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1.  National Oncology Practice Benchmark, 2012 Report on 2011 Data 
Journal of Oncology Practice  2012;8(6):51s-70s.
In this, the seventh iteration of the National Practice Benchmark, the authors made significant changes in the approach and analysis of the survey, including restructuring and shortening the survey instrument to facilitate the participation of hospital and academic oncology practices, in recognition of the ongoing changes in the oncology industry.
PMCID: PMC3500485  PMID: 23450974
2.  Oncology Practice Trends From the National Practice Benchmark 
Journal of Oncology Practice  2012;8(5):292-297.
The authors revise last year's predictions and project for the next 3 years, outlining a conceptual framework for contemplating the data based on an ecological model of the oncology delivery system.
In 2011, we made predictions on the basis of data from the National Practice Benchmark (NPB) reports from 2005 through 2010. With the new 2011 data in hand, we have revised last year's predictions and projected for the next 3 years. In addition, we make some new predictions that will be tracked in future benchmarking surveys. We also outline a conceptual framework for contemplating these data based on an ecological model of the oncology delivery system. The 2011 NPB data are consistent with last year's prediction of a decrease in the operating margins necessary to sustain a community oncology practice. With the new data in, we now predict these reductions to occur more slowly than previously forecast. We note an ease to the squeeze observed in last year's trend analysis, which will allow more time for practices to adapt their business models for survival and offer the best of these practices an opportunity to invest earnings into operations to prepare for the inevitable shift away from historic payment methodology for clinical service. This year, survey respondents reported changes in business structure, first measured in the 2010 data, indicating an increase in the percentage of respondents who believe that change is coming soon, but the majority still have confidence in the viability of their existing business structure. Although oncology practices are in for a bumpy ride, things are looking less dire this year for practices participating in our survey.
PMCID: PMC3439229  PMID: 23277766
Currently, the popular approach to post-concussion management of the athlete relies upon the use of a multidisciplinary team of healthcare providers, all typically coordinated by a physician. That core team is often supplemented by nurses, psychotherapists, coaches, teachers, the athletic director, and, of course, family members. However, access to such a model is frequently limited by financial, geographical, and numerous other factors. In the absence of such resources, a thorough clinical evaluation and management by an available, ongoing healthcare provider, quite often the sports physical therapist, becomes necessary.
The authors recommend that the professional who coordinates the athlete's post-concussion healthcare should focus efforts upon a comprehensive assessment and tailored treatment plan specific to the athlete's post-concussive symptoms. Assessment of both pre-morbid function and post-injury physical, cognitive, psychosocial, emotional, and behavioral issues, including the patient's support system, can assist the clinician with identifying specific constraints to sport, academic, social, and vocational activity participation. Hence, the assessment provides structure to the athlete's individualized treatment plan. Successful specialized interventions that address the multi-faceted impairments of sport related concussion frequently require knowledge of resources in a variety of other healthcare professions, in order to facilitate appropriate and necessary treatment referrals.
Initial assessment should be followed by repeat monitoring throughout treatment, and spanning a variety of environments, in order to ensure the athlete's full recovery prior to return, not only to sport participation, but also to involvement in social, academic, and/or employment related life activities.
Level of Evidence:
PMCID: PMC3414075  PMID: 22893863
evaluation; rehabilitation; sport concussion
4.  Achieving Meaningful Use and Operational Efficiency 
The Centers for Medicare and Medicaid Services (CMS), through the Electronic Health Record (EHR) Incentive Program, are providing incentive payments to eligible professionals as they demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 over a 5-year period for Medicare participation if they successfully demonstrate the ability to automatically generate, transmit, and meet thresholds for specific reporting elements from the EHR. Meeting the meaningful use requirement involves a reorganization of workflow within the clinical setting so that the data elements necessary to produce the relevant measurements are documented in the electronic medical record (EMR) as they are delivered. A by-product of this is operational efficiency improvement in three areas: coordination of data input throughout the care team to reduce or remove bottlenecks, assignment of responsibility for specific activity, and real-time objective monitoring of the work process.
Using the reporting system functionality of a certified EMR deployed in a two-physician medical oncology practice at the New London Cancer Center, the objective measurement of the ability of each of the eligible providers in the clinic to improve their individual MU scores was tracked. Analysis of the progress of each provider revealed gaps. Process issues were identified by work group: secretaries, laboratory preparation and phlebotomy staff, nurses, and clinicians. The designated physician leader met with each group to discuss the sections relevant to that particular group.
By discovering and addressing work processes that were not utilizing the ability of the EHR to capture and document (ie, meaningful use of the EHR), rapid progress that affected all of the eligible providers and all patients cared for was made. Changes resulted in increased clarity of clinical and administrative responsibilities during patient processing and clinical care provision. Meaningful use attestation was completed in 14 weeks.
