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.
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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.
My colleague Matt Garabrant just wrote this analysis of a new study from NEJM, and I thought it would be of interest.
At first blush, a study recently published in the New England Journal of Medicine provides slightly contrarian findings about the benefits of using surgery for treatment of early stage prostate cancer in men under 65. There has been a great deal of discussion about the perceived over-treatment of prostate cancer in the US, specifically focusing on the use of surgery and robotic surgery for patients who could potentially be well-served by watchful waiting.
This new study, performed by the University Hospital in Uppsala, Sweden, indicates that there was a significant reduction in the rate of death from prostate cancer in the study group that received radical prostatectomy, as compared to the group that received active surveillance. With other recent studies suggesting questionable benefits of surgery over watchful waiting for management of patients with early stage disease, there is still a lack of consensus on the appropriate way to balance the use of these treatment approaches.
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As part of the research we're doing right now on palliative care, I ran across a study from the Journal of Oncology Practice which sought to understand cancer patients' attitudes regarding advance directives. The results are fascinating as they reveal the often contradictory thoughts and feelings that people have towards end-of-life care issues.
The researchers interviewed 75 seriously ill cancer patients following admission to the hospital. Not surprisingly, they found that fewer than half (41%) had advance directives. The vast majority of patients (95%) believed that discussing advance directives was important, and most (87%) were willing to discuss them with the admitting physician, who they had never met before.
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Traditionally the majority of chemotherapy has been administered in the physician office setting. However, since Medicare changed its reimbursement methodology from AWP-based payment to ASP-based payment (resulting in significant declines in physician office revenues), we have been hearing reports of a shift of chemotherapy patients back to the hospital.
Until now, we have struggled to find data that quantifies this shift, but a new report from the pharmacy benefit management company Express Scripts includes some interesting numbers.
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As part of our 2010 research on patient navigation, our research team assembled a list of certification and training programs for navigators. We've included the prerequisites for participation, a summary of the curriculum and certification process, credentials earned, and cost.
Due to page restrictions, we weren't able to fit it into our latest publication on navigation, but you can view this information in the below PDF.