Future of Medicine?

[user_name]

Here is the type of article that usually sends this forum in to orbit:

http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande?currentPage=all

Enjoy the diversion.

Also, I like Cheesecake Factory, but never go with your grandparents. The menu is just too big to get them to order quickly.

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[medgator]

Caught the tail end of this on NPR this morning. Thanks for linking the article.

 

[user_name]

Some of you may think this applies little to our field since we are not in the unit or inpatient setting. One could easily argue that we are the perfect candidates for this type of oversight. A form of it already occurs on protocols. With so little of our treatments being emergent or urgent, there would be time for an observer to review most of our cases. He or she could decide active surveillance or not for prostate, whether 35/14 or 20/5 for mets, and even review the actual fields for postoperative gastric cases, for example. While "autonomy" is threatened, you would see some of the ourtright abuse or even ignorance of modern standards corrected. My American sensibility hates the idea, but I don't know that anyone will care or should care.

 

[rymd]

Patient-centered healthcare.
A dream. One worth pursuing though. Look at Apple- Focusing on the user experience sure seems to have lead to... the most valuable company on earth.

 

[deleted4401]

For some of our insurers, we have to go through this whole step-by-step thing by this company before it gets approved (and by 'we', I mean my biller goes through my dictation and fills it out). I think it is called Evitas. Basically, if I have a lung cancer case, have to say the stage. If I do stage IIIB, then it gives the options: concurrent or induction chemoRT or RT alone. Then, have to give dose and fractionation from a menu of options (ranging from 60 - 66 in 30-33 fx). Then, have to say what chemo they are giving. Then the plan (3D vs IMRT, energy, etc.). If you are within their internal framework, it gets approved. If not, you have to change your plan to get approval. I think it's pretty cool. I never disagree with what they ask. Why shouldn't the insurance company do it? If you put in 35/14 for a bone met, someone should deny it, or say 'fine, we'll pay for 5 fractions, you guys can deliver the last 9, but it's on you'. I don't think it's unreasonable.

 

[OTN]

This kind of oversight is infuriating to me. If we changed the whole "charge by the number of treatments paradigm" it would take care of nearly all the problems. I would MUCH rather see that done than be forced to jump through hoops to convince some person who has never seen the patients/films/etc, may not be current on the data, etc, that what I'm doing is the right thing. Infuriating.

 

[deleted4401]

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[Sheldor]

This kind of oversight is infuriating to me. If we changed the whole "charge by the number of treatments paradigm" it would take care of nearly all the problems. I would MUCH rather see that done than be forced to jump through hoops to convince some person who has never seen the patients/films/etc, may not be current on the data, etc, that what I'm doing is the right thing. Infuriating.

This is coming, my guess within the next few years. There are already states implementing a "bundled" payment approach. If radiation oncology manages to not get bundled with Med Oncs and surgeons, then this bundle, in my opinion, would cover the cancer, not necessarily the number of fractions etc. If Rad Onc gets bundled in with other providers (which I think would be a terrible idea), then whoever is in charge of distributing that money between the providers will decide how much it gets reimbursed, and you can bet that the number of fractions isn't going to matter to them.

 

[medgator]

If you put in 35/14 for a met, someone should deny it, or say 'fine, we'll pay for 5 fractions, you guys can deliver the last 9, but it's on you'. I don't think it's unreasonable.

Until some bean counter at the insurance company starts equating bone mets to brain mets. I generally don't consider WBRT with 20/5 unless the pt is pretty poor shape.