Papers by Samyukta Mullangi
JCO Oncology Practice
PURPOSE The Merit-Based Incentive Payment System (MIPS) is currently the only federally mandated ... more PURPOSE The Merit-Based Incentive Payment System (MIPS) is currently the only federally mandated value-based payment model for oncologists. The weight of cost measures in MIPS has increased from 0% in 2017 to 30% in 2022. Given that cost measures are specialty-agnostic, specialties with greater costs of care such as oncology may be unfairly affected. We investigated the implications of incorporating cost measures into MIPS on physician reimbursements for oncologists and other physicians. METHODS We evaluated physicians scored on cost and quality in the 2018 MIPS using the Doctors and Clinicians database. We used multivariable Tobit regression to identify physician-level factors associated with cost and quality scores. We simulated composite MIPS scores and payment adjustments by applying the 2022 cost-quality weights to the 2018 category scores and compared changes across specialties. RESULTS Of 168,098 identified MIPS-participating physicians, 5,942 (3.5%) were oncologists. Oncolog...
JAMA Oncology
This Viewpoint proposes 3 changes to the Enhancing Oncology Model of the US Centers for Medicare ... more This Viewpoint proposes 3 changes to the Enhancing Oncology Model of the US Centers for Medicare & Medicaid Services.
JAMA Oncology
This Viewpoint describes the association of various factors, including demographic factors, disea... more This Viewpoint describes the association of various factors, including demographic factors, disease-related factors, and social determinants of health, with cancer treatment delays among a cohort of patients across multiple sites who had all tested positive for SARS-CoV-2.
Journal of Clinical Oncology
430 Background: Anticancer drug regimens that are approved by accepted drug compendia and also co... more 430 Background: Anticancer drug regimens that are approved by accepted drug compendia and also considered high value based on their efficacy, toxicity, and costs are designated as “on-pathway” for a national commercial payer. This study compared quality and cost of cancer care among patients with metastatic solid tumors treated in the first line setting who were prescribed on- vs. off-pathway regimens. Methods: Using administrative claims data and prior authorization data from a national commercial payer, we identified 8,357 commercially insured or Medicare Advantage adult patients with solid tumor cancers including breast, lung, colorectal, pancreatic, melanoma, kidney, bladder, gastric, or uterine cancer, who were prescribed first-line anti-cancer regimens in the metastatic setting from 2018 to 2021. Patients were classified into on- vs. off pathway group based on the initial anticancer regimen that was prescribed. On-pathway status was prospectively defined by a panel of practici...
Journal of Clinical Oncology
7 Background: Rising healthcare costs have garnered interest from payers in shifting oncology car... more 7 Background: Rising healthcare costs have garnered interest from payers in shifting oncology care towards a value-based practice model. Pathways are a subset of evidence-based guidelines designed to standardize cancer drug prescribing by clarifying decisions along three priorities: efficacy, safety, and cost. However, the major predictors of compliance with clinical pathway recommendations are unknown. Methods: We conducted a retrospective cohort study using administrative claims linked with prior authorization data of Anthem commercial and Medicare Advantage members. We identified members aged 18 or older with a diagnosis of breast, lung, colorectal, bladder, kidney, uterine, pancreatic cancer or melanoma being treated with a first-line treatment regimen in the metastatic setting between July 2018 and October 2021. The primary outcome was pathway compliance (PC), defined as whether a patient’s anti-cancer drug regimen is also an Anthem pathway-endorsed regimen. We built a logistic...
New England Journal of Medicine
Journal of Clinical Oncology
e18675 Background: We sought to describe factors associated with treatment delay among cancer pat... more e18675 Background: We sought to describe factors associated with treatment delay among cancer patients with COVID-19. Methods: We conducted a retrospective analysis of de-identified data from the ASCO COVID-19 Cancer Data Registry, a longitudinal cohort study launched in April 2020 with 60 community and academic practices. We evaluated all patients who were documented as having therapy (anticancer drug therapy, surgery or radiation therapy) scheduled at the time of entry into the registry due to a positive SARS-CoV-2 test result. Treatment delay were defined based on length of delay: on schedule or within 14 days, and delay > 14 days or discontinued entirely. The latter is defined as “delay in care”. We used univariate and multivariate logistic analyses to address these questions. Results: At the time of data analysis, 3028 patients were included in the registry, of which 2103 had scheduled drug therapy, 125 had scheduled surgery, and 202 had scheduled radiation. 46% of patients ...
Circulation: Cardiovascular Quality and Outcomes, 2017
AHA QCOR 2017 submission Category: Cardiac Arrest/CPR “How well can you run a code?” Assessing re... more AHA QCOR 2017 submission Category: Cardiac Arrest/CPR “How well can you run a code?” Assessing resident comfort and competence with in-hospital cardiac arrest Background: Despite their frequent role in caring for patients with in-hospital cardiac arrest (IHCA), earlier data suggest residents often feel uncomfortable during resuscitations. We sought to characterize the experiences of residents at our academic institution with IHCA, delineate reasons for discomfort (if any) with their roles, and then assess what educational interventions were considered most valuable. Methods: We performed a 9-question survey that was electronically distributed to all internal medicine and medicine-pediatrics residents at the University of Michigan Health System. This survey asked residents about: 1) the number of IHCAs that residents had attended or led, 2) their comfort with their roles including leading an IHCA, 3) possible reasons for any discomfort in their roles, and 4) educational interventions...
