Jayson Slotnik, JD, MPH

Managing Partner Health Policy Strategies
Co-Chair, AVBCC

Authored Items

US Preventive Services Task Force and the Future of Prostate Cancer Screening

October 2011, Vol 2, No 6 - Health Policy

The decision this month (October 2011) by the US Preventive Services Task Force (USPSTF) to recommend against a prostate-specific antigen (PSA)-based screening for prostate cancer in healthy men1 has caused quite a stir both in and outside of medical circles, reminding many people of the task force’s 2009 recommendation against routine breast cancer screenings for women under age 50 years. [ Read More ]

The Affordable Care Act: The Day of Reckoning Arrives

July 2012, Vol 3, No 5 - Health Policy

Over the past 2 years, we have written about the impact of accountable care organizations, value-based purchasing, health insurance exchanges, and other programs relevant to the oncology community. These initiatives were all born out of the Affordable Care Act (ACA), which, on June 28, 2012, had its major day of reckoning. In a 5 to 4 decision authored by Chief Justice John Roberts, the US Supreme Court upheld the ACA’s individual mandate—the requirement that most Americans obtain health insurance that meets the definition of minimum essential coverage.

[ Read More ]

Medicare Proposes Rewarding Quality, Cutting Payments for Oncology Providers

September 2012, Vol 3, No 6 - Health Policy

On July 6, 2012, the Centers for Medicare & Medicaid Services (CMS) issued the Physician Fee Schedule (PFS) and Hospital Out­patient Prospective Pay­ment System (HOPPS) proposed rules for fiscal year 2013. These rules include a number of proposed changes aimed at improving quality and promoting value in cancer care in the Medicare program. Although many of these changes are positive, a number of proposed cuts to payment rates, particularly to services performed by radiation oncologists, could have a devastating impact on oncology providers and patients.

[ Read More ]

CMS Finalizes Payment Policies for 2013, Signaling a Shift toward Paying for Value

November 2012, Vol 3, No 8 - Health Policy

?In this article we address the final payment rules issued on November 1, 2012, by the Centers for Medicare & Medicaid Services (CMS), the Physician Fee Schedule (PFS), and the Hospital Outpatient Prospective Pay­ment System. These annual updates to Medicare payment rates for physicians and hospitals can have a dramatic impact on reimbursement and incentives within the Medicare program, but they also tend to impact trends in the commercial insurance market.

[ Read More ]

Time to Review Practice Policies: HIPAA Privacy and Security Regulations Released

February 2013, Vol 4, No 2 - Health Policy

On January 17, 2013, nearly 3 years after its initial proposed rule, the US Department of Health and Human Services (HHS) issued the long-awaited and much- anticipated HIPAA “omnibus” rule, extending the scope of the privacy law beyond providers to their business associates and subcontractors and adding increased penalties.1 Regulated entities must be in compliance with the new rules by September 22, 2013, although covered entities and business associates will have up to 1 year after the 180-day compliance date to modify existing contracts to comply with these revised [ Read More ]

Obinutuzumab Outperforms Rituximab in Older Patients with CLL

February 2014, Vol 5, No 1 - In the Literature

The anti-CD20 antibody rituximab (Rituxan), combined with chemotherapy agents, had been shown to prolong overall survival (OS) in physically fit patients with previously untreated chronic lymphocytic leukemia (CLL), but not in those with comorbidities. In a recent head-to-head, randomized, phase 3 trial of older patients, researchers investigated the benefit of the anti-CD20 antibody obinutuz­umab (Gazyva) plus chlorambucil (Leukeran) compared with rituximab plus chlorambucil in patients with previously untreated CLL and coexisting conditions (Goede V, et al. [ Read More ]

Adverse Events Reporting Suboptimal in Oncology Publications

February 2014, Vol 5, No 1 - In the Literature

Transparent and comprehensive reporting of AEs in published results of oncology-related clinical trials is crucial for the treatment of patients with cancer. In efforts to improve reporting of clinical trials results, the Consolidated Standards of Reporting Trials (CONSORT) extension group developed 10 recommendations in 2003 for reporting AEs. A new study of 175 publications assessed the degree to which the publication of phase 3 trials in oncology adhered with CONSORT recommendations (Sivendran S, et al. J Clin Oncol. 2014;32:83-89).