Completion of the documentation necessary to meet the requirements of the EHR Incentive Program led to the discovery of systemic inefficiencies in administrative and clinical workflows. Addressing these bottlenecks, along with using the reporting capability of the EHR to measure the impact of workflow changes, enabled the administrative and care teams to make changes quickly and effectively. The certified EHR provided guidance and status-reporting capabilities that allowed the practice to achieve the meaningful use requirement.
PMCID: PMC3457829
5.  Results of the ASCO Study of Collaborative Practice Arrangements 
Journal of Oncology Practice  2011;7(5):278-282.
The supply of oncologists is predicted to fall short of demand in decades to come. Addressing this workforce shortage by employing nonphysician practitioners as a routine part of practice can substantially benefit both patients and providers.
ASCO projects a shortfall of oncologists in the next decade. The study was designed to address the workforce shortage by exploring collaborative oncology practice models that include nonphysician practitioners (NPPs).
ASCO contracted with Oncology Metrics, a division of Altos Solutions, to conduct a national survey of NPP integration and identify collaborative practice models and services provided by NPPs, as the first phase of the ASCO Study of Collaborative Practice Arrangements. Results of the national survey were used to identify practices for the next phase, in which selected practices participated in a more detailed data survey and satisfaction surveys. Focus groups or interviews were conducted with NPPs to collect additional subjective information to inform the project.
The incident-to practice model was the predominant model. Satisfaction was universally high for patients and generally high for physicians and NPPs. In virtually all cases (98%), patients recognized they were seeing an NPP rather than a physician. Practices in which the NPP worked with all practice physicians showed significantly higher productivity than those practices in which the NPP worked exclusively with a specific physician or group of physicians.
The use of NPPs in oncology practices increases productivity for the practice and provides high physician and NPP satisfaction. Patients were aware when care was provided by an NPP and were very satisfied with all aspects of the collaborative care that they received. The integration of nonphysician practitioners into oncology practice offers a reliable means to address increased demand for oncology services without adding physicians.
PMCID: PMC3170055  PMID: 22211119
6.  Oncology Practice Trends From the National Practice Benchmark, 2005 through 2010 
Journal of Oncology Practice  2011;7(5):286-290.
The gap between practice costs and practice revenue will continue to narrow, and as this occurs, community oncology practices will find it difficult to maintain their current business models.
Oncology Metrics, a division of Altos Solutions, has been conducting organized surveys of practicing oncologists since 2005. In this article, we present data that represent trends in community oncology practice over a 6-year period, 2005 to 2010, and make projections on the basis of these data. Over the next 3 years, operating margins will continue to decrease, gains in business and clinical operating efficiencies will slow, and labor costs will rise. The cost of drugs provided to patients is also increasing while the amount above cost that is being reimbursed continues a slow decline. The gap between practice costs and practice revenue will continue to narrow, and as this occurs, community oncology practices will find it difficult to maintain their current business models.
PMCID: PMC3170058  PMID: 22211122
7.  National Oncology Practice Benchmark: An Annual Assessment of Financial and Operational Parameters—2010 Report on 2009 Data 
Journal of Oncology Practice  2011;7(2 Suppl):2s-15s.
Amid increases in costs and numbers of patients combined with decreasing or stagnant reimbursements from payers, many oncology practices are improving efficiency and decreasing costs. The National Oncology Practice Benchmark, a national survey of community practices, provides data to help practices improve and monitor progress as they adapt to the changing practice environment.
PMCID: PMC3071595  PMID: 21731526
8.  National Practice Benchmark: 2010 Report on 2009 Data 
Journal of Oncology Practice  2010;6(5):228-231.
Results from this survey indicate an overall lowering of the cost of practice operations, even as cost of drugs continues to rise; and an overall increase in service delivery efficiency.
Oncology practices continue to experience economic pressures as costs rise, numbers of patients increase, and reimbursements from payers remain flat or decrease. Many practices have responded to these challenges by examining business processes and making changes to improve efficiency and decrease costs. The National Practice Benchmark is a national survey of community oncology practices that provides data for practices to use in managing today's challenging practice environment.
Oncology practices were invited to participate in an online benchmarking survey. One hundred eighty-nine practices from 44 states responded to the survey, and demographic, operational, and financial data were collected for calendar year 2009 or the most recently completed fiscal year.
Data from 2009 were compiled and compared with previously collected 2007 and 2008 data. The data reveal that total revenue has increased by approximately 6% per year over this 3-year period. During the same period, however, cost of drugs increased dramatically: 13.5% increase from 2007 to 2008 and 16% from 2008 to 2009. Total practice expense increased at virtually the same level as drug costs in 2008 and was flat for 2009.
Survey results indicate an overall lowering of practice expenses even as cost of drugs continues to rise, and are consistent with the slight increase in the number of new patients per full-time equivalent hematology/oncology physician. These measures indicate an overall increase in service delivery efficiency and adaptation by many practices to the changing practice environment.
