As I am sure most of you are aware, to very expensive new drugs recently came onto the market - Provenge, a cancer vaccine used to treat metastatic prostate cancer, and Ipilimumab (often called "Ipi" for short) and commercially called Yervoy, which also utilizes your immune system to attack cancer. Neither is cheap - Provenges total costs for a full treatment approaching $100K and I've heard estimates that Ipi will exceed $100K.
A few of our members have physicians eager to prescribe these drugs and are concerned about what this means for them - will they get paid? Will these bust their budgets? It only takes a few denials to cause financial problems for an entire cancer program. From what I can hear, right now most programs that are providing them are doing all they can that they are prescribed strictly within the FDA approved guidelines, and while also trying to build in a cash flow buffer knowing that it will likely take them a while to get paid as they will undoubtely have to appeal denials and so forth. That said, many are eager to hear about others experiences - so please share - Are patients demanding these drugs? Are you prescribing them? What systems have you put in please to manage utilization and ensure you get paid? Are you getting paid? Please feel free to email us directly with your experiences (email@example.com) or just post them as a comment. I'll then summarize everything and share it with you.
Recently I've been receiving a number of requests from members looking for data and benchmarks around the service utilization of cancer patients and how this then connects to physicians. For instance, some questions we've heard include:
- What is the expected service utilization - both inpatient and outpatient - for newly diagnosed cancer patients for key cancer services such as chemotherapy, radiation therapy, imaging etc?
- What are the downstream revenues we can expect from a medical oncologist? Or radiation oncologist?
As you can imagine, these numbers are not always as easy to answer as you'd think, but that doesn't mean we can't work towards getting you some numbers that might be helpful.
Estimating Service Utilization of Cancer Patients
Over the past year we've received numerous questions about oncology pathways programs. There appears to be growing consensus that they may be the "right" thing to do, but many are concerned about adopting them as they worry the pathways could lead to decreased utilization, and thus decreased revenue (absent any corresponding new payment model). ViaOncology (now part of D3) is hoping to help cancer providers address these concerns by offering asking to their standard pathways risk-free for a limited amount of time - to try them out if you will. It's an interesting idea. You can learn more about it here.
We've posted extensively about pathways on this blog, see past post here example. Our most recent formal work on the topic is part of a larger presentation entitled Transforming Cancer Care.