Bobbi Buell: The Realities of Community Oncology Practice Management
The Group Room sits down with Bobbi Buell at the 2012 Community Oncology Alliance (COA) Annual Meeting. She gives some eye-opening information that patients need to understand about the current state of oncology care in this county and what the future holds.
The Group Room interviews at the Community Oncology Alliance (COA) 2012 annual meeting in Las Vegas was made possible by the generous support of our members.
VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International
This is Selma Schimmel for The Group Room at the Community Oncology Alliance meeting taking place in Las Vegas. And I’m joined now by Bobbi Buell, who is Principal in charge of practice research and reimbursement at onPoint Oncology in Hudson, Ohio. Hello.
Bobbi Buell, Principal, onPoint Oncology
Hello.
Selma Schimmel, Founder & CEO, Vital Options International
I think we have to really drive home to people what it costs to run an oncology practice. And, you go in for your treatment but you don’t really stop to think that it’s the practice that has to advance, basically, all your drugs in good faith.
Bobbi Buell, Principal, onPoint Oncology
Exactly. There’s a thing that I call the oncologist’s death spiral, when you start becoming indebted to your drug distributor, it’s sort of like you have no more way to stay in business. We have seen almost 200 practices go out of business and that is the beginning of the end. So it’s very important that people know it’s very expensive to run an oncology practice. People think of doctors as just getting all their fees and just putting them in their pockets but that is really not true in oncology. And there are a lot of problems now with even obtaining the drugs that patients need, and there is a cost now to even searching for those drugs. So it’s very important that people do know that.
Selma Schimmel, Founder & CEO, Vital Options International
Because when you think about some of the other practices- if you go, let’s say, to a dermatologist, you know his or her out of pocket, you know they all have expenses but they’re not the volume. Look at a doctor, when you go to a clinical practice, you know, you go to the chemo room and you’ve got these patients lined up in a chair, I don’t know if they’re realizing, ‘oh well, my insurance will deal with it but right now it’s the doctor that is financing it.’
Bobbi Buell, Principal, onPoint Oncology
Right. And the longer your insurance takes to pay, and many of them take a long time to pay, particularly for expensive drugs. We’re averaging, I think, I’d have to look, but around 30 days for these brand of expensive drugs. And the doctor, if he pays on day one, he is out of pocket for 30 days. And if you get in trouble with your distributor, you do have to pay COD. If you are a good customer in good standing then sometimes it’s quite a bit longer. And for new drugs it can be as much as 6-months to pay.
Selma Schimmel, Founder & CEO, Vital Options International
Any comments on the generics?
Bobbi Buell, Principal, onPoint Oncology
Well, the entire generic industry now has real serious problems because of the way Medicare pays. About 50% of cancer patients, but it varies depending on what kind of cancer you have, like my husband had prostate cancer and 75% of prostate cancer patients are Medicare, but generally, on average it’s about 50%. And Medicare pays by a system called ‘average sales price’ and the problems with generics drugs, when they come out, the cheapest drug is always the most popular and the average sales price for generics is always the best seller weights the average of this average sales price. So other producers can no longer afford… because Medicare is paying at a very low rate because of this averaging people all flock to the low price leader and other people can’t stay in business. Well if this low price leader all the sudden has a manufacturing problem there is no more entrance in the market, and therefore there is a drug shortage. And that’s why many cancer medications are very hard to find now, if not impossible because they’ve limited it to one producer or a very few.
Selma Schimmel, Founder & CEO, Vital Options International
And thus the current drug shortage.
Bobbi Buell, Principal, onPoint Oncology
Right. And also the tendency, we’ve had a problem in oncology lately with drugs coming into the supply chain that are fake.
Selma Schimmel, Founder & CEO, Vital Options International
Those are drugs that are coming from, let’s say, our neighbors in Canada?
Bobbi Buell, Principal, onPoint Oncology
Well, they’re coming from who knows where. They somehow get in the supply chain and people, practices looking for low price will buy them either knowingly or not-knowingly and it’s bad because if those drugs get in the supply chain and you’re a patient you may be getting something that wasn’t prescribed for you.
Selma Schimmel, Founder & CEO, Vital Options International
Thank you, Bobbi Buell- Principal in charge of practice, research, and reimbursement for onPoint Oncology in Hudson, Ohio.
Bobbi Buell, Principal, onPoint Oncology
Thank you.
END OF VIDEO