OBR Daily Commentary

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Oncology Medical Homes, Patient Navigators Improved Quality and Saved Costs at End of Life

(AJMC.com) March 13, 2017 - A recent study in Health Affairs assessed cost and utilization outcomes for 3 innovative care models for Medicare beneficiaries with cancer: oncology medical homes, patient navigator programs, and palliative care initiatives.

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Thomas Marsland, MD (Posted: March 20, 2017)

quotesThis report again confirms what we all suspected. That there are indeed significant savings to the "system" when practitioners take the responsibility to direct appropriate care themselves. This as discussed involved standardization of how the practice deals with patients that have "pathways" in place for triage and treatments. Also having expanded access by the patients to the physicians and other caregivers in the practice. No longer is it acceptable to have a recording say "hang up and dial 911" or have the practice on-call person say "go to the ER." WE have to be there for our patients. If we really do this and take responsibility, indeed this can result in reduced costs of care. HOWEVER, there have been numerous examples (Drexel, Wilshire and others) that also clearly show that the costs to the practice are significantly increased. Obviously in any new payment model these increased costs have to be recognized. In addition, these three newer models should be included as potential options for new APM's. quotes

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MedPAC Mulls Changes to Part B Drug Program

(MedPage Today) March 3, 2017 - The Medicare Payment Advisory Committee (MedPAC) says that the way physicians are paid for administering drugs under Part B of the Medicare program should be changed, but not all committee members agree on how that change should occur.

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Thomas Marsland, MD (Posted: March 08, 2017)

quotesWow.... maybe MedPac actually came up with a couple of good thoughts. This article is definitely worth looking at. They address the ASP issue and rising drug costs by limiting the amount the company may increase the price in a given period of time. This is a dramatic change from the idea that they can control drug costs but reducing the add on (ASP "+") that is the fee to the practice for drug handling. I like the idea of consolidated codes. It clearly has been helpful in the generic world and if done properly should work for biosimilars and even drugs within a give type that have equal efficacy and toxicities. The DVP idea is also one that deserves being looked at (darn, lot of dangling pariticiples today...). This is one way of allowing Medicare to "negotiate" pricing through an intermediary. The proposal removes the outside negotiating vendor from the direct patient billing and issue of drug procurement for the practice that was very problematic in the CAPS program. Clearly the "administrative" fee would need to be adequate to cover practice expenses on drug handling but we should be open to the idea. It would be interesting if this did then qualify as an APM. It wasn't really clear in the report if that was just an idea or was that a key part of the proposal. The final piece of this article that was very interesting was the discussion of a "virtual" group - a concept I had only very recently heard of ( darn again...). Once more the devil is in the details. Who is in the group??? What metrics are being looked at??? This would go a long way toward being sure that in any performance based payment model that you really are being compared to your peers in terms of quality outcomes and costs. No longer would the oncologist be compared to the internist. Gee maybe MedPac isn't so worthless after all......quotes

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Third of Oncologists Report High Burnout; 30% Turn to Alcohol

(Medscape Medical News) Feb 23, 2017 - A meta-analysis of data from 4876 oncologists found that a third reported high burnout, or emotional exhaustion, and 30% reported drinking alcohol in a problematic way.

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

quotesBoy are we a mess....... 30% of us are drunks, 20% drug addicts, and another 20% are crazy. Ok so maybe a tad dramatic... but burn out and stress are clearly an issue. I personally don't believe the dealing with dying patients is the most stressful part of practice. Hospice physicians and palliative care doctors didn't seem to have quite the same degree of problems yet they deal with end of life all the time also. For me the biggest stress producer is the constant battle with the regulatory agencies (payers and government) that continually put barriers in place that make good care more difficult. Stress itself is not always a bad thing. It can be a strong motivator for action. For me adequate time off to spend with family is critical. I think that we do need to be sure that as part of any training program that students and fellows are taught the importance of time off and relaxation. At this point think I will retire to the couch with my single malt. 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...

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...