UPMC needs a Chair of RadOnc

[deleted1111261]

💯

That department should have changed leadership 10-15 years ago.

Man, I have stories … but people get so mad when you even allude to anything- nobody is interested in reflection.

With the amount of market share, capital, technology - UPMC could have been on an MD Anderson like trajectory.

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[OTN]

💯

That department should have changed leadership 10-15 years ago.

Man, I have stories … but people get so mad when you even allude to anything- nobody is interested in reflection.

With the amount of market share, capital, technology - UPMC could have been on an MD Anderson like trajectory.

So...bullet dodged then?

 

[elementaryschooleconomics]

I think all departments should go to rotating chairs. (I believe some departments are run this way?) Three year terms. Would do a lot of good.

1. Takes away the "one person you need to impress" phenomenon in residency. Where I trained, the chair had absolute sway over whether you were going to be asked to stay and a disproportionate ability to influence your job prospects in academia. 3 year terms makes the chair club more inclusive and less powerful. I personally believe the emphasis on networking and the layers of exclusive networks in radonc has hurt the field.

2. Gets rid of this ridiculous "vision thing". I'm guessing nearly every attending in academic medicine has something to add to a department (of course there should be right of refusal for those docs who really just need their lab time). I'm sure that satellite, work horse clinical attending who is a great teacher and is not well known in the field will do just great for 3 years and will emphasize different and important things relative to the guy who sees 3 patients a week and has 2 RO1s.

I love this idea. There are a lot of folks who would do great things as Chair. Sadly, with this 20- to 30-year stranglehold people have on that position, so much opportunity is lost for everyone.

 

[RickyScott]

💯

That department should have changed leadership 10-15 years ago.

Man, I have stories … but people get so mad when you even allude to anything- nobody is interested in reflection.

With the amount of market share, capital, technology - UPMC could have been on an MD Anderson like trajectory.

Bring Steve Hahn in.

 

[communitydoc13]

I love this idea. There are a lot of folks who would do great things as Chair. Sadly, with this 20- to 30-year stranglehold people have on that position, so much opportunity is lost for everyone.

The department I was in in grad school had rotating chairs and it was excellent. It mitigated toxic personalities, (A pretty eminent faculty member famously gave himself departmental awards as chair, but was only chair for a few years) and forced the chairs to interact with other faculty as peers. As far as I could tell, it didn't hinder progress, but meant that consensus among the faculty was always a priority. In terms of career development, the chair was not a particularly powerful ally and this was a good thing. Eminent faculty still had opportunities for admin above the level of the department if they were interested. More faculty got to put "chair of department" on their CV and importantly, got to figure out if they were any good at admin and if this was something they would like to pursue above teaching/research and their rotational chair duties (most did not).

Doesn't seem to be that popular a model in academic medicine. The two academic places I'm very familiar with both basically worked on the departmental fiefdom model with entrenched chairs, strong personalities and tremendous personal power.

 

[RickyScott]

The department I was in in grad school had rotating chairs and it was excellent. It mitigated toxic personalities, (A pretty eminent faculty member famously gave himself departmental awards as chair, but was only chair for a few years) and forced the chairs to interact with other faculty as peers. As far as I could tell, it didn't hinder progress, but meant that consensus among the faculty was always a priority. In terms of career development, the chair was not a particularly powerful ally and this was a good thing. Eminent faculty still had opportunities for admin above the level of the department if they were interested. More faculty got to put "chair of department" on their CV and importantly, got to figure out if they were any good at admin and if this was something they would like to pursue above teaching/research and their rotational chair duties (most did not).

Doesn't seem to be that popular a model in academic medicine. The two academic places I'm very familiar with both basically worked on the departmental fiefdom model with entrenched chairs, strong personalities and tremendous personal power.

problem is that chairs can sometimes make bank ( 2 million Lou) and dont want to give that up. In biology, chemistry, probably have just small administrative stipend

 

[Neuronix]

fiefdom model with entrenched chairs, strong personalities and tremendous personal power.

