OBR Daily Commentary

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First Breast Cancer Home-Screening DNA Test Cleared By FDA

(KHN Morning Briefing) Mar 7, 2018 - While the FDA cautioned that regular checkups and screenings are still needed, the decision allows people to initiate testing on their own for three genetic mutations that put them at a substantially higher risk of developing breast and ovarian cancer.

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Winston Wong, PharmD (Posted: March 14, 2018)

quotesIt will be interesting to see if payers will reimburse for this test. I doubt that they will, since it is consumer driver, as opposed to provider driven, and time will be needed for payers to gain confidence in the accuracy and reliability of the test, as well as how the information will be handled by the providers. Will the providers simply just turn around an order another test? In additional, with a consumer driven test, can payers even be confident that the test is being used by the same person who purchased the test and would be billing it to the payer. Many questions to be answered.quotes

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Hospital Charges For Outpatient Cancer Care Highly Variable, Medicare Billing Records Show

(Johns Hopkins Medicine) Feb 20, 2018 - An analysis of recent Medicare billing records for more than 3,000 hospitals across the United States shows that charges for outpatient oncology services such as chemo infusion or radiation treatment vary widely and exceed what Medicare will pay by twofold to sixfold.

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Winston Wong, PharmD (Posted: March 13, 2018)

quotesHospitals will charge whatever they want to charge. The real question is what are they paid? Medicare reimburses from the DRG. Most payers will pay something based upon the DRG rate. Very few will pay charges, or even a percentage of charges. yes there are some exceptions, but even then, there are limits. So why do we look at the charge numbers?quotes

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First Opinion: Lives Hang In The Balance As Health Insurers Drag Their Feet On Coverage Appeals

(STAT) Feb 13, 2018 - Health insurers in the United States “keep on giving” when it comes to dishing out outrage to Americans who have already been battered by their denials for coverage.

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Winston Wong, PharmD (Posted: February 19, 2018)

quotesI lived through and was part of the payer process for many years. It is not a perfect system. It is a system developed for population health management. Unfortunately, the process for those falling outside of the population is not a smooth process. I venture to say that the time frame referred to here was a couple of years ago when genomic signatures were still up and coming. The mere fact that it was paid for is notable. Unfortunately, dealing with the results is not notable. Hopefully today, the test are more readily paid for and the results are believed.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

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...