This article provides a sweeping historical and modern day perspective on the care delivery ecosystem beyond the four walls of a hospital. While site of care (hospital, community, home, remote, etc.), and its appropriateness / value remains a hot topic of debate, there is no questioning that ultimately the best interests of the patient should govern where care is received / delivered. For oncology/hematology patients, safe, convenient and high quality / low cost care is best received in community settings, like here at Florida Cancer Specialists & Research Institute. Whenever site of care enters a patient discussion, there must be an acknowledgment of the underlying incentives / motivation for suggesting care in the hospital (340B), and/or in the home (white bagging). Until this is made clear and transparent to patients, families and stakeholders, community oncology providers across the country will continue to face challenges and ultimately be forced to assess the inherent tradeoffs of remaining in private practice, which over the medium / long-term is likely worse for the entire healthcare ecosystem.
It is hard to believe that medical house calls used to make up 40% of all U.S doctors’ visits.1 Home visits used to be the norm, but somewhere in the mid-20th century something changed, and by 1980 house calls accounted for fewer than 1% of patient encounters.2 As a result, people have largely forgotten about the once-famous black medical bag that physicians used to carry from door to door.
Numerous developments were responsible for the shift of care delivery from the home to clinics and hospitals, but perhaps none more than the rise of third-party payers and fee-for-service medicine. In 1960, patients personally paid for 67% of the aggregate bills for medical consultations. By 2014, that number fell to 11% as private insurers and government programs began paying for a larger share of care.3 With clinicians having less control over the money flow, convenience for the patient became less important and acknowledgement of their preferences for house calls dwindled. Instead, volume-based medicine and fee-for-service reimbursement makes it hard to justify the amount of time required to do house calls. Home visits were deemed inconvenient for the provider and an inefficient use of medical resources.
An interesting study showing that, on average, a cancer patient wastes >$4000 on unused drugs due to discontinuation of oral agents or dose modifications. Allowing a safe recycling method for patients to submit unused drugs could save a lot of wasted healthcare dollars.
While price transparency across sites of care on its face is a step in the right direction, datapoints when viewed discretely are less informative when it comes to the actual costs associated with cancer care. Additional work, analysis and research is much needed across the stakeholder continuum to fully understand the costs associated with the treatment of cancer, and to further achieve the transparency goals set forth by CMS in 2019 with this initiative.
STAT News published the below Op Ed from COA that does that highlights the dysfunction of the 340B system and how Hospital Systems and PBMs are profiting Billions of dollars a year off of a program that was intended to help underserved patients. Is a great “high level” review to help understand the overall impact on the US medical system and the importance of health care reform in this area.
Analysis of 61 NCI-designated cancers demonstrate parenteral cancer drug price markups across all centers ranging between 188.4% to 633.6%. Only 27 centers publicly disclose payer-specific prices for cancer therapies as required by federal regulation. Authors recommend public policies to discourage excessive hospital price markups on patenteral chemotherapeutics to reduce financial burden on cancer treatment for patients.
Thought-provoking oped highlighting the underbelly of buzzwords in healthcare today. The shift from volume to value that we’ve seen unfold over the past 3-5 years has moved front and center in many conversations, yet remains elusive insofar as its definition and implementation. This article rightly calls out that value is ultimately in the eye of the beholder, and yet there’s no disputing that doing what’s right for the patient trumps all.
FCS Hematology Oncology Review creates a platform for our physician network to observe the most recent articles and studies available in the oncology and hematology world. By sharing these articles we are building our wealth of knowledge of new observations and treatments as they come available.
