ASTRO Town Hall Discussion (Poll % on site)

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Necessary percent of time on site for RadOncs

  • 100%

  • 90%

  • 75%

  • 50%

  • 25%

  • 10%

  • 0%

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RO28 said:
you should see my inbox...not sure whats worse, my gmail inbox, my actual physical inbox or my aria task pad

to be clear, i do all the tasks, I just don't use the task pad.
Click to expand...

I am a proud task pad neglector. I brag about it and I think they let me do that so I feel like I have control over my career. I do all my work in a very timely manner and communicate like crazy to every through teams and text. I refuse to go in to a different program to mark off that, yes I saw my consult. If I dont do the note, I have another inbox for that plus a staffer that writes me, sometimes even if the note is done!

Right now I have... 557 overdue task pad items. Crushing!

You know whats really weird. I've asked for an Aria trainer like 6 times in 5 years across 3 different companies and I could never get it to take haha. It seems like a really powerful software designed by the devil. I'd love to learn about it some day, or not apparently.

Addendum: 558 🙂
 
NotMattSpraker said:
I am a proud task pad neglector. I brag about it and I think they let me do that so I feel like I have control over my career. I do all my work in a very timely manner and communicate like crazy to every through teams and text. I refuse to go in to a different program to mark off that, yes I saw my consult. If I dont do the note, I have another inbox for that plus a staffer that writes me, sometimes even if the note is done!

Right now I have... 557 overdue task pad items. Crushing!

You know whats really weird. I've asked for an Aria trainer like 6 times in 5 years across 3 different companies and I could never get it to take haha. It seems like a really powerful software designed by the devil. I'd love to learn about it some day, or not apparently.

Addendum: 558 🙂
Click to expand...
so...I'm at 3064 😆

I agree, I can only handle checking so many boxes day.
 




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ADKq_NbYco5TDl68n7kjjOH7U0EBgq6saBflvwCphxSGYnu0eMitij3D8cEjOfTeSVAjKE6d4WBQh44faB_zqtDlcUMwjUjyXKcC7wvN-Elf8cBcTs-tg12RajEkju8=s0-d-e1-ft
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Update on the American College of Radiation Oncology’s Position on Supervision in Radiation Oncology​

The American College of Radiation Oncology (ACRO) is pleased to release the following update concerning our position on supervision requirements for the delivery of radiation therapy. Since 2019, ACRO has advocated for a uniform level of supervision across sites of service with reasonable exceptions. This topic has been the source of significant discussion over recent months. As such the College has taken a deliberate, methodical, and informed approach to gather feedback from the radiation oncology community. ACRO has conducted two separate surveys on this matter gathering input from both member and non-member radiation oncologists in every state and every practice setting.


The findings conveyed include the following:
  1. Direct and general supervision have a role in safe, quality care delivery when used responsibly.
  2. Some degree of flexibility at the discretion of the Radiation Oncologist is warranted in all sites of service.
  3. Certain treatments demand direct supervision at each session, while other treatments may only require direct supervision at the initiation of therapy.
  4. Supervision requirements with reasonable exceptions should be unrelated to site of service and geographic location.
  5. Variations in supervision requirements based on advances in technology (e.g. “virtual direct supervision”) should be considered after further review in the future.

At the end of 2023, ACRO performed the most robust nationwide survey of which we are aware, conducted over five months with participation from over 500 Radiation Oncologists in all practice settings and representing every state across the USA. The study, entitled, “Consensus on Payment Model Reform amongst Radiation Oncologists: The Radiation Oncology Payment Reform Survey” was authored by Dr. Joseph Wilding and colleagues, and presented at the 2024 ACRO Summit with the following key finding:

  • 69% of practicing U.S. Radiation Oncologists agree or strongly agree with site-neutral direct supervision requirements with limited exceptions. This finding reflected general agreement across the community and included responses from Radiation Oncologists in academic hospitals and veterans’ healthcare centers as well as hospital-based and freestanding sites-of-service.

ACRO most recently conducted a second survey to gather additional feedback directly from its members. With 142 respondents, the key findings from the survey are as follows:

  • 94% of ACRO Members surveyed believe Radiation Oncologists are the only healthcare providers comprehensively trained in treatment and management of radiation therapy patients.
  • 64% of respondents believe direct supervision should be the standard across sites-of service at the initiation of radiation therapy.
  • 86% of respondents indicated general supervision should be allowed at the discretion of the Radiation Oncologist, after the initiation of radiation therapy.

We are grateful for this feedback from the Radiation Oncology community. An informed and thoughtful approach to these complex issues is essential. This feedback will be incorporated into an updated consensus statement to be released by ACRO in the coming days.