JAMA Internal Medicine, 2021
During the coronavirus disease 2019 (COVID-19) pandemic, many states waived requirements that phy... more During the coronavirus disease 2019 (COVID-19) pandemic, many states waived requirements that physicians and other health care professionals with out-ofstate licenses be licensed in the state in which they are providing services. Some states also extended this reciprocity for the provision of telehealth services. These crisis responses highlight the barriers that physician licensure procedures have created for the delivery of health care. Although state licensing requirements are largely similar across the country, most states require that physicians be separately licensed in each state in which they practice.
JCO Oncology Practice, 2020
Dermatology Online Journal, 2015
Scleromyxedema is a generalized and progressive fibromucinous disorder associated with substantia... more Scleromyxedema is a generalized and progressive fibromucinous disorder associated with substantial cutaneous and systemic morbidity. The diagnosis is often challenging, as is management. We present here a patient with scleromyxedema with atypical, granuloma annulare-like histology, which contributed to delayed diagnosis and management, including a delayed workup for multiple myeloma. Ultimately, the patient did well with appropriate therapy, but his presentation illustrates the importance of more widespread familiarity among dermatologists and dermatopathologists with this variant of scleromyxedema.
Journal of Clinical Oncology, 2018
6525Background: With the rising cost of health care in the US has come increasing emphasis on opt... more 6525Background: With the rising cost of health care in the US has come increasing emphasis on optimizing value. Value-based healthcare delivery models are designed to maximize outcomes and minimize costs through changes in care delivery. Little is known about the impact of value-based interventions in cancer care. We performed a systematic review to describe the landscape of value-based interventions in cancer. Methods: This review included peer-reviewed and non peer-reviewed articles describing value-based interventions in cancer care. We identified articles through structured searches of PubMed/MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Clinical Trials since passage of the Affordable Care Act. We used the Effective Public Health Practice Project Quality Assessment Tool to evaluate the quality of studies reporting results. Results: Twenty-three articles describing 22 unique value-based interventions in cancer met inclusion criteria. Of the 23 articles, 12 were published in the p...
Healthcare, 2019
Designing alternative payment models (APMs) to encourage providers to manage the needs of very co... more Designing alternative payment models (APMs) to encourage providers to manage the needs of very complex patients while limiting providers' financial risk is a major challenge. Most APMs limit providers' financial risk for complex patients through an annual per-patient expenditure cap, above which medical expenses are excluded from financial performance calculations. We consider three strategies to better strengthen the balance between motivation and risk mitigation. First, risk adjustment could be improved. Second, expenditure caps can be tailored to very high-cost patients. Third, payers could allow providers to determine their own risk preferences through alternative reinsurance policies.
JAMA, 2019
A f e w w e e k s a g o , a Tw i t t e r a c c o u n t c a l l e d @womeninmedchat facilitated an... more A f e w w e e k s a g o , a Tw i t t e r a c c o u n t c a l l e d @womeninmedchat facilitated an online conversation about imposter syndrome in medicine. Imposter syndrome is a psychological term that refers to a pattern of behavior wherein people (even those with adequate external evidence of success) doubt their abilities and have a persistent fear of being exposed as a fraud. Online, there were numerous responses: women talked frankly about how they attributed accomplishments to luck or good timing instead of merit, voicing fears that they had simply duped others with an illusion of competence. The sheer prevalence was emphasized by an aspiring surgeon: “I’d like to meet someone who HASN’T experienced imposter syndrome.” Others highlighted how the syndrome disproportionately affects women and minority groups—who often lack sufficient role models of success. Many reported that it led to meaningful setbacks in their careers, from being too paralyzed to speak up at meetings to not asking for opportunities or promotions due to feeling unqualified. An academic hospitalist wrote, “There are
Journal of General Internal Medicine, 2019
JAMA Oncology, 2019
Additional Contributions: We would like to thank Brian Chen, JD, PhD; Chadi Nabhan, MD, MBA; Tony... more Additional Contributions: We would like to thank Brian Chen, JD, PhD; Chadi Nabhan, MD, MBA; Tony Yang, ScD, LLM, MPH; Anuhya Kommalapati, MD; Sri Harsha Tella, MD; Carlo DeAngelis, PharmD; Ashley C. Godwin, BA; Paul Ray, DO; Paul R. Yarnold, PhD; Bryan L. Love, PharmD; LeAnn B. Norris, MD; Kevin Knopf, MD, MPH; Laura Bobolts, PharmD; Joshua Riente, PharmD; Stefano Luminari, MD; Robert C. Kane, MD (deceased); and James O. Armitage, MD, for their contributions to the paper, for which they did not receive compensation.
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Papers by Samyukta Mullangi