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Oncologists and cancer drug shortages are creating a crisis, with patient care at risk and legal liabilities looming. In the face of critical cancer drug shortages, oncologists grapple with suboptimal patient care and possible legal liabilities. The issue worsens due to insufficient guidelines for alternative treatment options. A contributing factor is the weak financial incentive for drug manufacturers to produce unprofitable generic drugs, compared to branded ones. Consequently, there’s greater dependence on foreign factories, leading to supply chain hitches and quality control issues. Barbara McAneny, MD, CEO of New Mexico Cancer Center, foresees drug shortages persisting, particularly affecting low-cost treatments. The American Society of Health-System Pharmacists (ASHP) reports shortages of vital oncology drugs like methotrexate, cisplatin, carboplatin, and fluorouracil, crucial for treating various common cancers. Furthermore, the lack of guidelines on alternative treatments exacerbates oncologists’ concerns about patient outcomes and legal liabilities. This absence of direction leaves physicians making crucial decisions single-handedly. In response, the American Society of Clinical Oncology (ASCO) has formed an advisory group to develop clinical guidance during these drug shortages. Immediate recommendations include reprioritizing nonessential use of scarce antineoplastic drugs, increasing interval cycles, reducing doses when clinically acceptable, and selecting evidence-based alternatives. Dr. Jeff Patton, CEO […]

Disheartening statistics reveal that suicide is the 12th leading cause of death in the United States, with nurses appearing to be at a higher risk than the general population, particularly following the relentless strain of the COVID-19 pandemic. Given that our profession can struggle with addressing institutional problems such as inadequate personal protective equipment and enforced overtime, these stressors can intensify the psychological toll. Despite several studies investigating the stress experienced by nurses, we’re often encouraged to endure these pressures stoically, even amidst a pandemic. The stigma surrounding mental health and suicide within our ranks is not addressed as it should be, which is detrimental to our wellbeing as individuals and professionals. In comparison, physician suicide does not pose a higher risk than that of nurses or the general public. However, a turning point came with the tragic suicide of Dr. Lorna Breen, an Emergency Department physician, leading to the enactment of the Dr. Lorna Breen Health Care Provider Protection Act in 2022. This legislation established a national program designed to prevent suicide, reduce mental health stigma, and enhance resilience among health care professionals. The Act emphasizes the importance of seeking mental health support and demystifying the stigma associated with […]

The Merit-Based Incentive Payment System (MIPS) is a program that ties Medicare payments to the quality of care provided by physicians. In recent years, the weight of cost measures in MIPS has increased, which could disproportionately penalize oncologists. A study published in JCO Oncology Practice found that the recent increase in the weight of cost measures, combined with lower cost scores, will likely result in lower composite MIPS scores, fewer total payment bonuses, and greater negative payment adjustments for oncologists. In non-oncologists, the maximum penalty decreased from $8,262.82 in 2018 to $7,473.57 in 2022. This suggests that oncologists are more likely to be penalized under the current MIPS scoring system. The researchers who conducted the study believe that the current paradigm of the MIPS scoring system will financially penalize heterogeneous and complex care-driven specialties such as oncology. They recommend that policymakers monitor whether the potential loss in revenue results in altered practice patterns and varying degrees of health care quality for patients with cancer.

Physicians and advanced practice practitioners average $3.8 million in annual billing to commercial payers. AMN Healthcare tracked billings to commercial payers by 18 different medical specialties, as well as nurse practitioners and certified registered nurse anesthetists (CRNAs), in a recent research.This research solely includes billings for services delivered directly by physicians, nurse practitioners, and certified registered nurse anesthetists. It excludes the revenue generated by testing, treatments, prescriptions, and other health-care services.

Community oncologists in the United States are at risk of violating the Stark Law if they continue to mail or use delivery services to ensure their patients have access to essential oral medications, after the COVID-19 public health emergency (PHE) ends on May 11th. The Stark Law is a federal law that prohibits healthcare providers from referring patients to entities with which they have a financial relationship, unless certain exceptions apply. The FAQ document published by the Centers for Medicare & Medicaid Services (CMS) in September 2021 suggests that mailing oral drugs could violate the Stark Law, even if the practice does not receive any financial benefit from the delivery. This interpretation is so broad that it could also bar relatives or caregivers from picking up patients’ medications. As a result, practices are facing a difficult choice: require patients to pick up medications in person or refer them to third-party mail-order pharmacies. The latter could lead to delays, denials, or sometimes errors because of a lack of direct communication between the pharmacy and physician.

The recent acquisition of OneOncology by AmerisourceBergen Corporation and TPG Capital highlights the potential for private equity to support and grow community oncology care across the United States. Private equity firms are seeing opportunities in oncology, as they could help slow or reverse the trend of hospitals consolidating practices by providing significant funding needed upfront to start and operate a community oncology practice. With all the changing insurance relationships and the cost of doing business on a day-to-day basis, that’s a pretty risky proposition. But if private equity firms provide capital support, then it’s somebody else’s financial risk. OneOncology is a management services organization that partners with community oncology practices to provide resources that help institutions improve care and remain sustainable as the reimbursement environment changes. Its services provide “shelter in the storm,” especially with value-based care. Many practices are entering into reimbursement models in which they are taking on downside-risk, being part of OneOncology’s network allows them to spread and minimize potential financial loss. The uniqueness of this model is that it supports practices while keeping the operational decision-making at the practice-level independent. The recent acquisition of OneOncology is further proof that OneOncology’s mission is receiving greater support, and […]