Blog posts that are not press releases.

Diagnosed With Breast Cancer? Ask These Eight Questions

One in eight women will receive a breast cancer diagnosis in her lifetime, according to the National Breast Cancer Foundation. While treatments for the disease have advanced and survival rates are improving, the National Breast Cancer Foundation also reported that breast cancer remains the most common cancer for American women and approximately 287,500 new diagnoses will be made by the end of 2022.

Early detection and prevention plans are important for slowing the progression of the disease and increasing the rate of survival. Additionally, asking the right questions when diagnosed with cancer is critical, providing essential information for patients who are beginning their journey to recovery.

Below are eight questions to ask upon receiving a breast cancer diagnosis.

  1. What type of breast cancer and receptor status do I have? Learning more about the type of cancer along with the receptor status can give patients clarity about their diagnosis and a better understanding of their current health status. Patients need to know their diagnosis because it encourages follow-up questions and the opportunity for accurate information to be discussed between the oncologist and patient.
  2. How is the type of treatment decided? Women are different and so are cancers and their characteristics. That is why treatments are individualized to the patient and targeted to the specific type of cancer. Certain therapies that work for one patient may not be as successful for another.
  3. Do all breast cancer patients require chemotherapy? Chemotherapy is a common treatment chosen for many cancer patients because of its aggressive nature. However, depending on the type of cancer, chemotherapy may not be recommended as part of the treatment plan for breast cancer.
  4. How will my cancer and treatment plan affect my quality of life? Cancer and cancer treatments can disrupt many aspects of life. Patients can struggle with cognitive performance and pain management, for example. It is important to share concerns with the oncologist throughout the cancer journey, from the start of the diagnosis to post-treatment. Oncologists do their best to ensure quality of life is maintained, and if it is not, sometimes there are changes that can be made to help patients in this particular area of concern or additional remedies that can be recommended.
  5. Will I be able to continue working or take care of my family while undergoing treatment? While many cancer patients find treatments lead to nausea, fatigue and weakness, each patient experiences their treatments differently. Discussing with the oncologist symptoms and side effects of the cancer diagnosis and associated treatments helps patients determine what is to be expected, allowing them to make needed adjustments in their day-to-day routine — whether that is at work or at home.
  6. Will I need to make any nutritional changes? Eating well and ensuring proper nutrition is maintained play important roles in a patients’ cancer journey and recovery, which is why a  dietitian is often part of the care team. There are several foods that patients will want to consume and others, such as raw fish and unpasteurized dairy products, that need to be avoided.
  7. How do I tell my children I have breast cancer? Sharing news of a life-threatening disease is difficult and emotionally taxing. Patients should share their diagnosis with children when they are ready and have received accurate information to avoid misleading the conversation. Many patients have found it helpful to rehearse what is to be said with a spouse, family member or close friend.
  8. Are there support groups available to help patients and their families? Having support throughout the cancer journey is important because cancer can take a toll mentally, physically and emotionally. Support systems have been shown to positively influence cancer outcomes, and patients should establish their support systems early on. Start with creating a support group of family and friends and then branch out to local and national groups such as those provided by the American Cancer Society to find additional resources.

These questions provide transparency into a complicated disease. Knowing not only the type of breast cancer but more about the treatment options available and lifestyle changes that may be required helps patients understand their diagnosis, make better-informed health decisions and feel involved in their care plan.

Natural Hazard Preparedness: Your To-Do List as a Cancer Patient

Five tasks to complete to keep your health in order when dealing with a natural hazard.

Natural hazards include severe storms, hurricanes, tornadoes and the like. These situations can easily cause anxiety, stress and even fear of what is to come. These feelings may be heightened if you happen to have a disease or illness that requires specialized medications and medical equipment to manage.

