ASTRO ROCR Town Hall

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thesauce said:
Convenience as the primary oncologic endpoint (which is almost every trial run in the last 10 years) has gotten entirely out of hand. One of these days (if we survive as a field) we'll get back to actually trying to improve REAL oncologic outcomes.
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1) not every trial or almost every trial, gross exaggeration

2) I agree convenience on its own may not excite anyone at this point. However - I have to ask. If we had not made advances, radiation would still be 6 weeks for breast and 9 weeks for prostate. This puts our modality at a significant disadvantage for patients who are either comparing local options (prostate cancer) or considering whether they should get RT at all (breast cancer/DCIS).

5 fraction partial breast RT has been a BOON to my practice. As has 20-28 fraction prostate, and yes even SBRT sometimes (some patients choose SBRT over prostatectomy in my practice when given all options. Your mileage may vary but my patients like coming fewer times and it makes radiation more attractive. When they come to me after googling and thinking 9 weeks and hear about much shorter options, it is pretty apparent that their calculus has shifted).

We should not be so short sighted.
 
Just so I'm understanding -- some people prefer the status quo of cuts year after year, instead of something that could make payments predictable/stable?

Sure, the PPS and proton arguments are real, but real-life legislation doesn't ever make everyone happy. That's okay. Live to fight another day.

The alternative to ROCR is almost certainly ongoing cuts, and we've seen how that's changed our payments for the last 2 decades.
 
GapCalc said:
Just so I'm understanding -- some people prefer the status quo of cuts year after year, instead of something that could make payments predictable/stable?

Sure, the PPS and proton arguments are real, but real-life legislation doesn't ever make everyone happy. That's okay. Live to fight another day.

The alternative to ROCR is almost certainly ongoing cuts, and we've seen how that's changed our payments for the last 2 decades.
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The idea that ROCR will stop payment cuts is delusional. Whatever good it was supposed to deliver is undone by mandates, documentation recs, and the big players essentially writing it and then exempting themselves from the process.

Also When it comes to dealing with Medicare, it’s heads I win tails you lose. We aren’t gonna get a special dispensation because we did this to ourselves.
 
GapCalc said:
Have you read the bill?
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Yes Gap I have. It will not promote payment stability as written. especially when it runs up against other healthcare budget priorities such as reducing payments to specialists and shifting payments to primary care - which has been in the works now and RFK seems onboard with.
 
Fpg1245 said:
and the big players essentially writing it and then exempting themselves from the process.
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I ask again why so much focus on 11 cancer centers? They have had special rules for 40 years. They would be insane to willingly tell the government 'PLEASE PLEASE cut our funding'

I don't know what people expect?
 
I have no idea. but I have to expect astro's lobbyists may know something about its chance of success. I think a bipartisan bill from a relatively niche part of cancer care is unlikely to gain that much opposition, but what do I know.
 
Fpg1245 said:
The idea that ROCR will stop payment cuts is delusional. Whatever good it was supposed to deliver is undone by mandates, documentation recs, and the big players essentially writing it and then exempting themselves from the process.

Also When it comes to dealing with Medicare, it’s heads I win tails you lose. We aren’t gonna get a special dispensation because we did this to ourselves.
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Correct. They will take the voluntary cuts we give them and keep on cutting. ROCR will not prevent any of that except make it MUCH MUCH EASIER to cut since they only have to cut one code rather than evaluate a bunch of them.
 
drowsy12 said:
1) not every trial or almost every trial, gross exaggeration

2) I agree convenience on its own may not excite anyone at this point. However - I have to ask. If we had not made advances, radiation would still be 6 weeks for breast and 9 weeks for prostate. This puts our modality at a significant disadvantage for patients who are either comparing local options (prostate cancer) or considering whether they should get RT at all (breast cancer/DCIS).

5 fraction partial breast RT has been a BOON to my practice. As has 20-28 fraction prostate, and yes even SBRT sometimes (some patients choose SBRT over prostatectomy in my practice when given all options. Your mileage may vary but my patients like coming fewer times and it makes radiation more attractive. When they come to me after googling and thinking 9 weeks and hear about much shorter options, it is pretty apparent that their calculus has shifted).

We should not be so short sighted.
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Love how you always throw in a little jab at the end of your posts demonstrating arrogance.

I realize you're the pinnacle of radonc, and I can appreciate your financial motivation for wanting the shorter courses, but given at the cost of side effects is just not worth it IMO. I want my patients to feel well during and after the treatment and report back to the referring that they had a "good" experience. Yes, for some patients the extended courses are too much and that's when shorter courses are helpful. It's better than nothing, but should not be preferred.

