists in a nation of over 5000 medical oncologist is hardly representative. With that said, value is always problematic. Value to whom?? The patient, the payer, the employer, the provider??? Plus the cost is a constantly changing target. Drugs that were considered horribly expensive may be considered a deal when viewed in light of $500,000 Car-T cell therapy. Organized medicine such as NCCN, ASCO and COA have all weighed in with some suggestions on value. Clearly clinical outcomes, quality of life, and cost are all important in the decision process. I always at least briefly discuss cost with the patient and I suspect most oncologist do. Anyway I suspect this issue will be with us for a long time as I don't see pricing coming down soon. 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

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

Distinguished Professor of Medicine, Rutgers Robert Woo...

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...