[ Read More ]

New Gene Mutation Identified in Myeloproliferative Neoplasms

February 2014, Vol 5, No 1 - In the Literature

New research shows promise in deciphering the underlying mechanism of myeloproliferative neoplasms (MPNs), according to findings from a recently reported study (Klampfl T, et al. N Engl J Med. 2013;369:2379-2390).

The Janus kinase 2 (JAK2) gene is present in approximately 50% to 60% of patients with essential thrombocythemia or primary myelofibrosis, and an additional 5% to 10% have activating mutations in the thrombopoietin receptor gene, MPL. However, no specific molecular marker has been identified in the remaining 30% to 45% of patients.

[ Read More ]

Statin Therapy Lowers Mortality in Patients with Prostate Cancer

February 2014, Vol 5, No 1 - In the Literature

Statin use has been shown to improve lipid profiles and to reduce cardiovascular morbidity and mortality. A 2012 study found that statins may have antitumor effects in various cancer types, including prostate cancer. Observational studies have investigated the association between statin use and different prostate cancer outcomes, but the findings were inconsistent. Also, these studies did not specifically assess whether the use of statins before the diagnosis of prostate cancer modified the association regarding the use of statins after diagnosis. [ Read More ]

NCI Pilot Trial to Assess Value of Genetic Sequencing for Improving Patient Outcomes

February 2014, Vol 5, No 1 - Value Propositions

The National Cancer Institute (NCI) has launched a clinical trial to determine whether selecting therapies based on genetic mutations can improve outcomes in patients with metastatic solid tumors. Molecular Profiling based Assignment of Cancer Therapeutics (M-PACT) is one of the first randomized trials to assess if using genetic mutation as the basis for treatment selection can improve the rate and duration of response in patients with advanced-stage solid tumors.

[ Read More ]

ASCO Launches Value in Cancer Care Initiative

February 2014, Vol 5, No 1 - Value Propositions

Responding to the relentless economic pressures on patients and oncologists and the ever-escalating costs of cancer care delivery, the American Society of Clinical Oncology (ASCO), in collaboration with the Value in Cancer Care Task Force, is developing a working definition of “value” in oncology, as well as identifying how to incorporate the implications of that approach into clinical decision-making in patient care.

[ Read More ]

M.D. Anderson’s Scientists Collaborate with Pfizer to Enhance Immunotherapy in Oncology

February 2014, Vol 5, No 1 - Value Propositions

Researchers at the University of Texas M.D. Anderson Cancer Center have announces a new collaboration with Pfizer to develop immune-based approaches to new therapies for cancer. This new effort is based on M.D. Anderson’s Moon Shots Program that aims to reduce cancer deaths significantly in the future, using the 6 moon shots that target 8 types of difficult-to-treat cancer.

[ Read More ]

Aetna Announced First Patient-Centered Medical Home in Oncology

February 2014, Vol 5, No 1 - Value Propositions

Late last year, Aetna, together with Consultants in Medical Oncology and Hematology, launched the first patient-centered medical home for oncology. This collaborative program is based on evidence-based decision support in cancer care, using personalized medicine and realigning payment structure with the goal of increasing patient treatment coordination, improving quality outcomes, and reducing overall costs of cancer care.