Our trials over the past 10 years have been largely omission or hypofrac. Not all, but I'd wager more than half. And these new studies looking at 3 vs 5 fractions? Give me a break...
 
drowsy12 said:
I ask again why so much focus on 11 cancer centers? They have had special rules for 40 years. They would be insane to willingly tell the government 'PLEASE PLEASE cut our funding'

I don't know what people expect?
Click to expand...

If it's that great, why wouldn't they? Instead, they expect the cuts to be taken by the rest of us. That's a negative externality and unethical in the extreme.
 
Once again, I feel like I'm a little out of lock-step with the experiences of most others on this board. Prostate SBRT has been great for us, we've been using it for the past few years with nice outcomes and high patient satisfaction. I will say that we've run into problems using SBRT with guys who have pre-existing LUTS and I have gotten to a point where I don't offer to those guys anymore. Outside of them, SBRT has been very successful in appropriately selected patients.
 
And I really can't think of the last guy that now has urinary incontinence (after SBRT or otherwise) who didn't have it at baseline. 7% seems extremely high, though its small #'s on that trial and I'm also not sure that the baseline incontinence # was reported prior to RT. I go so far as to tell my patients explicitly "no, radiation doesn't cause incontinence"..... because it doesn't. Maybe I'm not doing it right?
 
thesauce said:
Correct. They will take the voluntary cuts we give them and keep on cutting. ROCR will not prevent any of that except make it MUCH MUCH EASIER to cut since they only have to cut one code rather than evaluate a bunch of them.
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Cut one code? What one code?

So for those who are anti-ROCR (including warts, I get that): status quo good with you?

Also, for anyone wanting the text, there are apparently minor changes from the bill from last year, which you can find here:
https://www.congress.gov/bill/118th-congress/senate-bill/4330/text -
 
But... that's not how it works. The rate is based on FFS rates, with an adjustment. Then we get an inflation adjustment. And it's not subject to budget neutrality.

Let me repeat my earlier question:
So for those who are anti-ROCR (including warts, I get that): status quo good with you?
 
Pointless said:
And I really can't think of the last guy that now has urinary incontinence (after SBRT or otherwise) who didn't have it at baseline. 7% seems extremely high, though its small #'s on that trial and I'm also not sure that the baseline incontinence # was reported prior to RT. I go so far as to tell my patients explicitly "no, radiation doesn't cause incontinence"..... because it doesn't. Maybe I'm not doing it right?
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Ditto. I use prostate SBRT EXTENSIVELY. I've made multiple posts on this so I don't have to rehash them here. Since I live in an area where there are multiple radiation centers, my patients have a lot of choices. Virtually all patients prefer the short course - in fact, I've had several patients travel > 100 miles to see me for five consecutive days of radiation rather than do it locally over 8-9 weeks.

We use x4 gold fiducials, hydrogel, CT-MRI fusion, and CK with 6D correction on an MLC head. 15 minutes per fraction.
 
GapCalc said:
But... that's not how it works. The rate is based on FFS rates, with an adjustment. Then we get an inflation adjustment. And it's not subject to budget neutrality.

Let me repeat my earlier question:
So for those who are anti-ROCR (including warts, I get that): status quo good with you?
Click to expand...
Yes
 
drowsy12 said:
I have no idea. but I have to expect astro's lobbyists may know something about its chance of success. I think a bipartisan bill from a relatively niche part of cancer care is unlikely to gain that much opposition, but what do I know.
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Congressional opposition not this bill’s only hurdle, right? The bill must also get approved by CBO too methinks.

And even though we invented hippocampal sparing whole brain RT, it seems like rad oncs have short political memories. I do not think the ~100+ ASTRO-defunded Republicans in office or their congressional staffers do.

1742247203123.png





Epilogue: I wonder if Ibram Kendi now regrets his middle initial.......
 
Ray D. Ayshun said:
I must've misunderstood what status quo means. Good news is, if they keep taking half they'll never get it all. Also, please don't ask rhetorical questions.
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My apologies, I should have said "do you wish to maintain the current trajectory of yearly cuts?"

I'm not sure our small specialty can pull off ROCR (I hope it can), but it seems insane to me to think we'll stop cuts if we don't try something different than what has been done over the last 10+ years.