If you are finding yourself in a state of panic because Mother Nature decided to send a biological or geological hazard your way, take a moment to breathe and complete the recommended steps to find some peace of mind:

  1. Notify your physician and care team: Contact your care team to let them know of your situation including if you are planning to evacuate the area. They will also be able to answer any questions you may have about managing your health during the unprecedented time and provide additional care guidance.
  2. Ensure you have enough medications for several days. Take count of how much medication you have on hand, and if needed, request from your physician some additional days’ worth just in case you happen to be relocated and are unsure of when you can return. You’ll want to have enough medications to last you for at least seven days.
  3. Make sure you have a list of your current medications. In times of panic, you may forget your medications while hurriedly leaving or may run out. Have a few lists of your medications, the dosage amount, instructions and prescriber name and information available and accessible in at least two places. For example, you may have a list made out on your phone and a paper list in the car or your purse. Be sure to take this list with you no matter where you go.
  4. Connect with your caretakers. If you rely on a caretaker, such as a family member or friend, who helps you manage your health, reach out to them immediately and request help. Share with them any new learnings from talking to your care team and update them on your current medications and quantity. Additionally, discuss a plan early on in case evacuation is required.
  5. Have important phone numbers accessible in at least two places. Important numbers for your physician, care team, preferred pharmacy, health plan, caretakers and family should be readily available in at least two places in case of emergencies. You’ll want to keep this information close to you in case you need to relocate.

In addition to the five tasks, listen to and follow the recommendations from state and local officials.

Impressive Results with the Oncology Care Model (OCM)

Despite the program’s closure on June 30, 2022, the Oncology Care Model (OCM), an initiative by the Centers for Medicare & Medicaid Services (CMS), provided participating clinics the opportunity to pioneer a value-based care model focused on decreasing the healthcare costs for Medicare beneficiaries undergoing either chemotherapy or hormonal therapy treatments. These treatments are often costly yet necessary, leaving many patients to struggle financially. Nineteen AON community oncology clinics were part of the initial 200 practices across the nation that were approved to participate in the OCM after successfully meeting the criteria required by the CMS.

To learn more about AON’s successes with the OCM, read the full article “Impressive Results with Oncology Care Model Confirm American Oncology Network at the Forefront of Patient-Centered Cancer Care.”

Patients With Cancer May Need Help Changing Their Eating Approaches

In an interview with Oncology Nursing News, Caitlin Benda, MBA, MS, RD, CSO, LDN, a clinical oncology nutritionist supervisor at American Oncology Network, comments on different ways oncology nurses can assist patients in reaching their overall caloric intake. Read the article.

Pivoting Toward Oncology’s Future: Perspectives Based on My COA 2022 Experiences

I had the recent honor and privilege to once again co-Chair the Community Oncology Alliance (COA) annual Community Oncology Conference, which featured two days packed with medical updates, legislative updates, best practice patterns, patient advocacy efforts, and networking with colleagues and thought leaders.

As our largest conference to date with over 1,500 attendees, it was a hugely impactful meeting, highlighting and addressing the issues currently facing community oncology practices. This blog shares what I considered to be the main take-aways from the conference, including the challenges and opportunities that lie ahead.

340B

Old story, new verse. We engaged in extensive discussions regarding the ongoing abuses of the 340B Drug Pricing Program.

Although initially developed to improve patient access to care, the 340B program has been hijacked by numerous health systems to fund expansion of hospital-owned physicians and infusion centers. It has, paradoxically, increased patients’ costs due to higher site-of-service fees and subsequent drug price increases issued by Pharma to offset the 340B subsidies to these institutions, thereby actually limiting patient access to care.

Additionally, these 340B-based health systems leverage excess drug margins, pressuring community oncology practices to capitulate and join their fold, again resulting in limited sites of service and higher costs for more patients. This erodes the community oncology platform that repeated studies have shown to be a more efficient and cost-effective means of providing oncology care.

Though Congress has issued some cuts to 340B reimbursement, we as Community Oncology must remain diligent and united in continuing to shed light on program abuses as a major cost-driver in oncology care.

PBMs

The evolution of pharmacy benefit managers’ (PBMs) influence in oncology and specialty care is almost beyond comprehension. They have always been among the most egregious offenders in terms of patient access issues through their use of step-edits, prior authorizations, limited formularies, out-of-network exclusions, and veiled rebate systems which drive price increases.