Just like the cooperative group leadership and committees.

problem is that chairs can sometimes make bank ( 2 million Lou) and dont want to give that up

Every chair I've ever worked under had far less clinical obligation than their faculty and 100% coverage by mid-level, resident, or both with 2-3x the pay of unsupported junior faculty. I often wonder how quickly they'd quit if they were treated like junior faulty.

 

[communitydoc13]

problem is that chairs can sometimes make bank ( 2 million Lou) and dont want to give that up. In biology, chemistry, probably have just small administrative stipend

Spot on. The basic science profs often kind of dreaded being chair but felt obligated to do it and knew if too many people abdicated the responsibility things would go to hell. Just way too top heavy in academic medicine IMO. Goal should be to be the best academic clinician or Lasker prize winner or some such thing, not to be chair. Even the incentive to be chair is dumb.

 

[RSAOaky]

Spot on. The basic science profs often kind of dreaded being chair but felt obligated to do it and knew if too many people abdicated the responsibility things would go to hell. Just way too top heavy in academic medicine IMO. Goal should be to be the best academic clinician or Lasker prize winner or some such thing, not to be chair. Even the incentive to be chair is dumb.

Chairmen are to radonc departments what admin are to hospitals. They skim off the top and rarely contribute anywhere near what they are paid. It's the strangest thing that a successful and prolific research career, in which one rises through the ranks of academia, culminates in a chairman position. What aspect of being a good scholar translates into being a good chairman? These people often lack people skills, clinical skills, and most importantly business savvy.

 

[medgator]

Chairmen are to radonc departments what admin are to hospitals. They skim off the top and rarely contribute anywhere near what they are paid. It's the strangest thing that a successful and prolific research career, in which one rises through the ranks of academia, culminates in a chairman position. What aspect of being a good scholar translates into being a good chairman? These people often lack people skills, clinical skills, and most importantly business savvy.

They expanded residency programs.... That helped drive down faculty salaries. Good ROI there if you're a chair

Just ask Dennis Hallahan

 

[seper]

Chairmen are to radonc departments what admin are to hospitals. They skim off the top and rarely contribute anywhere near what they are paid. It's the strangest thing that a successful and prolific research career, in which one rises through the ranks of academia, culminates in a chairman position. What aspect of being a good scholar translates into being a good chairman? These people often lack people skills, clinical skills, and most importantly business savvy.

That not always the case... I know some places where Chair is a figurehead, while true MBA-type admins are the ones skimming off the top.

 

[Lamount]

I think all departments should go to rotating chairs. (I believe some departments are run this way?) Three year terms. Would do a lot of good.

1. Takes away the "one person you need to impress" phenomenon in residency. Where I trained, the chair had absolute sway over whether you were going to be asked to stay and a disproportionate ability to influence your job prospects in academia. 3 year terms makes the chair club more inclusive and less powerful. I personally believe the emphasis on networking and the layers of exclusive networks in radonc has hurt the field.

2. Gets rid of this ridiculous "vision thing". I'm guessing nearly every attending in academic medicine has something to add to a department (of course there should be right of refusal for those docs who really just need their lab time). I'm sure that satellite, work horse clinical attending who is a great teacher and is not well known in the field will do just great for 3 years and will emphasize different and important things relative to the guy who sees 3 patients a week and has 2 RO1s.

Working in academics, I am pretty happy avoiding in the most remote-of-possibilities that I could be asked to "rotate" as chair one day. I don't think I am alone among academics not EVER wanting to be chair. It's sometimes hard to say "no" to things... so the possibility would make me nervous

Maybe it could work if there was the option of a "leadership track" for P&T (as opposed to a "clinical track", "educator/scholar track" etc...) so that folks like me could avoid that track entirely haha

 

[communitydoc13]

Working in academics, I am pretty happy avoiding in the most remote-of-possibilities that I could be asked to "rotate" as chair one day. I don't think I am alone among academics not EVER wanting to be chair. It's sometimes hard to say "no" to things... so the possibility would make me nervous

Maybe it could work if there was the option of a "leadership track" for P&T (as opposed to a "clinical track", "educator/scholar track" etc...) so that folks like me could avoid that track entirely haha

You, of course would make a great chair. That's the rub. The reluctant leaders, not elected, by definition representative of the people they lead and eager to get back to citizenry (regular academic job) at first chance will outperform the extraordinarily ambitious any day. Rotating chairs aren't young attendings BTW. It would be something you could look forward to sometime between year 7-20 of your academic career.

