Dawn Holcombe, MBA, FACMPE, ACHE

DGH Consulting
South Windsor, CT

Authored Items

The Practice of Pharmacy in Medical Settings: A Ticking Time Bomb

April 2019, Vol 9, No 4 - From the Editor

Physicians order, dispense, and administer medications under the scope of their medical license, approved by the Board of Medicine in the state where they practice. In oncology, this drug management usually involves the acquisition, transport, storage, handling, reconstitution, mixing, and administration of nonhazardous and hazardous drugs in their offices. Many physicians also dispense drugs that patients take home; this may be under the scope of a medical license or a pharmacy license, depending upon state laws. [ Read More ]

To Risk or Not to Risk? Or Is Risk Contracting Too Risky?

February 2019, Vol 9, No 2 - From the Editor

The word on the street is that value-based, or risk-based, oncology contracts for physicians are the inevitable wave of the future. But are they? I had a conversation late last year with someone in the federal government. We were discussing whether oncology practices should be accepting the modified alternative risk model that has recently been offered to them under the Oncology Care Model (OCM) program. This individual felt very strongly that payment programs that put oncologists at full risk for their patients’ treatment costs (including drug costs) were so imminent that it would be irresponsible for practices to not accept the modified alternative risk model as soon as possible so that they can be prepared. [ Read More ]

What Does the Future Hold for PBMs? Implications for Oncology Practices

October 2018, Vol 8, No 10 - From the Editor

Pharmacy benefit managers (PBMs) have been seeking greater influence in the oncology market for several years. They are contracted by health plans and employers to manage the drugs covered under pharmacy benefits, which may include newly approved drugs added to the plan; provision of operational controls, such as step edits; prior authorizations; formulary restrictions; and the review of medical necessity for oral medications. [ Read More ]

Will Oncologists Change Their Treatment Patterns Based on New Clinical Evidence?

July 2018, Vol 8, No 7 - From the Editor

In medical parlance, there is a wide gap between the terms “prognostic” and “predictive.” At a plenary session at the 2018 American Society of Clinical Oncology (ASCO) meeting, results presented from the TAILORx clinical trial cast a spotlight on that gap, and narrowed it. The question now is, will physicians and patients take action and cease the use of chemotherapy when its effectiveness can be predictively deemed ineffective, despite the challenges of hope and habit? [ Read More ]

The Promise and Peril of Technology

April 2018, Vol 8, No 4 - From the Editor

What seems like just a few years ago, oncology practice technology amounted to a billing system and an electronic medical records (EMR) system, possibly even a drug inventory management system. When a practice participated in quality or performance metrics, such as the American Society of Clinical Oncology Quality Oncology Practice Initiative, it was usually through the process of a manual chart review conducted for a subset of patients being treated by the group. [ Read More ]

Slowing Down to Move Forward: The Summer of 2017 May Be Pivotal for Oncology Practices

July 2017, Vol 7, No 7 - From the Editor

This year has been more hectic for practice administrators than I have seen in decades. Practice administrators keep telling me they feel they are working harder and harder, and have so many more demands on the practice involving reporting, chasing reimbursement, securing access for their patients, and helping their physicians navigate the increasing demands on them, that it is just too hard to keep up. [ Read More ]

Strategic Planning Under MACRA/MIPS

April 2017, Vol 7, No 4 - From the Editor

Strategic planning for oncology practices has always been an interesting exercise, and has become much more challenging in the past 3 years. Historically, a practice’s leaders would step away from the daily routine; review their history; discuss their opportunities, challenges, and changing markets; and then establish a 3- to 5-year strategic plan. [ Read More ]

2017—the Year of the Huddle?

February 2017, Vol 7, No 2 - From the Editor

In 2017, more than ever before, oncology practices of all sizes will ultimately be responsible for the quality and the continuity of the care that they provide to their patients. Notably, under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Merit-based Incentive Payment System (MIPS), Medicare will be tracking performance and scores that practices accumulate through self-reporting or Medicare claims tracking. These performance metrics include quality measures, resource utilization, Advancing Care Information under MIPS, and the Clinical Practice Improvement Activities of MACRA. Practices that are participating in the Medicare Oncology Care Model (OCM) are subject to the MIPS measures, as well as the requirements and expectations for practice transformation under the OCM, although some OCM activities may also facilitate performance for the MIPS measures. [ Read More ]

Leaving 2013 Behind

December 2013, Vol 3, No 8 - From the Editor

The management of oncology practices has always been complicated. Under the best of circumstances, managing the expectations of patients, staff, and owner-physicians is difficult. If you are lucky, you have been blessed with a strong team and a well-oiled machine. [ Read More ]