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Murciano-Goroff YR, McCarthy AM, Bristol MN, Domchek SM, Groeneveld PW, Motanya UN, Armstrong K. Medical oncologists' willingness to participate in bundled payment programs. BMC Health Serv Res 2018; 18:391. [PMID: 29855315 PMCID: PMC5984411 DOI: 10.1186/s12913-018-3202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 05/13/2018] [Indexed: 12/15/2022] Open
Abstract
Background Bundled payment programs play an increasingly important role in transforming reimbursement for oncologic care. We assessed determinants of oncologists’ willingness to participate in bundled payment programs for breast cancer. We hypothesized that providers would be more likely to participate in bundled payment programs if offered higher levels of reimbursement for each episode of care. Methods Oncologists from Florida, New Jersey, New York, and Pennsylvania were identified in the AMA database or by patients listed in state cancer registries. Providers were randomized to receive one of four versions of a survey describing bundled payment programs offering different levels of compensation for the first year of localized breast cancer treatment ($5000, $10,000, $15,000, or $20,000). Physicians rated their likelihood of participation in a bundled program on a Likert scale. Logistic regression was used to analyze determinants of likelihood of participation in bundling. Results Among 460 respondents, only 17% of oncologists were highly likely to participate in a bundled program paying $5000 for the first year of care, rising to 41% for the $15,000 program, but falling to 34% for the $20,000 program. Likelihood of participation was higher among oncologists who were male, older, and believed that cancer patients should not be offered high-cost drugs with minimal survival benefit. Conclusion Our results suggest that medical oncologists have limited enthusiasm for bundled payments, and higher payments may not overcome resistance to bundling among a substantial proportion of physicians.
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Affiliation(s)
- Yonina R Murciano-Goroff
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA.
| | - Anne Marie McCarthy
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA
| | - Mirar N Bristol
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA
| | - Susan M Domchek
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
| | - Peter W Groeneveld
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - U Nkiru Motanya
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA
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Murciano-Goroff YR, McCarthy AM, Bristol MN, Groeneveld P, Domchek SM, Motanya UN, Armstrong K. Uptake of BRCA 1/2 and oncotype DX testing by medical and surgical oncologists. Breast Cancer Res Treat 2018; 171:173-180. [PMID: 29737473 DOI: 10.1007/s10549-018-4810-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE The diffusion of genomic testing is critical to the success of precision medicine, but there is limited information on oncologists' uptake of genetic technology. We aimed to assess the frequency with which medical oncologists and surgeons order BRCA 1/2 and Oncotype DX testing for breast cancer patients. METHODS We surveyed 732 oncologists and surgeons treating breast cancer patients. Physicians were from Florida, New York, New Jersey, and Pennsylvania, and were listed in the 2010 AMA Masterfile or identified by patients. RESULTS 80.6% of providers ordered BRCA 1/2 testing at least sometimes and 85.4% ordered Oncotype DX (p = 0.01). More frequent ordering of BRCA 1/2 was associated with more positive attitudes toward genetic innovation (OR 1.14, p = 0.001), a belief that testing was likely to be covered by patients' insurance (OR 2.84, p < 0.001), and more frequent ordering of Oncotype DX testing (OR 8.69, p < 0.001). More frequent use of Oncotype DX was associated with a belief that testing was likely to be covered by insurance (OR 7.33, p < 0.001), as well as with more frequent ordering of BRCA 1/2 testing (OR 9.48, p < 0.001). CONCLUSIONS Nearly one in five providers never or rarely ever ordered BRCA 1/2 testing for their breast cancer patients, and nearly 15% never or rarely ever ordered Oncotype DX. Less frequent ordering of BRCA 1/2 is associated with less frequent use of Oncotype DX testing, and vice versa. Those who do not order BRCA 1/2 testing report less positive attitudes toward genetic innovation. Further education of this subset of providers regarding the benefits of precision medicine may enable more rapid diffusion of genetic technology.
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Affiliation(s)
- Yonina R Murciano-Goroff
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA,, 02114, USA.
