Physicians

PHARMA/PHYSICIANS/POLICY: Oncologists getting paid for reporting data they should report anyway, by Gregory D. Pawelski

Congress has authorized the payment for oncologists reporting whether their treatment adheres to guidelines. Greg Pawelski, who follows the oncology market very carefully, was not too impressed.
When Senate Finance Committee Chairman Chuck Grassley found out that the value of the approximately $300 million-a-year medicare chemotherapy demonstration project to report on a patient’s level of nausea, vomiting, pain and fatigue was for nothing (providers were being paid $130 to simply forward the data that is already collected), they hoodwinked Congress into additional reimbursement to oncologists that report whether their treatment adheres to practice guidelines published by either NCCN or ASCO.

Looks like cancer patients will have to continue overpaying their oncologists and not have access to cutting-edge cancer treatments, and continue to suffer side-effect consequences and even death. The system will continue to serve the clinical investigators and the clinical oncologists, but not serve the best interests of cancer patients.

I think that the concept that some "authoritative" organization (made up primarily of practitioners and researchers with built in conflicts of interest) should determine the "correct" approach to cancer treatment has been very harmful to progress.

Livongo’s Post Ad Banner 728*90

Categories: Physicians

Tagged as: , , ,

9
Leave a Reply

9 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
6 Comment authors
Sharon KnapeJeffrey Gene Kaplan, MD, MSeric NovackGregory D. PawelskiTom Recent comment authors
newest oldest most voted
Gregory D. Pawelski
Guest
Gregory D. Pawelski

Eric M.D. Anderson Cancer Center is taking a new look at how to evaluate new medicines and treatments for cancer. “We need to rethink how we design and conduct clinical trials in the U.S.” says Dr. Donald Berry, one of its scientists. He feels that we should turn the ‘statistical method’ used to evaluate new drugs on its head, stating that it limits innovation and learning. What he’s talking about is the adoption of the Bayesian method of science because it is more in line with how science works. They are putting this approach to the test with more than… Read more »

Sharon Knape
Guest
Sharon Knape

My 76 year old mother’s doctor told a room full of worried relatives that he could not remove the tumor from her liver and pancreas, and had to close up the wound. He said there was nothing that could be done, he was specific, NOTHING would help her, not chemo, not radiation. Several hours later when she was lucid, and she asked if chemo and radiation would help, he said yes, and arranged for them. I could not believe my ears! Her suffering was long lasting and horrid. She could not eat, her teeth crumbled because of the radiation. She… Read more »

Gregory D. Pawelski
Guest
Gregory D. Pawelski

Dr. Andrew C. von Eschenbach, chief of the National Cancer Institute and tapped to be the temporary chief of the FDA is championing the cause of “individualized treatment.” Von Eschenbach has said that our increasing understanding of diseases at “a molecular level” will lead to an entirely new kind of health care. “Now, doctors treat illnesses based on how well other people have responded to a given treatment (evidence-based). Soon, they will develop a tailored response built around specific understandings of the patient, the treatment and the disease,” he said. “Much of what we have done … has been based… Read more »

Jeffrey Gene Kaplan, MD, MS
Guest

Look, I’m not saying oncologists don’t take advantage, but: 1) They do operate by protocol, 2) They do contribute to field research (if not with a present case than by being the main specialty of medicine and surgery that sets that precedent), 3) Keeping said database is not easy, moreover, it IS complicated and expensive and not to the extent required, ‘what they do anyway, 4) They hope and treat accordingly (You wouldn’t have it any other way). This is not to say that they could be more discretionary but that’s Monday morning quarterbacking at its worst. Give ’em a… Read more »

Gregory D. Pawelski
Guest
Gregory D. Pawelski

Eric There is a need for changes in our approach to the chemotherapy of the most common forms of adult cancers. The experience in metastatic breast cancer shows that back in the early 70s, the median survival for metastatic breast cancer was just under two years. Today, it is just under two years. Despite scores of prospective randomized trials involving tens of thousands of patients, showing that response rates (tumor shrinkage) have gone up, yet the overall survival rates have not improved. You give more aggressive chemotherapy by utilizing combinations, high dose therapy, etc, in diseases like metastatic breast cancer… Read more »

eric Novack
Guest
eric Novack

Greg- what do you mean by “aim higher”? How would you design trials for new drugs? Who would/ should pay for them? If the drug manufacturers must pay– then the conflict of interest will exist. New drugs cost, currently, 100s of millions of dollars to get to market. Would you have the public fund trials of privately developed drugs? Who should get profits?

Gregory D. Pawelski
Guest
Gregory D. Pawelski

The problem is that, all too often, the “best” therapy is so poor that it does not deserve the exhalted status of “standard” therapy. Current approaches to cancer therapy are too often ludicrously ineffective and “progress” over the past 30 years has too often been virtually non-existent, from the viewpoint of anyone who is not impressed when a 2,000 patient prospective randomized trial produces a “significant” improvement in median survival which translates out to an 18.4 month median survival versus a 17.1 month median survival and that means that everyone should receive the treatment producing the 18.4 month survival, even… Read more »

Tom
Guest
Tom

The Oncology Industrial Complex is astonishing. In the course of our research on the evolution of specialty drug management, oncology continues to stand out for its well-organized resistance to anything that would challenge its independence and authority. The changes to Part B may achieve somethign despite this: as more and more commercial insurers move to adopt the Medicare payment rate (ASP+6%), pressure on providers will grow. Since payers aren’t buying the “I’ll-start-sending-patients-to-the-hospital” argument, I think this is going to have a significant impact on cancer medicine, particularly in terms of drug choice at the margins. We predict a rationalization in… Read more »

Trapier K. Michael
Guest

Reminds me of the movie “Whit,” which was also a play: the story of an English professor who gets cancer and is pressured by research oriented physicians to endure excrutiating treatment that helps their study even though a more gentle plan may have been better.
The thought of being a patient is downright scary when other people are making the crucial decisions that affect your life and health.