 

[thecarbonionangle]

U.S. accuses UPMC surgeon, physicians group of false billing

The chairman of the University of Pittsburgh Medical Center's Department of Cardiothoracic Surgery has for years systematically billed for unnecessary...

www.post-gazette.com

UPMC accused of massive fraud. Surprised?

 

[RickyScott]

U.S. accuses UPMC surgeon, physicians group of false billing

The chairman of the University of Pittsburgh Medical Center's Department of Cardiothoracic Surgery has for years systematically billed for unnecessary...

www.post-gazette.com

UPMC accused of massive fraud. Surprised?

Best esophageal surgeon in the world . Very sad

 

[StIGMA]

U.S. accuses UPMC surgeon, physicians group of false billing

The chairman of the University of Pittsburgh Medical Center's Department of Cardiothoracic Surgery has for years systematically billed for unnecessary...

www.post-gazette.com

UPMC accused of massive fraud. Surprised?

I've seen this occur at other institutions. Also with 1 surgeon running 3 ORs simultaneously. Maybe I should also whistleblow...

 

[thecarbonionangle]

I've seen this occur at other institutions. Also with 1 surgeon running 3 ORs simultaneously. Maybe I should also whistleblow...

Sounds like you are witnessing fraud. FBI will show up at their door too.

 

[TheWallnerus]

U.S. accuses UPMC surgeon, physicians group of false billing

The chairman of the University of Pittsburgh Medical Center's Department of Cardiothoracic Surgery has for years systematically billed for unnecessary...

www.post-gazette.com

UPMC accused of massive fraud. Surprised?

One mans fraud is another mans standard operating procedure.

however when you see fraud don’t be stupid! It can make you millions, report it to your local or google searched attorney

 

[elementaryschooleconomics]

One mans fraud is another mans standard operating procedure.

however when you see fraud don’t be stupid! It can make you millions, report it to your local or google searched attorney

Fraud, anti-trust, violations of Stark Law, malpractice...when I was a starry-eyed premed, I thought these things had meaning. I thought they were concrete.

Now, three million papercuts to my soul later..."one man's fraud is another man's SOP" is the only truth I believe in.

 

[medgator]

One mans fraud is another mans standard operating procedure.

however when you see fraud don’t be stupid! It can make you millions, report it to your local or google searched attorney

15-25% of the haul the government takes. Of course it is all taxable

 

[RadOncDoc21]

Lawyers love us! I feel like everyone makes money off doctors yet we find ways to screw each other and ourselves. I’m not justifying anything, just saying there is a reason why the healthcare industry is a trillion dollar business.

 

[TheWallnerus]

15-25% of the haul the government takes. Of course it is all taxable

Joe Ting

Former head of medical physics at Emory U

Made 7.2 million from whistle blowing on 21st Century… from the government

The govt took back 3 million in taxes

 

[RickyScott]

By far and away the most prominent esophageal surgeon- Probably had a hard time turning pts away. Esophagectomy has highest mortality rate of any surgery so basically anyone who does a 5 minute google search would want this man operating on them.

 

[RadOncMegatron]

By far and away the most prominent esophageal surgeon- Probably had a hard time turning pts away. Esophagectomy has highest mortality rate of any surgery so basically anyone who does a 5 minute google search would want this man operating on them.

But was he operating? I guess that's the main question. Hopefully the 3 surgeries at the same time were hernia repairs not esophagectomies. I can't imagine even attempting 2 esophagectomies at the same time, so it would be sad if all this is from 3 minor surgeries.

 

[RickyScott]

But was he operating? I guess that's the main question. Hopefully the 3 surgeries at the same time were hernia repairs not esophagectomies. I can't imagine even attempting 2 esophagectomies at the same time, so it would be sad if all this is from 3 minor surgeries.

More likely, he was present for the crucial parts of the survey whatever that may be.