DIR fees PBMs charge to pharmacies and dispensing practices have increased over 1000% in the past few years with little to no transparency regarding the justification for, or utilization of, these funds.

The vertical integration of PBMs within payers shows how valuable they are as a profit center. The consolidation in this space has left us with only three PBMs managing approximately 80% of prescribed medications in this country – limiting competition, which results in further price increases and even more limited access.

A concerning trend is the exclusion of high-cost drugs from formularies, with PBMs expressly directing the patient and provider to apply for compassionate/free drugs from Pharma. This has become almost epidemic.

Deadly Duo

An unconscionable development is the alliance of PBMs and 340B institutions, which are joining forces to gain access to 340B discount pricing on PBM managed drugs.

Multiple Pharma companies have boycotted this effort, which will undoubtedly drive prices higher. Stay tuned as this will be decided in the courts later this year

OCM and Value-based Models

Another significant issue discussed at COA was the sunsetting of the Centers for Medicare and Medicaid Services’ (CMS) Oncology Care Model (OCM). Though the published data for this model suggested overall minimal financial benefit to CMS, the value to our patients is unquestionable.

Oncology practices throughout the country have dedicated millions of dollars in resources to reposition their practices as value-based sites. Through additional patient support networks and improved 24-7 access to their oncology caregivers, this effort was clearly successful in minimizing high cost, low benefit emergency department visits, hospitalizations, and improving timely access to palliative care services.  

The funding for these patient touchpoints is in jeopardy unless a new value-based model is enacted by CMS. Appropriating funding for incentives that improve access to and reduce the cost of care should continue to be a high legislative priority. In the meantime, a pivot to professional case management, transitional care management, and chronic care management programs supported by CMS may offset some of these expenses.

Precision Medicine

No longer a “pie-in-the-sky” quip, precision medicine is rapidly becoming a reality in oncology.

The most cost-effective treatment for our patients will always be the “right” treatment, which is best defined with NGS biomarker panels, whole exome sequencing, RNA/transcriptome sequencing, germline testing, and pharmacogenomics. The complexity involved in the analysis of this tidal wave of data, coupled with the exponential development of targeted agents, creates a challenge for the community oncologist. This data needs to be codified and quantified in a usable format that can be integrated within our EHR’s to power therapeutic decision-making, treatment selection, and monitoring for our individual patients in multiple lines of therapy.

We will likely need to employ the help of artificial intelligence (AI) based solutions to achieve this goal. I strongly believe that Community Oncology will lead the way in this endeavor.

Stay Tuned

The continued growth and success of Community Oncology will be driven by our response to these challenges. How we react to adversity rather than the adversity itself will define our path forward.

Resilience has long been the cornerstone of community oncologists. Fueled by innovation, ingenuity, and a commitment to patient-centered care, we can and will create a brighter tomorrow for our patients and their families.

Pathologists’ Role in Precision Oncology Care

My experience delivering diagnostic pathology services within the laboratory and in the patient exam room have made clear the importance of pathologists serving alongside oncology care teams. The success of these collaborations is driving change in the pathologist’s role in providing precision care.

A complete and accurate pathology report is crucial to diagnosing patients and deciding on the best treatment plan. Pathologists are highly skilled and experienced members of the care team, specializing in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. We use state-of-the-art equipment and the most advanced techniques to analyze tissue samples.

As part of my journey, I’ve participated in diagnosing multiple challenging and interesting cases and have collaborated with our network’s oncologists by providing crucial laboratory results that determine an array of cancer therapeutic decisions.

Pathology Reports Are Not Always Clear

Pathologists’ important work on the oncology care team can often be obscured by reports that are not meant for patient consumption. In particular, pathology and ancillary test reports are not written at a level most patients can understand. It can be discouraging for the diligent and engaged patient who proactively seeks out detailed information about their lab results and what these might mean for the prognosis.

