brown water

Found this. Not sure how credible the source but it’s consistent with the discussion I mentioned. https://www.kevinmd.com/blog/2014/08/oncologist-pay-chemotherapy-buy-bill-needs-stop.html Passage of new legislation: A step in the right direction? Congress attempted to fix the problem with passage of the Medicare Modernization Act (MMA) in 2003. The new law did not take away physician’s ability to buy chemotherapy drugs, administer them in-office or bill for them. However, it did alter the reimbursement structure. To bridge the gap between the price physicians pay for drugs and the pay they collect, the MMA developed a reimbursement model based on average sales price (ASP), plus a 6 percent markup and administrative fee. As part of this legislation, manufacturers are required to report a drug’s ASP to the Centers of Medicare and Medicaid Services (CMS) quarterly to substantiate reimbursements. This change did not address the problem. Oncologists maintained their income by altering their practice patterns. As the reimbursement for established medications decreased, oncologists have chosen to use progressively more expensive chemotherapy drugs with increased frequency of treatment. That’s because under the fee-for-service reimbursement model, each new treatment equals another payment. It’s difficult, if not impossible, to prove this shift is directly motivated by personal financial gain. But it’s also hard to deny the financial gain that resulted.

I’ll try to run it down from an open source. I was a senior executive at US Oncology when it was acquired by McKesson (drug distributor) in 2010. The usage data relative to reimbursement model change was part of an internal public policy presentation.

Much of the migration from clinics to hospitals happened for reasons similar to my prior post. Many hospitals qualified for even lower drug prices under a federal rule (340b) that was intended to subsidize hospitals that cared for underserved communities. Under 340b the significant drug discount created a windfall profit that was used to hire the oncologists out of private practice often for well more than they were currently earning. The point remains, the system puts in conflict patient outcomes, total cost to the system and economic incentives to financially rational actors.

She’s not wrong about this. Medicare pays average sales price plus 6% for chemotherapy drugs. Large oncology practices with buying power negotiate lower than average prices from distributors while smaller practices typically pay more but everyone receives the same reimbursement. So, yes, oncologists do make money on chemotherapy and, frankly, it has been a obstacle (among others) to the uptake of personalized medicine where genomic testing may indicate a more effective treatment. In fact, in the early 2000s the Medicare reimbursement changed from average wholesale price plus 15% to average sales price plus 6% which significantly narrowed the margin made on drugs. As a result, the total amount of chemotherapy prescribed increased significantly. I wish it wasn’t true but like everywhere cost plus payment tends to yield more cost to generate more payments. In this case, the narrowing of margin produced more cost as physicians seemed to solve back for their otherwise lost income.

Would Fullvarine be an acceptable compromise?

Caption... Florida Georgia Whine embarks on the This Is How We Troll tour

I’d find the place with the longest post arrival quarantine requirement. And then conveniently forget to mention the requirement.

Chokkums Razor

The Deli Lama?

So made a minor course correction. Opted for white face instead of black. Felt like it was a bit more traditional and that the white showed the subtle complications like the panoramic date better. The AD didn’t have a steel bracelet available so they made a minor discount on a strap with deployant clasp and are getting the bracelet from the factory at no additional cost. @52-80 I lost the blue lume which was disappointing and what first caught my attention

In honor of the Masters opening round. 2 lb bone in ribeye over pimento cheese mashed potatoes

Project Homecoming!

niiiiiiiiice

Got a text from one of my whiskey contacts that he just got in a 17 yo store pick whistle pig rye. Tasting notes are candy and cola. Asked him to consider renaming it the “Gaetz Batch.” I know the label says 10 but those who share my vice know that it’s a minimum and individual barrels can be older...

More like Medium Pace HS amirite?

Also took a long look at this...

Just ordered this GO on a stainless bracelet. Will probably add a leather and rubber band soon. Seems pretty flexible. What say the brethren?

Thursday. Nearly 5lb bone in ribeye... Actually the dry brine started Monday.

Not that intellectual honesty has ever been their strongest trait but I’m coming around to letting them go. I get the irony that these idiots likely railed against public health driven restrictions on economic grounds. Now they choose to take their discretionary spending that could support local businesses out of the country. Logically inconsistent. Sure. Hypocritical. Of course. Totally on brand. Yep. But where I land is being fine with them never coming back. Would I prefer them rot in prison? Sure. But I’ll take getting the fuck out forever as a consolation prize.

Lazy Tuesday night. NY strip and figuring out the new grill. Thursday is looking like the big day. Double cut prime bone in ribeye with my best friend and his 2 sons.

^^ Klandora’s Box?

Texas Star Grills in Houston. They were great but iirc not in your part of the world.

Bought one over Christmas. Guess I was the beneficiary of the transition because it’s the old model at the new price. Loving it so far.

And by the way, has the republican infighting been called klannibalization? Because it should.