This board isn't a fan of ASTRO (and I'm not either, you can go look at my post history) but this bill seems like it gets more right than wrong. Stabilized payments, doesn't penalize new technology (if that's your thing), site neutral payments (a huge deal for us in free standing PP, and something that non-corporate/non-academic docs have wanted for many years), reimbursement for transportation (helpful to practices with a rural footprint)...

Anyway, I guess agree to disagree, but I'm wondering why we'd want to maintain our current trajectory, given how poorly it's gone for 10+ years..
 
GapCalc said:
My apologies, I should have said "do you wish to maintain the current trajectory of yearly cuts?"

I'm not sure our small specialty can pull off ROCR (I hope it can), but it seems insane to me to think we'll stop cuts if we don't try something different than what has been done over the last 10+ years.

This board isn't a fan of ASTRO (and I'm not either, you can go look at my post history) but this bill seems like it gets more right than wrong. Stabilized payments, doesn't penalize new technology (if that's your thing), site neutral payments (a huge deal for us in free standing PP, and something that non-corporate/non-academic docs have wanted for many years), reimbursement for transportation (helpful to practices with a rural footprint)...

Anyway, I guess agree to disagree, but I'm wondering why we'd want to maintain our current trajectory, given how poorly it's gone for 10+ years..
Click to expand...
I have to say I agree with GapCalc on this one. The status quo will only lead to slow, inexorable death.

I also agree that ASTRO is mostly a terrible organization who has not served its members well over the last 10+ years but this proosal from them is better than the alternative.
 
GapCalc said:
This board isn't a fan of ASTRO (and I'm not either, you can go look at my post history) but this bill seems like it gets more right than wrong.
Click to expand...
There was a William Buckley column, can't find it now, where he made a case that a mark of a true conservative was adherence to the status quo and affection for keeping things the same. While very boring sounding, perhaps this ethos comes from millennia of human mistakes and an almost evolutionary sociopolitical protection mechanism that's developed therefrom.

Be that as it may, a saying I often say is "Be careful to stick your head up above the parapet." People who like ROCR may not take much stock in this saying.
 
Gfunk6 said:
I have to say I agree with GapCalc on this one. The status quo will only lead to slow, inexorable death.

I also agree that ASTRO is mostly a terrible organization who has not served its members well over the last 10+ years but this proosal from them is better than the alternative.
Click to expand...

Slow is the operative word here. This and all specialties are on the same trajectory.

I'm ok with 2% per year cuts and will find ways to grow and adapt. If ROCR passes, congress will just roll back the parts they don't like, whenever they like, but ultimately just find another way to cut. We'd just be making it easier on them.

ROCR will also stifle any new investments in our field. Everyone will just replace machines with older and cheaper ones. No sense in spending money on better technology since we can't make it back. Without this demand companies won't even try to come up with new equipment. Protons will take off though.
 
GapCalc said:
My apologies, I should have said "do you wish to maintain the current trajectory of yearly cuts?"

I'm not sure our small specialty can pull off ROCR (I hope it can), but it seems insane to me to think we'll stop cuts if we don't try something different than what has been done over the last 10+ years.

This board isn't a fan of ASTRO (and I'm not either, you can go look at my post history) but this bill seems like it gets more right than wrong. Stabilized payments, doesn't penalize new technology (if that's your thing), site neutral payments (a huge deal for us in free standing PP, and something that non-corporate/non-academic docs have wanted for many years), reimbursement for transportation (helpful to practices with a rural footprint)...

Anyway, I guess agree to disagree, but I'm wondering why we'd want to maintain our current trajectory, given how poorly it's gone for 10+ years..
Click to expand...
I don't like getting **** on. I'm getting paid just fine right now.
 
TheWallnerus said:
Be that as it may, a saying I often say is "Be careful to stick your head up above the parapet."
Click to expand...
Do you really say this IRL? If so, that is awesome, but does anyone know what the hell you are talking about?
 
GapCalc said:
Cut one code? What one code?

So for those who are anti-ROCR (including warts, I get that): status quo good with you?

Also, for anyone wanting the text, there are apparently minor changes from the bill from last year, which you can find here:
https://www.congress.gov/bill/118th-congress/senate-bill/4330/text -
Click to expand...

This is the old bill. In my opinion, the changes are more than minor, so it's worth reading the new one.

I can't seem to find it online though...
 
GapCalc said:
But... that's not how it works. The rate is based on FFS rates, with an adjustment. Then we get an inflation adjustment. And it's not subject to budget neutrality.