According to the Association of Community Cancer Centers, these reports may also be organized in ways that are confusing to both clinicians and patients. While some patients may meet or speak with pathologists, most pathologists don’t have the time or training to explain their findings directly to patients – a significant hurdle in today’s healthcare environment.

However, as calls for advancements in precision medicine grow louder, so too are calls for ensuring information from pathology is presented in a consumable, patient-friendly manner. The National Academy of Medicine recommends “good communication about key findings” of the reports for patient use. “Pathology report and ancillary test results are integral to patients fully understanding their disease, treatment options, and participation in shared decision-making. Put another way, when patients can access the key information from their pathology and ancillary test reports, in patient-accessible formats, patients can be empowered to understand their disease and treatment options better and engage in the shared decision-making process with their care team.”

Delivering Consumable Pathology Reports for Patients

To deliver the highest level of consumable information about the precise nature of a patient’s condition, some steps to take may include giving the patient a list of reliable sources for additional information about their cancer, connecting patients to cancer-specific advocacy and support groups, and providing patients with patient-centered education and resources for additional information, such as clinical trials.

Clinicians have access to experts and resources designed to help them better understand the information contained in pathology and ancillary test reports. Paired with the reports prepared by pathologists, which they can use to guide shared decision-making conversations about treatment plans, patients can use this information to refresh their memory about the details of their condition before speaking with clinicians.

The role of pathologists is increasingly vital in the practice of precision cancer medicine because of the continuous advances in genomic and molecular testing and the transformation of the traditional exclusively high-level practice of pathology into a more molecular-based medical specialty, as well as the desire for more consumable information related to precision medicine.

Continuously adapting with the newest medical discoveries to provide the most accurate and informative cancer diagnoses for our patients remains paramount, but it’s only one of our charges. By integrating pathologists into patient care teams, we can provide more comprehensive strategies for managing information sharing and meeting the requirements of precision medicine for all patients in our network.

Engaging patients in portions of their care, even those areas that can be difficult to translate and communicate, is a step toward holistic, whole-person care.

Value-Based Care and OCM: The Federal Program Ends, but our Focus on Value-Based Care Continues

Before 2016, there was little going on regarding value-based care in oncology. That changed with the introduction of the oncology care model (OCM), the intention of which was to better align financial incentives to drive improvements to care coordination and appropriateness, as well as expand access to care for patients undergoing chemotherapy.

After six years, the pilot program is at its end. OCM encouraged participating practices to improve care and lower costs through an episode-based payment model that financially incentivized high-quality coordinated care. Fine in theory, but not so easy in practice.

Despite its demise, OCM significantly impacted the practice of oncology, and great strides in patient care were nonetheless realized.  

The Benefits of OCM

Participating in OCM helped transform practice operations within the AON network to focus on patient experience more than ever – rather than simply delivering care. Additionally, the investments we made in services and a quality-based care infrastructure to support associated OCM program requirements will continue to deliver value to our patients and practices.

OCM required the delivery of care plans directly to patients, which our physicians did excellently.  Before OCM, most in oncology care were not driven to provide care plans and documentation directly to the patient. Oncology was about care delivery less than it was about coordinating or including the patient in the care. OCM required that patients received information about their care plans in a shareable format that patients could use as they wanted.  

With the cessation of OCM, the most significant disadvantage for patients is that they may face a more difficult task of acquiring patient information in which they can act upon. For example, when a patient is newly diagnosed with cancer, they typically retain very little of the information discussed around prognosis, treatment options and treatment plans. Compliance with OCM data guidelines helped patients retain this knowledge.

In fact, the required care plans were one of the best things to come from OCM because they easily translated to meaningful, patient-friendly paper documents outlining all the information a patient needs to understand their diagnosis and treatment. Though this information has always been in the patient’s chart, through OCM they also had something tangible to share with their families and loved ones. This shareable information led to patients being more engaged in their care and asking questions related specifically to their treatment plans rather than engaging in a more nebulous manner. That’s been a positive impact, useful for patient navigation.

