Kaiser Permanente CEO slams independent radiation oncology

[subatomicdoc]

Dr. Robert Pearl, a plastic surgeon and CEO of Kaiser Permanente Medical Group, wrote a misinformed, biased article on radiation oncology in Forbes and on KevinMD.Com. He points at radiation oncologist equipment ownership as a cost-driver but botches any clinical information accuracy in a folksy, readable way for the uninformed.

In my opinion, it appears more like an easy way to share Kaiser as 'low cost' where it competes in non-CON states. I have written comments both on KevinMD and Forbes (not posted/approved yet) suggesting he share Kaiser's utilization data to show Kaiser is any better.

What do you think? Is his portrayal of prostate SBRT as mainstream reasonable?

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[medgator]

I'd love to hear his comments on all of these proton centers opening up at major academic and tertiary hospital systems. Interestingly, his Forbes editiorial ignores that elephant in the room.

Funny he picks on freestanding centers, all of whom have been bearing the disproportionate amount of cuts in radiation oncology over the last several years while remaining interestingly silent on the proliferation of high-cost proton centers, the finances of which are predicated on treating low-risk prostate CA to survive.

It's in his interest to attack his freestanding competition and push for consolidation of radiation therapy away from smaller outlying freestanding centers into larger, more costly hospital-based systems. The editorial doesn't surprise me one bit. Of course, what he fails to mention is what happens to healthcare spending when independent practices are bought up.

As for prostate sbrt, I think he should stick to plastic surgery rather than endorse a treatment for the community which has not been completely vetted in terms of long term outcomes and toxicity. One need look no further than recent prostate hypofractionation data published in the jco to see the folly of his recommendation outside of clinical trials.

EDIT: "And for select groups with low-risk breast cancer, radiation therapy can be delivered as a one-time dose in the operating room."

Forgot to mention the ludicrousness of mentioning IORT/Intrabeam as a mainstream standard therapy for breast cancer based on essentially one randomized phase III trial (TARGIT) with just recently reported 5-year results. Even at 5 years, there are suggestions that it may be suboptimal treatment compared to standard WBRT. Hypofractionation has longer data than that and is just starting to gain acceptance. Would anyone honestly give IORT to a 48 y/o F with a life expectancy for Stage IA IDC of the Breast well beyond 5 years? I sure as heck wouldn't feel comfortable, personally.

 

[Gfunk6]

It's all about crushing competition, reducing patient choices, and inflating salaries for non-physician executives.

Kaiser gets all of their money up front. To maximize profit, their primary tenet is to implement rule #13 of the 'House of God."

THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

 

[seper]

Just to be a devil's advocate, do you have any data or personal experience to say that Kaizer under-utilizes XRT? As you know, there are published data showing that "non-integrated" XRT Departments over-utilize.