Let me repeat my earlier question:
So for those who are anti-ROCR (including warts, I get that): status quo good with you?
Click to expand...
I don’t understand how it solves the problem. Cuts are every year. AMA already fighting to tie to inflation. Of course that may not work. But if cuts keep occurring to codes, why would they not apply it to a diagnosis instead? It seems easier to cut us with ROCR

Dislike the process. This is a major change made behind closed doors with little input. It’s was like a “surprise! Now you must love it”.

Benefits large practices. Makes individual physicians and choices less important. Radiation oncology already has a few visionaries and the rest of us are mindless cogs good for patient care only. Urorads encouraging doing everything as long as possible is awful. So is a model encouraging everything to be done as short as possible.

In short, ROCR offers no premise of reversing cuts over the long term, and in fact could make them easier to implement while hastening the most rad oncs to a lemmings like practice.
 
I will prove my age once again. in 1989 the ACR, in anticipation of the CMS adoption of the Harvard produced RBRVS system that we now live under, made the decision to offer a voluntary significant cut and an alternative fee schedule in hopes of being excluded.

If my fading memory is correct it was a massive 20ish percent cut. The head of the ACR James Morehead was somehow suprised when after this was implemented, radiology and radiation oncology were still included in the RBRVS a few years later (1991).

It was another 20 plus percent as I recall.

I looked for a simple internet article explaining the history and found a lot of incorrect whitewashed articles.
BUT, I did find the actual congressional hearing transcript from Dr. Morehead complaining about being knifed in the back, so to speak.

For your enjoyment. https://ia804607.us.archive.org/14/items/medicarepayments00unit_2/medicarepayments00unit_2.pdf
Page 141 of the document. I attempted to upload a PDF of the pertinent pages but I am not sure it was successful.
My point being, those who forget history......
 

Attachments

iradi8r said:
I will prove my age once again. in 1989 the ACR, in anticipation of the CMS adoption of the Harvard produced RBRVS system that we now live under, made the decision to offer a voluntary significant cut and an alternative fee schedule in hopes of being excluded.

If my fading memory is correct it was a massive 20ish percent cut. The head of the ACR James Morehead was somehow suprised when after this was implemented, radiology and radiation oncology were still included in the RBRVS a few years later (1991).

It was another 20 plus percent as I recall.

I looked for a simple internet article explaining the history and found a lot of incorrect whitewashed articles.
BUT, I did find the actual congressional hearing transcript from Dr. Morehead complaining about being knifed in the back, so to speak.

For your enjoyment. https://ia804607.us.archive.org/14/items/medicarepayments00unit_2/medicarepayments00unit_2.pdf
Page 141 of the document. I attempted to upload a PDF of the pertinent pages but I am not sure it was successful.
My point being, those who forget history......
Click to expand...

YES! This is what happens!

It's no different than doing something nice for the hospital system that you work for and then being surprised when they don't reciprocate at a later time.

The people you originally did it for will be gone and new people will come in and do as they please. NEVER EVER EVER volunteer a cut! Complete rookie mistake.
 
The AMA has been pushing for inflationary adjustments for decades. Congress won’t pass something that doesn’t show savings by the CBO. Supposedly ROCR will be around a 1% cut specialty-wide but also implement annual inflationary adjustments. If implemented for even 1 year before AMA finally gets house of medicine-wide inflationary adjustments passed, then that would be a win, right?

TBD how CBO scores and if the savings are enough for Congress to pass. Advocating for a bill with no cuts would signal what we want, but it not realistically be politically viable. Would we rather the specialty signal what we ideally want long-term or try for something that may actually be politically viable in the near-term?
 
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Here is a link to the new bill for those interested: https://www.tillis.senate.gov/services/files/A85445FA-7ED5-41DE-962E-2E1CFC254BA8

I enjoyed Beckta's podcast on the updates so will link that too:

Tumorinator said:
TBD how CBO scores and if the savings are enough for Congress to pass. Advocating for a bill with no cuts would signal what we want, but it not realistically be politically viable. Would we rather the specialty signal what we ideally want long-term or try for something that may actually be politically viable in the near-term?
Click to expand...

I get it. However, we seem to be taking the approach of giving away the house to all of these "stakeholders" to get this done. I'm not a fan. Of course reasonable people can and should disagree, and discuss it a lot more than we have in the past.

If they can tone down some of these technology stipulations and make the accreditation requirement a lot more flexible, they'd have my support. Writing in a requirement that equipment manufacturers get to design accreditation stipulations is an over the top conflict of interest. We need a lot less of that in medicine, not more.