[ Read More ]

First Drug Combination Approved for Unresectable or Metastatic Melanoma

February 2014, Vol 5, No 1 - FDA Approvals, News & Updates

The US Food and Drug Admin­istration (FDA) approved the use of dabrafenib (Tafinlar; GlaxoSmith­Kline) plus trametinib (Mekinist; GlaxoSmithKline) as a new combination therapy for the treatment of patients with advanced melanoma that is unresectable or metastatic. The 2 drugs were individually approved by the FDA in 2013 for melanoma. Each of the 2 drugs blocks molecular signaling in different sites of the same pathway that promotes cancer-cell growth. Dabrafenib was initially approved for patients with melanoma whose tumors express the BRAF V600E mutation. [ Read More ]

Dual-Vaccine Combination Improves Survival in Patients with Metastatic Pancreatic Cancer

February 2014, Vol 5, No 1 - GI Cancers Symposium

San Francisco, CA—A dual-vaccine strategy improved survival more than single vaccination of patients with metastatic pancreatic ductal adenocarcinoma (PDAC). Data from a randomized phase 2 trial were reported by Dung T. Le, MD, Assistant Professor of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, at the 2014 Gastrointestinal Cancers Symposium.

[ Read More ]

Value Propositions

March 2014, Vol 5, No 2 - Value Propositions

New Evidence Confirms Value of Yoga for Women with Breast Cancer A new study from M.D. Anderson has shown that patients with breast cancer who participated in yoga exercises that incorporated controlled breathing, meditation, and relaxation techniques into their treatment [ Read More ]

Bortezomib plus Thalidomide Maintenance Therapy Improves Overall Survival in Transplant-Ineligible Patients with Newly Diagnosed Myeloma

March 2014, Vol 5, No 2 - In the Literature

Patients with multiple myeloma (MM) who are not fit to undergo stem-cell transplantation (SCT), typically receive melphalan (Alkeran) plus prednisone in combination with either thalidomide (Thalomid) or bortezomib (Velcade). Recent studies are exploring the clinical benefit of the 4-drug induction regimen of melphalan, prednisone, bortezomib, and thalidomide, followed by maintenance with bortezomib plus thalidomide (VMPT-VT). In a recent phase 3 clinical trial, a total of 511 patients with newly diagnosed MM who were not candidates for SCT were randomized to receive VMPT-VT (N = 254) or bortezomib, melphalan, and prednisone (VMP; N = 257). The patients’ median age was 71 years, and 27% of the patients were aged >75 years (Palumbo A, et al. J Clin Oncol. 2014;32:634-640). [ Read More ]

Nintedanib plus Docetaxel an Effective Combination in Patients with Advanced Non–Small-Cell Lung Cancer

March 2014, Vol 5, No 2 - In the Literature

Currently, the US Food and Drug Administration–approved second-line treatments for non–small-cell lung cancer (NSCLC) include monotherapy with docetaxel (Taxotere), erlotinib (Tarceva), or pemetrexed (Alimta). A recent phase 3 clinical trial explored the safety and efficacy of nintedanib (Vargatef)—a potent oral angiokinase inhibitor—in combination with do­cetaxel, as a second-line treatment in patients with NSCLC (Reck M, et al. Lancet Oncol. 2014;15:143-155). [ Read More ]

Implications of the Affordable Care Act for Adult Survivors of Childhood Cancer

March 2014, Vol 5, No 2 - In the Literature

Among adult survivors of childhood cancer, the lack of health insurance is a major obstacle to obtaining the recommended follow-up care. The goal of the Patient Protection and Affordable Care Act (ACA) enacted in 2010 was to broaden insurance coverage for all Americans. A new commentary by Mueller and several health policy experts addressed the questions regarding how several provisions in the ACA could help adult survivors of childhood cancers overcome insurance-based barriers to receiving the recommended follow-up care for patients with cancer (Mueller EL, et al. J Clin Oncol. 2014;32:615-617). [ Read More ]

Up Next for the Center for Medicare and Medicaid Innovation: Cancer

May 2014, Vol 5, No 4 - Health Policy

In passing the Affordable Care Act (ACA) in 2010, Congress had as one of its central goals the creation of new, innovative ways of paying for and delivering healthcare services. With this goal in mind, the ACA established the Center for Medicare and Medicaid Innovation (CMMI), which is tasked with developing new payment and service delivery models to “demo” and, if successful, to eventually roll out nationwide. [ Read More ]