 

[TheWallnerus]

if you did a thorough and complete enough audit of every high billing and very busy academic MD in this country, you could nail every single one of them on at least a couple hundred “fraudulently” billed codes over a many years period (from among the thousands and thousands of codes billed properly)

The govt gets to threaten $20k penalty per $20 wrongly billed code… that’s the qui tam law in medicine. Plus triple damages.

That is why all these cases settle

It is a major wonder why there are not several whistleblowers at every university making major bank … the govt is always glad to join in

 

[StIGMA]

if you did a thorough and complete enough audit of every high billing and very busy academic MD in this country, you could nail every single one of them on at least a couple hundred “fraudulently” billed codes over a many years period (from among the thousands and thousands of codes billed properly)

The govt gets to threaten $20k penalty per $20 wrongly billed code… that’s the qui tam law in medicine. Plus triple damages.

That is why all these cases settle

It is a major wonder why there are not several whistleblowers at every university making major bank … the govt is always glad to join in

That's my point. I'm sure most surgery residents (or disaffected staff physicians, like what appeared to happen in this case) could do this at the majority of institutions. While rotating to a different surgical subspecialty than the main one I was assigned, I 'first assisted' at a university medical center with one of these guys on a case. First time I met this surgeon was while we were scrubbing in. I wasn't proficient with tying off tiny vessels so I did 100% of the electrocautery for the case while the surgeon told me where to cut & did the ties/suturing. Was nuts. 3-4x the necessary anesthesia time as patient was waiting >1 hour while surgeon was working 2 other ORs simultaneously; residents were dispersed to the 2 longer cases). This is that guys SOP. The medical center rewards these surgeons with treasure chests.

 

[radoncftw]

Isn't this how almost how many academic surgeons operate?

 

[deleted941485]

Isn't this how almost how many academic surgeons operate?

My experience on ortho was the same way. Academic center. The 4s and 5s do the operation and the supervising surgeon checks in with them while they float between 2-3 rooms. It has to be pretty wide spread but my guess is that the inexperienced ones need little more hands on approach.


Also for a monster hospital system like UPMC, I’m sure dealing with disgruntled employees, billing improprieties, and insurance company tactics are just par for the course. They have a massive legal team. They fought off accusations of monopolistic practices and continue to rake it in. UPMC I think is biggest non profit in PA and possibly one of the biggest employers in the state. This stuff looks bad but ultimately you write a check make an apology maybe fire some people and move on.

 

[elementaryschooleconomics]

My experience on ortho was the same way. Academic center. The 4s and 5s do the operation and the supervising surgeon checks in with them while they float between 2-3 rooms. It has to be pretty wide spread but my guess is that the inexperienced ones need little more hands on approach.

I mean, this entire enterprise is a castle made of sand. CMS says you can only bill for certain things done in a certain way; medical students and residents need training. I'm certain the majority of residents (surgical or otherwise) want increasing autonomy for their own experience, which incentivizes this practice of multiple ORs supervised by a single faculty member and disincentivizes whistleblowing, even if what is happening - and being billed for - is not "appropriate".

Everyone wins. Residents get training, attendings, and ESPECIALLY the hospital, make an incredible profit off the whole arrangement.

It's almost like...there's a tremendous financial incentive to have as many residents as possible...hmm.

I would be lying if I said I never had my volumes as a resident "attending approved" based on screenshots or a 3 second scroll through the axial slices sitting in Dosimetry. How many millions did my labor generate for my residency institution over the years which my attendings received RVU bonuses for? The world will never know.

I'm sure there are similar situations across ALL specialties.

 

[RadOncDoc21]

I mean, this entire enterprise is a castle made of sand. CMS says you can only bill for certain things done in a certain way; medical students and residents need training. I'm certain the majority of residents (surgical or otherwise) want increasing autonomy for their own experience, which incentivizes this practice of multiple ORs supervised by a single faculty member and disincentivizes whistleblowing, even if what is happening - and being billed for - is not "appropriate".

Everyone wins. Residents get training, attendings, and ESPECIALLY the hospital, make an incredible profit off the whole arrangement.

It's almost like...there's a tremendous financial incentive to have as many residents as possible...hmm.