I know that industry has been a barrier, but I still strongly believe physicians not industry should be calling the shots when it comes to quality and patient care. This is especially important in technology forward fields like ours.

These will be the things I focus on when I write my representatives.
 
NotMattSpraker said:
Here is a link to the new bill for those interested: https://www.tillis.senate.gov/services/files/A85445FA-7ED5-41DE-962E-2E1CFC254BA8

I enjoyed Beckta's podcast on the updates so will link that too:



I get it. However, we seem to be taking the approach of giving away the house to all of these "stakeholders" to get this done. I'm not a fan. Of course reasonable people can and should disagree, and discuss it a lot more than we have in the past.

If they can tone down some of these technology stipulations and make the accreditation requirement a lot more flexible, they'd have my support. Writing in a requirement that equipment manufacturers get to design accreditation stipulations is an over the top conflict of interest. We need a lot less of that in medicine, not more.

I know that industry has been a barrier, but I still strongly believe physicians not industry should be calling the shots when it comes to quality and patient care. This is especially important in technology forward fields like ours.

These will be the things I focus on when I write my representatives.
Click to expand...

Geez oh Pete. One thing only can be said after listening to Beckta’s podcast: F,,K ASTRO. I regret the thousands of bucks I’ve given ASTRO through the years. This is kind of akin to ObamaCare, and when the Supreme Court decided people weren’t actually forced to buy health insurance… it was just a tax wink wink. Ronald Reagan would say: hello, I’m from ASTRO, and I’m here to help.
 
thesauce said:
I've seen some very severe complications from SBRT requiring multiple procedures and even surgeries.

But the acute effects that are higher (which we can all agree on) are completely unnecessary when they have the alternative of standard frac with which these issues are essentially non-existent. Better they come a few more times and skip the toxicity altogether and are happy and tell their friends what a great option RT is. Instead they say how much better it would be with protons since they are comparing it with SBRT, when it was only the fractionation that made a difference.

Convenience as the primary oncologic endpoint (which is almost every trial run in the last 10 years) has gotten entirely out of hand. One of these days (if we survive as a field) we'll get back to actually trying to improve REAL oncologic outcomes.
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sauce where are you seeing 7%? I see 2/45 at 2 yrs here: https://ascopubs.org/doi/pdf/10.1200/JCO.2023.41.6_suppl.298?role=tab
 
Tremendously informative podcast, thank you so much for posting it. Here’s the TLDH version:

1. This town hall was a real one. Open forum, questions asked and questions answered.

2. ASTRO said that the ROCR was collaborative and was done in collaboration with “stakeholders.” Jason never heard about this, I echo his sentiments. The collaboration was likely from the usual ASTRO academic echo chamber.

3. ROCR favors larger hospital and academic practice who can pay for ACR/ASTRO accreditation. It makes accreditation mandatory at the federal level or you are financially penalized. It forces you to buy products from ASTRO/ACR.

4. There are shorter windows for palliative care patients compared to older proposed models. From one capitated payment every 90 days to once every 30 days. This is an improvement.

5. Five critical flaws in ROCR:
A) $500/patient for transportation assistance. The funds are sent directly to hospital accounts without any requirement to actually use this money on transport.
B) New CPT codes allow us to bill for adaptive on top of capitated rate. Evicore already denies these claims from large health systems for abuse. If allowed, the rich get richer.
C) Mandatory ACR/ACRO/APEX certification. We also have quality standards for accelerators that can be heavily influenced by manufacturers. This can result in a need for newer machines or else you lose accreditation.
D) Technology adoption goes to 12 years. This allows big pocketed Rad Onc departments to keep buying new capital to be exempt from capitation.
E) 10% of people will get exemptions as “limited resource practices.” This percentage is too small to include all people who are truly deserving.

6. Taking oversight of Medicare out of the hands of CMS and putting it in the hands of Congress is unprecedented. Rad Onc is rendered uniquely vulnerable to political fluctuations (see USAID).

7. No mandated changes for 7 years after implementation. If ROCR is a disaster after a year or two, we have to live with it.