PMCID: PMC2936463  PMID: 21197184
9.  2009 National Practice Benchmark: Report on 2008 Data 
Journal of Oncology Practice  2009;5(5):223-227.
Many oncology practices have responded to rising supply costs and decreasing reimbursements by examining their operational processes and working to reduce costs and enhance practice efficiency.
Oncology practices are experiencing increasing economic pressures as costs rise, the number of patients needing services increases, and reimbursements from payers remain flat or decrease. Many practices have responded to these challenges by examining business processes and making changes to improve efficiency and decrease costs. Benchmarking is a valuable tool for such practice improvement. This article presents results from the 2009 National Practice Benchmark.
Oncology practices were invited to participate in an online benchmarking survey. Two hundred eight practices from 41 states responded to the survey, and demographic, operational, and financial data were collected for calendar year 2008 or the most recent fiscal year.
Data from 2008 were compared with previously collected 2007 data. The 2008 data show fewer small practices (with one to three full-time equivalent physicians) reporting and fewer sites of clinical service per practice. The most compelling data presented show that total practice expense increased 15% from 2007 to 2008, whereas total collected revenue increased by only 6%. Clearly there are fewer dollars available to support clinical operations.
These results highlight some of the challenges faced by oncology practices today. Some practices have responded to these challenges by cutting costs (and sometimes eliminating services) and improving efficiency. For many practices, continued business management improvements will be necessary to provide adequate compensation for physician partners to warrant acceptance of the business risks associated with practice ownership and operation. In practices in which these improvements do not materialize, physicians will either close their practices and exit the field or seek other practice arrangements to continue to provide oncology services at less personal risk.
PMCID: PMC2790672  PMID: 20856732
10.  The 2007 National Practice Benchmark: Results of a National Survey of Oncology Practices 
Journal of Oncology Practice  2008;4(4):178-183.
Long-term trends in the cost of pharmaceutical goods purchased by community oncology practices seem to have dramatically changed in 2007, potentially ending an era of practice growth built on the economic engine of in-office chemotherapy provision.
PMCID: PMC2793960  PMID: 20856769
13.  Utilizing Virtual Microscopy for Quality Control Review 
Disease Markers  2007;23(5-6):459-466.
PMCID: PMC3850808  PMID: 18057529
16.  Effect of l-Homoserine on the Growth of Mycobacterium tuberculosis 
Infection and Immunity  1971;3(2):328-332.
l-Homoserine was observed to inhibit the growth of Mycobacterium tuberculosis. In the metabolism of M. tuberculosis, l-homoserine was found to be a precursor of threonine, isoleucine, and methionine. l-Homoserine-inhibited cells contained elevated levels of the enzyme acetohydroxy acid synthetase. In addition, washed cell suspensions of M. tuberculosis formed significant amounts of alpha-amino-n-butyric acid from supplements of l-homoserine. dl-Alpha-amino-n-butyric acid proved to be much more inhibitory for growth than l-homoserine. Growth antagonism by l-homoserine was reversed by l-lysine, l-threonine, and combinations of l-leucine with l-valine. At the cellular level, these amino acids reduced the amount of acetohydroxy acid synthetase in cells grown with l-homoserine and competed with dl-homoserine-4-14C for entrance into the extractable cell pool. l-Isoleucine also antagonized the conversion of l-homoserine to alpha-amino-n-butyric acid. Available data indicated that the effect of l-homoserine was related to its conversion to alpha-amino-n-butyric acid which subsequently inhibited growth
PMCID: PMC416151  PMID: 16557973
Journal of Bacteriology  1963;86(6):1321-1325.
O'Barr, Thomas P. (Agricultural Research Service, Washington, D.C.). Effect of alanine and threonine on the synthesis of serine by Leuconostoc mesenteroides. J. Bacteriol. 86:1321–1325. 1963.—Growth of Leuconostoc mesenteroides in the absence of serine was inhibited by l-alanine and l-threonine. Varying the glycine concentration when l-alanine was present suggested a direct relationship between the molar ratio of these two amino acids and the amount of growth achieved by the test organism. Supplements of leucovorin did not reverse the effect of l-alanine upon growth. In experiments with washed cells of L. mesenteroides, both l-alanine and l-threonine reduced the amount of C14-labeled formate fixed into serine and the amount of glycine-1-C14 found in boiling-water extracts of the cells. Neither l-alanine nor l-threonine had any inhibitory effect upon the glycine-dependent disappearance of formaldehyde by acetone powders prepared from L. mesenteroides.
PMCID: PMC283648  PMID: 14086108
21.  Giddiness and Staggering in Ear Disease. II 1 
British Medical Journal  1897;1(1896):1074-1076.
PMCID: PMC2433562  PMID: 20756951
British Medical Journal  1895;2(1826):1608-1610.
PMCID: PMC2509639  PMID: 20755912

Results 1-25 (30)