I would be lying if I said I never had my volumes as a resident "attending approved" based on screenshots or a 3 second scroll through the axial slices sitting in Dosimetry. How many millions did my labor generate for my residency institution over the years which my attendings received RVU bonuses for? The world will never know.

I'm sure there are similar situations across ALL specialties.

Agree, I think because we have to document so much, we are more open to the minuscule detail being scrutinized. For instance, do I really spend 60 minutes with all my consults or do I just say that to get billing done. I bet if my nurse stood outside and timed me, I could be committing "fraud" despite me actually spending >90 minutes with the note, reviewing the plan and discussing the case. Now am I also committing fraud because I actually spend more time then I documented? Why do I need to review 10 systems if all I need to know is 2? Again, not justifying any actions but the system is designed to work against us!

 

[seper]

My experience on ortho was the same way. Academic center. The 4s and 5s do the operation and the supervising surgeon checks in with them while they float between 2-3 rooms. It has to be pretty wide spread but my guess is that the inexperienced ones need little more hands on approach.


Also for a monster hospital system like UPMC, I’m sure dealing with disgruntled employees, billing improprieties, and insurance company tactics are just par for the course. They have a massive legal team. They fought off accusations of monopolistic practices and continue to rake it in. UPMC I think is biggest non profit in PA and possibly one of the biggest employers in the state. This stuff looks bad but ultimately you write a check make an apology maybe fire some people and move on.

This complaint mentions that the surgeon was floating between different hospitals while patients were under anesthesia. That's pushing it too hard. Gotta pay

 

[thecarbonionangle]

This complaint mentions that the surgeon was floating between different hospitals while patients were under anesthesia. That's pushing it too hard. Gotta pay

Yeah this is serious and best case scenario UPMC will pay tons of money

 

[RickyScott]

This complaint mentions that the surgeon was floating between different hospitals while patients were under anesthesia. That's pushing it too hard. Gotta pay

If true that would be egregious/not good optics.

 

[Chartreuse Wombat]

If true that would be egregious/not good optics.

Decades ago Penn got in trouble when attending was in the Caribbean while billing for service in Philly

 

[brushbeamscanning]

I think there are a lot of instances of this. E.g. Swedish double-booked its surgeries, and the patients didn’t know

 

[Gfunk6]

Yeah this is serious and best case scenario UPMC will pay tons of money

This tragedy will play out in the following acts:

1. The Feds accuse UPMC and their physician group of fraudulent billing
2. UPMC issues denial: "These claims are not true and we will legally fight these scurrilous charges."
3. Several months pass, everyone forgets about this in the public eye
4. UPMC quietly agrees to pay 100s of millions of dollars in fines to the feds without admitting any wrong doing
5. All the executives keep their jobs and their hefty bonuses. In the extraordinarily unlikely scenario that someone is actually terminated, they are given a golden parachute.
6. A Rad Onc in one of UPMCs satellites in Butt****, PA is generating 15,000 RVUs and asks for a raise of her $400,000 compensation. She is told: "Sorry we don't have the budget for that right now because of the lawsuit. Also, we are letting your RN go because her billings don't justify her salary. We are also laying off a couple of front desk people - we are just going to re-route calls to the linac so the RTTs can take care of it."

 

[seper]

While we are on the subject, this thread mentioned another prominent physician. The info I'm getting is that the doc was asked to leave UPMC, and is being sued/threatened to be sued by UPMC, with an effort to enforce his non-compete. The doc is therefore not practicing medicine currently

 

[DoctwoB]

This has been brewing for years, I know some of the CT residents who were deposed by the goverment as part of the lawsuit. There were nastier allegations involving drug use that do not appear to be part of the federal suit, though it is possible that it would be part of a separate criminal complaint.

As with all things, it comes down to billing. Running multiple rooms is legal and is SOP at many places (though less and less over time). Billing based on being present for parts of cases you did not perform is fraud. Realistically, many surgeons who run multiple rooms could reasonably be accused, even if acting in good faith as "key portions," is ripe for interpretation and you can reasonably argue for almost any part of any case as being key. A lot of badness can happen when putting ports in for a laparoscopic case for example. In addition to the fradulent practices, this guy was known for being an a**hole, and not surprisingly had someone blow the whistle on him. The lesson of course being if you're going to commit fraud, don't make people want to turn you in.