Sieven proposed modifications:

A) Replace $500 payments with radiation travel network that anyone can use for ride share and the like.
B) Cap annual accreditation fee to $4,000. Give alternative to ACR/APEX. Like peer review across multiple practices. Delete manufacturer influence on legally required quality standards.
C) Technology exemption is 7 years. Give 2% bonus for adoption of new tech.
D) Raise hardship exemption cap from 10% to 20%. Create a fund to bring rural programs into compliance with accreditating bodies.
E) Regulate double dipping. If adaptive FFS on top of capitation - only one per episode.
F) Payment modifiers for treatment complexity
G) Shield payments from congressional risk
 
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Gfunk6 said:
3. ROCR favors larger hospital and academic practice who can pay for ACR/ASTRO accreditation. It makes accreditation mandatory at the federal level or you are financially penalized. It forces you to buy products from ASTRO/ACR.

C) Mandatory ACR/ACRO/APEX certification.
Click to expand...
Hard no.

👎
 
Based on what I read it seems as though the entity collecting the technical revenue can enter the Z code and collect the $500 for patients in urban areas up to 75 miles away (no mileage limit if the patient is in a rural area). Am I reading this correctly? It seems like this is going to further encourage treatment at large academic centers instead of having patients getting treated in the community, close to home. If someone in a non rural area wants to drive 75 miles to get treatment at a particular center (and likely drive past 3 other radiation facilities) that is certainly their prerogative. But it seems crazy to me that the facility would still be able to collect the $500, unless there is something in the bill I am missing that would prevent this.
 
njdamic said:
Based on what I read it seems as though the entity collecting the technical revenue can enter the Z code and collect the $500 for patients in urban areas up to 75 miles away (no mileage limit if the patient is in a rural area). Am I reading this correctly? It seems like this is going to further encourage treatment at large academic centers instead of having patients getting treated in the community, close to home. If someone in a non rural area wants to drive 75 miles to get treatment at a particular center (and likely drive past 3 other radiation facilities) that is certainly their prerogative. But it seems crazy to me that the facility would still be able to collect the $500, unless there is something in the bill I am missing that would prevent this.
Click to expand...

The rich get richer. Which is why I think it will pass. This is America. This is Congress.

Corporate medicine wins again. Some large health systems that offer absolutely nothing different in terms of trials or technology are going to milk this to the max. Systems like Optum, Providence etc.
 
Gfunk6 said:
Not sure what you are referring to
Click to expand...

Every few years, CMS updates the practice expense valuation. Years ago, they were trying to lump us in with radiology, but by the grace of God, we had a radiation oncologist in the House of Representatives who spoke out against it and they carved it out. They wanted to lump us in with radiology because they literally had no idea what Rad Onc was.

Now they’re looking at updating the PEs and again lumping us in with rads (because there’s no institutional memory) which would likely be a substantial cut.

Just wondering if it came up in the Town Hall
 
drowsy12 said:
The rich get richer. Which is why I think it will pass. This is America. This is Congress.

Corporate medicine wins again. Some large health systems that offer absolutely nothing different in terms of trials or technology are going to milk this to the max. Systems like Optum, Providence etc.
Click to expand...

Im not as confident even though I agree with your comments about America. Id be curious to hear how hospitals are receiving ROCR v2 with the new technology stipulations. The AHA is powerful.

I think some in government and healthcare lobbying from other fields may view our field as greedy. No one has told me this explicitly, it is based on numerous conversationse over a few years. This version of the bill has several aspects that could be viewed as more RO greed.

It also does not seem like RO representatives are viewed favorably by CMS or the AMA/RUCC.

Im not making a prediction, just don't think its a lock. We still dont even know if the government agrees that any version of ROCR will save them money (no CBO score to date).
 
thesauce said:
Every few years, CMS updates the practice expense valuation. Years ago, they were trying to lump us in with radiology, but by the grace of God, we had a radiation oncologist in the House of Representatives who spoke out against it and they carved it out. They wanted to lump us in with radiology because they literally had no idea what Rad Onc was.

Now they’re looking at updating the PEs and again lumping us in with rads (because there’s no institutional memory) which would likely be a substantial cut.

Just wondering if it came up in the Town Hall
Click to expand...
I don’t recall hearing that in the town hall or podcast.
 
njdamic said:
Based on what I read it seems as though the entity collecting the technical revenue can enter the Z code and collect the $500 for patients in urban areas up to 75 miles away (no mileage limit if the patient is in a rural area). Am I reading this correctly? It seems like this is going to further encourage treatment at large academic centers instead of having patients getting treated in the community, close to home. If someone in a non rural area wants to drive 75 miles to get treatment at a particular center (and likely drive past 3 other radiation facilities) that is certainly their prerogative. But it seems crazy to me that the facility would still be able to collect the $500, unless there is something in the bill I am missing that would prevent this.
Click to expand...

That is my understanding of this.
 
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