Sincerely,​
Tarita Thomas, MD, PhD, MBA, FACRO
Chair, ACRO Government Relations & Economics Committee​
ADKq_NbYco5TDl68n7kjjOH7U0EBgq6saBflvwCphxSGYnu0eMitij3D8cEjOfTeSVAjKE6d4WBQh44faB_zqtDlcUMwjUjyXKcC7wvN-Elf8cBcTs-tg12RajEkju8=s0-d-e1-ft
Dwight E. Heron, MD, MBA, FACRO, FACR, FASTRO
ACRO President​
 
medgator said:


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ADKq_NbYco5TDl68n7kjjOH7U0EBgq6saBflvwCphxSGYnu0eMitij3D8cEjOfTeSVAjKE6d4WBQh44faB_zqtDlcUMwjUjyXKcC7wvN-Elf8cBcTs-tg12RajEkju8=s0-d-e1-ft
​
​

Update on the American College of Radiation Oncology’s Position on Supervision in Radiation Oncology​
​

The American College of Radiation Oncology (ACRO) is pleased to release the following update concerning our position on supervision requirements for the delivery of radiation therapy. Since 2019, ACRO has advocated for a uniform level of supervision across sites of service with reasonable exceptions. This topic has been the source of significant discussion over recent months. As such the College has taken a deliberate, methodical, and informed approach to gather feedback from the radiation oncology community. ACRO has conducted two separate surveys on this matter gathering input from both member and non-member radiation oncologists in every state and every practice setting.


The findings conveyed include the following:​
  1. Direct and general supervision have a role in safe, quality care delivery when used responsibly.
  2. Some degree of flexibility at the discretion of the Radiation Oncologist is warranted in all sites of service.
  3. Certain treatments demand direct supervision at each session, while other treatments may only require direct supervision at the initiation of therapy.
  4. Supervision requirements with reasonable exceptions should be unrelated to site of service and geographic location.
  5. Variations in supervision requirements based on advances in technology (e.g. “virtual direct supervision”) should be considered after further review in the future.


At the end of 2023, ACRO performed the most robust nationwide survey of which we are aware, conducted over five months with participation from over 500 Radiation Oncologists in all practice settings and representing every state across the USA. The study, entitled, “Consensus on Payment Model Reform amongst Radiation Oncologists: The Radiation Oncology Payment Reform Survey” was authored by Dr. Joseph Wilding and colleagues, and presented at the 2024 ACRO Summit with the following key finding:
​
  • 69% of practicing U.S. Radiation Oncologists agree or strongly agree with site-neutral direct supervision requirements with limited exceptions. This finding reflected general agreement across the community and included responses from Radiation Oncologists in academic hospitals and veterans’ healthcare centers as well as hospital-based and freestanding sites-of-service.


ACRO most recently conducted a second survey to gather additional feedback directly from its members. With 142 respondents, the key findings from the survey are as follows:
​
  • 94% of ACRO Members surveyed believe Radiation Oncologists are the only healthcare providers comprehensively trained in treatment and management of radiation therapy patients.
  • 64% of respondents believe direct supervision should be the standard across sites-of service at the initiation of radiation therapy.
  • 86% of respondents indicated general supervision should be allowed at the discretion of the Radiation Oncologist, after the initiation of radiation therapy.


We are grateful for this feedback from the Radiation Oncology community. An informed and thoughtful approach to these complex issues is essential. This feedback will be incorporated into an updated consensus statement to be released by ACRO in the coming days.

Sincerely,​
​
​
Tarita Thomas, MD, PhD, MBA, FACRO
Chair, ACRO Government Relations & Economics Committee​
ADKq_NbYco5TDl68n7kjjOH7U0EBgq6saBflvwCphxSGYnu0eMitij3D8cEjOfTeSVAjKE6d4WBQh44faB_zqtDlcUMwjUjyXKcC7wvN-Elf8cBcTs-tg12RajEkju8=s0-d-e1-ft
​
​
Dwight E. Heron, MD, MBA, FACRO, FACR, FASTRO
ACRO President​


Click to expand...
I would rate this as way better than the ASTRO letter to CMS
 
"ACRO most recently conducted a second survey to gather additional feedback directly from its members. With 142 respondents..."
"At the end of 2023, ACRO performed the most robust nationwide survey of which we are aware, conducted over five months with participation from over 500 Radiation Oncologists."

Post this only to ask does cms even care about our opinions with these kinda numbers?
 
Last edited:
Mandelin Rain said:
Correct.