What’s Next

Participating in a large value-based care arrangement like the OCM has been invaluable for AON, our practices, physicians, and patients. While participation was voluntary, most who took part did so by embracing it fully. That is why I don’t believe value-based care practices or the principles of OCM are going away – nor do I believe any other healthcare providers want it to go away.

Unfortunately, the most significant problem before OCM was that payers were not fully prepared for how to address value-based care in oncology. Treating cancer is very expensive and oncology drug prices are unpredictable, which is likely a significant deterrent for some commercial payers when it comes to developing any type of shared savings program for community oncology practices. The overwhelming challenge faced by payers is alignment of interaction and reimbursement. It is a complicated, detail-driven challenge where various payment models and contracts created roadblocks to streamlining payment mechanisms. 

When OCM officially concludes on June 30, 2022, there is no other quality program coming online in its place – making it a challenge to maintain an oncology value-based care program. Outside of organizations like AON, there are likely some very real challenges ahead for practices as they attempt to do so. Most invested in services and infrastructure to support participation in OCM, and will likely lose at least some momentum without another value-based model to follow, especially regarding data collection and dissemination.

However, for practices within the AON network, basing care on quality over all else remains a priority. We continue working with our practice partners to ensure training and education related to value-based care. We make clear the benefits and put in the work to prove the value of value-based care for patients and practices. We’ll continue to follow the structure of OCM – every practice transformation effort that we put into place will continue – because it is flourishing. We will not revert to pre-OCM care.

Our patients are the ones who win in the end, and that’s why we’re here – to provide the very best care for our patients, with or without a formal OCM program.

AON Partnership Means Expanding Community-Based Cancer Care Throughout Arizona

Cancer & Blood Specialists of Arizona (CBSA) was established in March 2021 in partnership with American Oncology Network (AON), it pledged to serve patients within the communities in which they live.

Along with its focus on community-mindedness, CBSA leadership maintains a focus on expanding the practice’s footprint to provide patients with a meaningful alternative to hospital-based care. Continuing to achieve these goals requires overcoming several challenges. In addition to geographic hurdles, expansion means adding providers, securing additional patients, identifying communities that will benefit from CBSA’s services, and opening new locations. Its partnership with AON plays a key role in meeting these goals.

A Message from Our CEO: Fighting for Our Practice Partners’ Financial Survival in 2022

As the sun sets on another year dominated by an evolving and unprecedented global pandemic, we find ourselves on the threshold of what promises to be another year of familiar challenges. To address them, American Oncology Network (AON) will leverage the many lessons learned from our experiences clearing the hurdles presented by 2021 while maintaining focus on our primary mission of ensuring our partner practices can continue providing patients with top-quality care.

In fact, despite the ongoing challenges of COVID-19 and the changes it has necessitated to the practice of oncology and the healthcare industry, AON realized several milestones over the past year. We’ve grown to more than 100 physicians in 16 states and expanded both the clinical trials underway within AON sites and the volume of non-oncology infusion services offered by many of our practice partners.

These are just a few of the ways AON is continuing to help keep community oncology viable so that patients have access to affordable yet high-quality care close to home – a commitment that takes on greater significance as we gear up for another battle against a round of cuts to Medicare physician reimbursements that will take place in the spring without additional action by Congress.

Cuts Delayed, But Not Gone

While recent action by Congress has given providers a reprieve from what would have been financially devastating reimbursement cuts totaling 9.75%, it could be short-lived. That’s because the legislation passed in mid-December only extends until April a moratorium on the 2% Medicare sequestration relief originally mandated by the Budget Control Act of 2011 and in effect since 2013 – cuts that had already been delayed three times due to the pandemic. A 1% sequestration cut (which will impact both Traditional and Managed Medicare) will be in effect from April thru June 2022 with 2% going into effect the remainder of the calendar year.

The package, which is now with President Biden, also prevents a 4% cut due to statutory budget rules known as “PAYGO,” which require Congress to pass legislation in a deficit-neutral manner or automatic sequestration is triggered at the end of the year. It also offsets a rate cut finalized in the Medicare Physician Fee Schedule final rule from November that was originally slated to happen due to the expiration of a temporary across-the-board increase previously authorized to partially offset cuts triggered by the 2021 MPFS Final Rule.

