OBR Daily Commentary

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Home Health Proposal Could Improve Access to Telemedicine, Concerns About Home Infusion of Chemotherapy Remain

(ASCO in Action) Aug 26, 2020 - The Association for Clinical Oncology (ASCO) recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Medicare and Medicaid Programs; CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements (CMS-1730-P) proposed rule. For 2021, CMS is proposing to allow home health agencies (HHAs) to utilize telecommunications technologies in providing care to beneficiaries under the Medicare home health program on a permanent basis, as long as:

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Thomas Marsland, MD (Posted: September 09, 2020)

quotesSo ongoing tele video health is a welcome provision (although still somewhat problematic for many oncology patients, I have yet learned how to do a good breast exam by televideo....). The home infusion of chemotherapy is a huge issue. There is a trend to try to do chemo infusions in less costly sites. As I am now part of a hospital based program, we are struggling with some payers who are refusing to cover some infusion drug in a hospital out-patient setting, looking to mandate infusions in a less costly site. As payers, PBM's, and pharmacies become more integrated we are seeing questions of what drugs might be able to be administered as part of a home infusion program. While admitting that perhaps some drugs could be safely given in a home setting, there are many obstacles in place. What is the training expertise of the home infusion team, nurses and pharmacists? How are folks dealing with the issue of toxic waste USP regulations?? What about the discrepancies of having to have a doc on site for administration in the office, but yet allowing home infusions??? I suspect that cost will drive care to less compensated programs. Home infusions will most likely be a part of our future....quotes

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Trump Wants Broader Role For Telehealth Services In Medicare

(Associated Press) Aug 3, 2020 - The Trump administration is taking steps to give telehealth a broader role under Medicare, with an executive order that serves as a call for Congress to make doctor visits via personal technology a permanent fixture of the program.

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Thomas Marsland, MD (Posted: August 04, 2020)

quotesSo a couple of comments to share..... Now having close to 6 months of telehealth experience, there are definite limits to what one can do via electronic televideo experiences. One cannot evaluate a breast mass or compare size of a lymph node by computer or phone. With that said much of what we do does not require a face to face encounter. Reviewing labs, images, path reports and developing a treatment approach require a large amount of my time, but certainly can be done without the patient in front of me. Although I think discussing health expectations and outcomes, especially when delivering negative reports, is better done in person where that personal contact and interaction may hopefully give a little extra comfort; those discussions could well be had via an electronic format. Older patients are also something of a problem in their comfort with a digital/electronic format. I recently saw a report from UCSF on how a significant number of seniors are not comfortable with this approach in spite of coaching, while younger tech-sophisticate patients were. I think expanding these services in general is good. The acceptance however will ultimately come in the final compensation packages. If docs end up losing revenue and payers end up seeing this as a "cheaper" option, then in the end it is not going to work. quotes

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Opinion: Pandemic Makes Expanding Medicaid Even More Vital For Cancer Patients

(The Tennessean) June 5, 2020 - The COVID-19 pandemic has caused unexpected financial hardships and reduced hospital capacity for cancer screenings and treatment.

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Thomas Marsland, MD (Posted: June 16, 2020)

quotesI actually enjoyed the experience. I certainly missed mingling with friends and colleagues. Also missed the Chicago experience. However as an educational experience, I felt it more than met my needs. I was able to "attend" the presentations I wanted and didn't have to run through crowded halls to make a lecture and miss others I wanted to hear that happened to be scheduled at the same time. I was able to hear the presentations and see the slides in the comfort of my own home (also while enjoying a fine red wine...) I hope we are all back together in person in Chicago but I think ASCO did a really good job with this meeting in a relatively short time frame. Kudos. 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

Associate Clinical Professor, Medical Oncology Executi...

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 Professo...

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

Steven Spielberg Family Chair in Hematology Oncology P...

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Stephen M. Schleicher, M.D., MBA

Community Oncology, Medical Oncologist, OneOncology...

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 ...

Health Policy
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William McGivney, PhD

National Health Policy Expert...