My biggest issue with the practice of multi-booking is that patients rarely are given a true informed consent regarding the practice. If you told patients that your resident/fellow was doing the case with you available as backup, many would choose to go elsewhere. I know that when I tell patients that I'm operating on them that it will be me, which may or may not be the case at local AMC.

 

[Mandelin Rain]

This tragedy will play out in the following acts:

1. The Feds accuse UPMC and their physician group of fraudulent billing
2. UPMC issues denial: "These claims are not true and we will legally fight these scurrilous charges."
3. Several months pass, everyone forgets about this in the public eye
4. UPMC quietly agrees to pay 100s of millions of dollars in fines to the feds without admitting any wrong doing
5. All the executives keep their jobs and their hefty bonuses. In the extraordinarily unlikely scenario that someone is actually terminated, they are given a golden parachute.
6. A Rad Onc in one of UPMCs satellites in Butt****, PA is generating 15,000 RVUs and asks for a raise of her $400,000 compensation. She is told: "Sorry we don't have the budget for that right now because of the lawsuit. Also, we are letting your RN go because her billings don't justify her salary. We are also laying off a couple of front desk people - we are just going to re-route calls to the linac so the RTTs can take care of it."

This is the way.

 

[evilbooyaa]

While we are on the subject, this thread mentioned another prominent physician. The info I'm getting is that the doc was asked to leave UPMC, and is being sued/threatened to be sued by UPMC, with an effort to enforce his non-compete. The doc is therefore not practicing medicine currently

**** man, you got an axe to grind with Beriwal?

That's like having an axe to grind with Tendulkar or Kavanagh or something.

I'm 100% sure UPMC is suing or will be willing to sue to enforce his non-compete as he heads over to their direct competitor, especially when it comes to clinical medicine, but what do you mean by 'asked to leave' to UPMC? They asked one of the most prominent GYN Rad Oncs of all time, known for being an excellent educator, to just leave?

That's like CCF asking Tendulkar to leave. IDK, mang.

But was he operating? I guess that's the main question. Hopefully the 3 surgeries at the same time were hernia repairs not esophagectomies. I can't imagine even attempting 2 esophagectomies at the same time, so it would be sad if all this is from 3 minor surgeries.

From the article:

"On Nov. 17, 2017, for example, Dr. Luketich performed or participated in and then billed for four surgeries: a 14-hour procedure in OR 26, a 12-hour procedure in OR 27 and back-to-back multi-hour procedures on two patients in OR 16. The procedure in OR 26 was extended by at least four hours and 16 additional anesthesia time units were billed to insurance because Dr. Luketich was participating in other surgeries, the suit said."

This guy was *apparently* responsible for 26 hours of surgery + 2 additional surgeries. All on one day.

Something about "not enough hours in the day for all the billing that this guy did"

 

[seper]

Perhaps he thought UPMC won’t try to enforce non-compete, due to some verbal assurances? Lesson for us to learn.

This is so incorrect that I wonder where it comes from.

Not asked to leave. In fact, could have been chairman, but chose to leave and still recently within the months was asked by senior people at institution to stay.

As far as threats of litigation - yes - and when that story gets out, one side will look extremely petty and mean spirited. You can guess which side 😃

EDIT: People know that I don’t pretend that place was heaven on earth. Lots of flaws, especially when I was in training. Much has improved. However, the outright erroneous facts by some and lies by others about UPMC are lunacy. The obsession with the program is befuddling to me.

 

[deleted1111261]

Perhaps he thought UPMC won’t try to enforce non-compete, due to some verbal assurances? Lesson for us to learn.

You speak like you have the facts, comrade, but you do not.

 

[seper]

You speak like you have the facts, comrade, but you do not.

“If the facts will change, so will my opinion about them”

 

[deleted1111261]

“If the facts will change, so will my opinion about them”

Your facts are wrong. He did not get asked to leave. Do you want to start with that?