| | - Anne Marie McCarthy
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA,, 02114, USA
| | - Mirar N Bristol
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA,, 02114, USA
| | - Peter Groeneveld
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Susan M Domchek
- University of Pennsylvania Abramson Cancer Center, Philadelphia, USA
| | - U Nkiru Motanya
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA,, 02114, USA
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McCarthy AM, Bristol M, Domchek SM, Groeneveld PW, Kim Y, Motanya UN, Shea JA, Armstrong K. Health Care Segregation, Physician Recommendation, and Racial Disparities in BRCA1/2 Testing Among Women With Breast Cancer. J Clin Oncol 2016; 34:2610-8. [PMID: 27161971 DOI: 10.1200/jco.2015.66.0019] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Racial disparities in BRCA1/2 testing have been documented, but causes of these disparities are poorly understood. The study objective was to investigate whether the distribution of black and white patients across cancer providers contributes to disparities in BRCA1/2 testing. PATIENTS AND METHODS We conducted a population-based study of women in Pennsylvania and Florida who were 18 to 64 years old and diagnosed with invasive breast cancer between 2007 and 2009, linking cancer registry data, the American Medical Association Physician Masterfile, and patient and physician surveys. The study included 3,016 women (69% white, 31% black), 808 medical oncologists, and 732 surgeons. RESULTS Black women were less likely to undergo BRCA1/2 testing than white women (odds ratio [OR], 0.40; 95% CI, 0.34 to 0.48; P < .001). This difference was attenuated but not eliminated by adjustment for mutation risk, clinical factors, sociodemographic characteristics, and attitudes about testing (OR, 0.66; 95% CI, 0.53 to 0.81; P < .001). The care of black and white women was highly segregated across surgeons and oncologists (index of dissimilarity 64.1 and 61.9, respectively), but adjusting for clustering within physician or physician characteristics did not change the size of the testing disparity. Black women were less likely to report that they had received physician recommendation for BRCA1/2 testing even after adjusting for mutation risk (OR, 0.66; 95% CI, 0.54 to 0.82; P < .001). Adjusting for physician recommendation further attenuated the testing disparity (OR, 0.76; 95% CI, 0.57 to 1.02; P = .06). CONCLUSION Although black and white patients with breast cancer tend to see different surgeons and oncologists, this distribution does not contribute to disparities in BRCA1/2 testing. Instead, residual racial differences in testing after accounting for patient and physician characteristics are largely attributable to differences in physician recommendations. Efforts to address these disparities should focus on ensuring equity in testing recommendations.
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Affiliation(s)
- Anne Marie McCarthy
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mirar Bristol
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Susan M Domchek
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Peter W Groeneveld
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Younji Kim
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - U Nkiru Motanya
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Judy A Shea
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Katrina Armstrong
- Anne Marie McCarthy, Mirar Bristol, Younji Kim, and Katrina Armstrong, Massachusetts General Hospital; Anne Marie McCarthy and Katrina Armstrong, Harvard Medical School, Boston, MA; Susan M. Domchek, Peter W. Groeneveld, U. Nkiru Motanya, and Judy A. Shea, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Goldsack JC, Reilly C, Bush C, McElligott S, Bristol MN, Motanya UN, Field R, Vozniak JM, Wong YN, Schwartz JS, Domchek S. Impact of shortages of injectable oncology drugs on patient care. Am J Health Syst Pharm 2014; 71:571-8. [DOI: 10.2146/ajhp130569] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jennifer C. Goldsack
- The Value Institute, Christiana Care Health System, John H. Ammon Medical Education Center, Newark, DE
| | | | - Colleen Bush
- American Society of Health-System Pharmacists, Bethesda, MD
| | | | - Mirar N. Bristol
- General Internal Medicine, University of Pennsylvania, Philadelphia
| | - U. Nkiru Motanya
- General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Robert Field
- Department of Health Management and Policy, Drexel School of Public Health, Drexel University, Philadelphia, PA
| | - J. Michael Vozniak
- Professional Practice, Hospital of the University of Pennsylvania, Philadelphia
| | - Yu-Ning Wong
- Medical Oncology, and Assistant Professor, Fox Chase Cancer Center, Philadelphia
| | - J. Sanford Schwartz
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Susan Domchek
- Department of Medicine, University of Pennsylvania, Philadelphia
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Schopfer FJ, Cole MP, Groeger AL, Chen CS, Khoo NKH, Woodcock SR, Golin-Bisello F, Motanya UN, Li Y, Zhang J, Garcia-Barrio MT, Rudolph TK, Rudolph V, Bonacci G, Baker PRS, Xu HE, Batthyany CI, Chen YE, Hallis TM, Freeman BA. Covalent peroxisome proliferator-activated receptor gamma adduction by nitro-fatty acids: selective ligand activity and anti-diabetic signaling actions. J Biol Chem 2010; 285:12321-33. [PMID: 20097754 DOI: 10.1074/jbc.m109.091512] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The peroxisome proliferator-activated receptor-gamma (PPARgamma) binds diverse ligands to transcriptionally regulate metabolism and inflammation. Activators of PPARgamma include lipids and anti-hyperglycemic drugs such as thiazolidinediones (TZDs). Recently, TZDs have raised concern after being linked with increased risk of peripheral edema, weight gain, and adverse cardiovascular events. Most reported endogenous PPARgamma ligands are intermediates of lipid metabolism and oxidation that bind PPARgamma with very low affinity. In contrast, nitro derivatives of unsaturated fatty acids (NO(2)-FA) are endogenous products of nitric oxide ((*)NO) and nitrite (NO(2)(-))-mediated redox reactions that activate PPARgamma at nanomolar concentrations. We report that NO(2)-FA act as partial agonists of PPARgamma and covalently bind PPARgamma at Cys-285 via Michael addition. NO(2)-FA show selective PPARgamma modulator characteristics by inducing coregulator protein interactions, PPARgamma-dependent expression of key target genes, and lipid accumulation is distinctively different from responses induced by the TZD rosiglitazone. Administration of this class of signaling mediators to ob/ob mice revealed that NO(2)-FA lower insulin and glucose levels without inducing adverse side effects such as the increased weight gain induced by TZDs.
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Affiliation(s)
- Francisco J Schopfer
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
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