It’s important to note that the fight is not limited to the pay cuts. Should the temporary rate increase to lessen the blow of the 2021 MPFS Final Rule be allowed to expire, the Centers for Medicare and Medicaid Services (CMS) will factor that into the conversion factor as outlined in the 2022 MPFS proposed rule lowering reimbursement by 3.75%. Further, the 2022 Medicare Hospital Outpatient Payment System and Ambulatory Surgical Center Payments Systems (HOPPS) proposed rule included the mandatory Radiation Oncology Model (ROM) would lower physician reimbursement rates and create uncertainties that will negatively impact providers and patients.

A Voice for Community Oncology

While the current delay is certainly reason to celebrate, the fight is far from over. AON will continue to do everything in our power to ensure the voice of community oncology is heard in the push for Congress to take action to prevent what will be a devastating 9.75% cut in Medicare physician pay from taking effect in April.

We encourage practice leaders, physicians, and the entire AON provider network to join us by contacting their senators and requesting that the necessary action be taken to protect reimbursement rates. Addresses and phone numbers can be found here.

Winning this fight will protect community practices from a potentially devastating financial blow that could have long-term implications for the scope of care they’re able to provide to their patients.

Study: Infusion Therapy in Community Oncology Practices Less Costly than Hospital-Based Care

Prices for biologics, chemotherapies and other infused cancer drugs and hormonal therapies provided by in-hospital outpatient departments were double those paid in physician offices, according to a recent Health Affairs study that looked at prices paid in 2019 by Blue Cross Blue Shield health plans. Per the findings, prices paid for these drugs were 99%-104% higher in hospital outpatient departments than those paid in physician offices for infused cancer drugs and 68% higher for infused hormonal therapies.

The biggest takeaway from the study is that it is much less expensive to provide the same level of care in a community oncology practice than in a hospital-based outpatient center – as much as 35% less in some cases. In the study’s cohort, the savings reached would have been nearly $1.3 billion.

That is significant.

Practice-Based Infusion Therapy

Lower cost to the patient is one of a host of benefits associated with practice-based infusion therapy. Unfortunately, for many community-based oncology practices, the price of these drugs and associated infrastructure can make it difficult to offer these services in-house. Unless, that is, they are part of a national network like American Oncology Network (AON), which has the contracting power and management experience to give our practices access to a wide formulary of oncology and non-oncology medications that may not be available to or are financially out of reach of smaller private practices.

Further, some independent practices may not have the time or manpower to fully manage infusion therapy. AON manages all that with standardized education, training, processes and evidence-based clinical guidance. AON provides user friendly tools for clinicians and staff to access that are rooted in the latest clinical publications in oncology. Further, our electronic medical records system allows access to standardized protocols for oncology and non-oncology treatments.

With the power of AON in their corner, our practice partners can provide their patients with an important therapeutic service that goes far beyond lower costs for their care. This extends specialty infusions for patients who need treatment for non-oncology disorders such as asthma, genetic and skin disorders, rheumatoid diseases, and Crohn’s disease and other gastrointestinal problems.

Receiving infusions at their community-based oncology practice makes for a convenient, cost-effective experience for patients, who benefit from being treated by specialized nurses and physicians without having to travel long distances. AON practices can provide the same level of evidence-based care for patients close to where they live at less cost. Also, along with saving on the cost of the drugs themselves, patients won’t incur the facility fees they would have to pay at a hospital, further easing the financial burden.

Patients First

At AON, we’ve built our entire business model around providing the support our partner practices need to stay independent and focus on patients instead of paperwork. This includes putting our size to work negotiating the drug prices that enable them to provide comprehensive care in the community – including infusion therapy.

The quality of the care provided in the community oncology setting is second-to-none. That it is less expensive, as demonstrated by the Health Affairs study, is simply one of its many benefits.