D
deleted1111261
Aside from obvious issues (proton/adaptive/SGRT carve out, PPS exemption exemption, etc., lack of transparency, etc.), what are you all thinking?
- case rates make a lot of sense in our world; however, prior auth cannot be the rationale - pure MCR does not have prior auth
- playing with spreadsheet, pro fees actually do quite well in the model, especially if you tx SOC with regards to fx
- they actually go up faster than FFS estimates up until 2028 and the spread between ROCR and FFS actually grows with time
- stability ... well, until 2028. What I don't understand is how our reimbursement is protected / stabilized and for what time period. I've asked Keole and others this, and they circle around answer by saying "it will be worse if we don't do it" rather than why/how it is protected/stabilized.
- the 90 day episode length is problematic for mets; that is going to have to get adjusted. I think the most noise needs to be made about this and I do believe it will be modified.
- technical takes a hit; and b/c technical is majority of reimbursement, it appears that the gross total payment is decreased - the spreadsheet does not combine the spreadsheets which is super annoying but I'm sure @elementaryschooleconomics can fix that for us.
- if I were pro fee guy, I'd be generally okay with this; if I am overall looking at it as a hospital, I'm a little less okay with it b/c my guess is that as prof:tech increases, prof+tech decreases.
- this is a small percentage of my patients b/c Medicare Advantage and commercial insurers are exempted; this is for most people in practice these days.
- the accreditation measure is 100% bullsh*t, please do not undervalue this statement, it is yet another money grab
- "quality" can also mean too few fractions or under-utilization of technology; why do IMRT even if better if you can do 3D cheaper? Why do 67/15 when you can 50/5? Can lead to some risk taking in the opposite direction
- if commercial and MA plans do not follow suit in a meaningful way, I am uncertain that this will be affecting us other than on the margins - i.e. - If I earned 600,000 in pro fees and 100,000 were Medicare and I'm getting a 4% increase to 104,000, but the hospital is getting a 1% decrease in their 400,000, it's a wash and they may decide to reduce your $/RVU
But, I'm interested in hearing a technical discussion of this part. I see no path to getting rid of the proton or PPS exemption exemptions, as their lobby is their lobby + ASTRO.
Burning it down is an option and it is very possible with grassroots effort, but for the near short future, that means we are gonna take a decent hit with no guarantees that cuts won't be deeper later.
Have asked Keole to come on to SDN and give some long form thoughts rather than tweets, hopefully he can do that soon. Maybe Vapiwala can join, too.
- case rates make a lot of sense in our world; however, prior auth cannot be the rationale - pure MCR does not have prior auth
- playing with spreadsheet, pro fees actually do quite well in the model, especially if you tx SOC with regards to fx
- they actually go up faster than FFS estimates up until 2028 and the spread between ROCR and FFS actually grows with time
- stability ... well, until 2028. What I don't understand is how our reimbursement is protected / stabilized and for what time period. I've asked Keole and others this, and they circle around answer by saying "it will be worse if we don't do it" rather than why/how it is protected/stabilized.
- the 90 day episode length is problematic for mets; that is going to have to get adjusted. I think the most noise needs to be made about this and I do believe it will be modified.
- technical takes a hit; and b/c technical is majority of reimbursement, it appears that the gross total payment is decreased - the spreadsheet does not combine the spreadsheets which is super annoying but I'm sure @elementaryschooleconomics can fix that for us.
- if I were pro fee guy, I'd be generally okay with this; if I am overall looking at it as a hospital, I'm a little less okay with it b/c my guess is that as prof:tech increases, prof+tech decreases.
- this is a small percentage of my patients b/c Medicare Advantage and commercial insurers are exempted; this is for most people in practice these days.
- the accreditation measure is 100% bullsh*t, please do not undervalue this statement, it is yet another money grab
- "quality" can also mean too few fractions or under-utilization of technology; why do IMRT even if better if you can do 3D cheaper? Why do 67/15 when you can 50/5? Can lead to some risk taking in the opposite direction
- if commercial and MA plans do not follow suit in a meaningful way, I am uncertain that this will be affecting us other than on the margins - i.e. - If I earned 600,000 in pro fees and 100,000 were Medicare and I'm getting a 4% increase to 104,000, but the hospital is getting a 1% decrease in their 400,000, it's a wash and they may decide to reduce your $/RVU
But, I'm interested in hearing a technical discussion of this part. I see no path to getting rid of the proton or PPS exemption exemptions, as their lobby is their lobby + ASTRO.
Burning it down is an option and it is very possible with grassroots effort, but for the near short future, that means we are gonna take a decent hit with no guarantees that cuts won't be deeper later.
Have asked Keole to come on to SDN and give some long form thoughts rather than tweets, hopefully he can do that soon. Maybe Vapiwala can join, too.