From the FAQ:
Many radiation therapy services specifically include physician presence in the CPT code descriptor and are valued accordingly. Changes in physician presence can impact valuation, therefore a shift to virtual supervision is likely to result in reduced reimbursement to radiation oncologists for services.
Click to expand...
What if I had an avatar present to represent my physical self?

I’m obviously late to the thread but appreciate the arguments presented.

To all of those who fear the CMS, just know they will come at you regardless. I believe we need to evolve and adapt and not hide behind some misguided necessity of the importance of having a physical presence in the clinic. Instead, we need to justify our importance as radiation oncologist and the cerebral aspect of our field. We have staff to push the buttons and “providers” who can chat about the use of aquaphor to the patients.

As far as safety goes, if someone is going to be a bad radiation oncologist, they will continue to be one rather if they are present or not. It wouldn’t change their plan of giving 97 Gy to the brain stem.
 
Last edited:
RadOncDoc21 said:
What if I had an avatar present to represent my physical self?

I’m obviously late to the thread but appreciate the arguments presented.

To all of those who fear the CMS, just know they will come at you regardless. I believe we need to evolve and adapt and not hide behind some misguided necessity of the importance of having a physical presence in the clinic. Instead, we need to justify our importance as radiation oncologist and the cerebral aspect of our field. We have staff to push the buttons and “providers” who can chat about the use of aquaphor to the patients.

As far as safety goes, if someone is going to be a bad radiation oncologist, they will continue to be one rather if they are present or not. It wouldn’t change their plan of giving 97 Gy to the brain stem.
Click to expand...
Agree wholeheartedly. I really respect ACRO for bringing the question to its members, but I think their initial response is too convoluted. It doesn't feel like CMS wants to complicate things with all these bullet points and exceptions attached exclusively to supervision for a small specialty like rad onc. Sameer did mention this during the ASTRO town hall. Okay, the doc needs to be there the first day, but not the subsequent days. How is that safer than daily virtual direct? What if you just do ports the first day? Does that count as being there for the first day or does the person need to be treated? What if machine breaks down mid-treatment and you need to complete the first treatment the next day? If we go to ROCR and everything goes to case rate...what if you just convert all your SBRTs to 6 fractions and still collect the full IMRT case rate? Now you don't need to be there? Guys like RonD build careers on this uncertainty.
 
MidwestRadOnc said:
"Changes... are expected in July"?

How do they know changes are expected? Sounds like they are expecting virtual direct to be made permanent and are gearing up to officially challenge it.
Click to expand...
You can bet your ass ASTRO and RonD are furiously searching billing and coding guidelines to come up with some esoteric way to invalidate a simple CMS proposal for permanent virtual direct. Maybe IGRT will be neither a diagnostic or therapeutic service and since MACs and CMS haven't weighed in on this new type of non-diagnostic, non-therapeutic imaging, personal supervision is required at all sites of service.
 
Last edited:
Reaganite said:
You can bet your ass ASTRO and RonD are furiously searching billing and coding guidelines to come up with some esoteric way to invalidate a simple CMS proposal for permanent virtual direct. Maybe IGRT will be neither a diagnostic or therapeutic service and since MACs and CMS haven't weighed in on this new type of non-diagnostic, non-therapeutic imaging, personal supervision is required at all sites of service.
Click to expand...
Haha. ASTRO already called CMS unsafe and a danger to patient care at the town hall. Now maybe they will say that Medicare is committing Medicare fraud. Maybe Ron can whistleblow CMS?! So meta.
 
MidwestRadOnc said:
Was ASTRO planning to attack the 2019 general supervision rule as well, then the pandemic just delayed things?



Next you are going to tell me social security is a Ponzi scheme.
Click to expand...
I believe pyramid scheme may be more accurate? Need more workers to support the beneficiaries!
 
In all seriousness, I predict if CMS makes virtual supervision permanent, ASTRO will suddenly have a major hard on for RonD site of service stuff. It'll be the new meta and the new basis for qui tam.
 
MidwestRadOnc said:
Can you make FOIA request if you really wanna know?
Click to expand...
i dont think its a gov agency. called the arrt and all they will confirm is that licenses are only revoked for severe ethical violations. For a "minor" violation like a meth binge, they would just suspend you.
 
RickyScott said:
i dont think its a gov agency. called the arrt and all they will confirm is that licenses are only revoked for severe ethical violations. For a "minor" violation like a meth binge, they would just suspend you.
Click to expand...

I have no idea in this case if a license was actually revoked, but for a physician it would typically be something like:

Possibilities I can think of:
- Felony? Multiple DUIs, Crimes of moral turpitude, assault and battery/rape, etc.
- Stealing controlled meds, coming to work and treating patients drunk, etc.
- Sexual misconduct towards patients and/or staff
- Gross negligence (really insanely bad stuff like giving 70 Gy whole brain or something), operating after smoking crack, etc.
 
MidwestRadOnc said:
I have no idea in this case if a license was actually revoked, but for a physician it would typically be something like:

Possibilities I can think of:
- Felony? Multiple DUIs, Crimes of moral turpitude, assault and battery/rape, etc.
- Stealing controlled meds, coming to work and treating patients drunk, etc.
- Sexual misconduct towards patients and/or staff
- Gross negligence (really insanely bad stuff like giving 70 Gy whole brain or something), operating after smoking crack, etc.
Click to expand...
George Costanza Seinfeld GIF
 
I don't like this paper, it doesn't support the notion that our specialty is imploding.
 
I thought it showed how increased consolidation does create more jobs, albeit fewer very high paying jobs that existed in small business-type setups in the past.

corporate takeover of medicine is the original sin. in all of medicine. all else comes from that or is hand in hand with it, like corporate insurance and corporate middle men in Pharma are. and then these sectors create the conditions for other small cottage industries arise like Evicore and other insurance side monkeys.

capitalism, baby!
 
drowsy12 said:
I thought it showed how increased consolidation does create more jobs, albeit fewer very high paying jobs that existed in small business-type setups in the past.

corporate takeover of medicine is the original sin. in all of medicine. all else comes from that or is hand in hand with it, like corporate insurance and corporate middle men in Pharma are. and then these sectors create the conditions for other small cottage industries arise like Evicore and other insurance side monkeys.

capitalism, baby!
Click to expand...
Number of radoncs are increasing while indications and rvus decrease. University systems like to overhire. It keeps the docs hungry and more likely to over treat. Last time I looked at the acr survey, new pts per doc was down considerably vs when I started out.
 
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Chartreuse Wombat said:
These large academic health systems seek to employ persons who are satisfied with mediocre comp for median effort. They don't like persons that work hard and demand compensation "above the median". Lazy sheep are easier to manage
Click to expand...

Also ensures working long into life rather than earlier retirement
 
Workforce growing at 4.1% per year. Job openings growing at 4.2% per year. That was the headline I took from it. I'm not a numbers guy, but seems like supply is growing with demand?
 
My group’s new starts are up ten percent from last year. But total number on beam at any time are not what they were 10 years ago of course
 
Pointless said:
Workforce growing at 4.1% per year. Job openings growing at 4.2% per year. That was the headline I took from it. I'm not a numbers guy, but seems like supply is growing with demand?
Click to expand...
In a way is this like saying that the rising number of dollars in circulation means people can keep up with the rising price of eggs very easily
 
Pointless said:
It's... not like saying that. But sure.
Click to expand...
I don't need a survey to tell me pay is going down.

If we have 5000 rad oncs making on average $500K a year each, we can easily have 10000 rad oncs nationwide making $250K a year each... why not. Workforce and job openings growing for as far as the eye can see.
 
TheWallnerus said:
If we have 5000 rad oncs making on average $500K a year each, we can easily have 10000 rad oncs nationwide making $250K a year each... why not. Workforce and job openings growing for as far as the eye can see.
Click to expand...
This is exactly what management/employers want. Coverage is easier; oversupply helps the employers and hurts the employees.
 
TheWallnerus said:
I don't need a survey to tell me pay is going down.

If we have 5000 rad oncs making on average $500K a year each, we can easily have 10000 rad oncs nationwide making $250K a year each... why not. Workforce and job openings growing for as far as the eye can see.
Click to expand...
That's fine, and that may be true, all I'm saying is that's not what the quoted study says is happening. It IS obvious that consolidation is happening; small hospitals are being absorbed by larger hospitals at an increasing rate. It has happened in my own practice, but the actual substance of my job has not changed one bit, just the name on the door.

My personal experience is that I am busier than ever and that is consistent with the other people I keep in touch with in private/hospital based practices. So for all of the hypofractionation/elimination of radiation, it feels like we are replacing with complex re-treats of patients who are living longer and doing better than would have been reasonably expected 5-10 years ago. We are getting better at managing cancer and it shows in these kinds of cases.

I also see a disturbing trend of younger patients coming in with new diagnoses and I wonder if we aren't starting to see the tip of an iceberg of increased cancer incidence owing to pollution, poor diet, pesticides, etc. There is a non-zero chance that cancer incidences will rise significantly in the coming years, both due to the aging population and for as-of-yet undefined reasons amongst younger patients. I hope that is not the case and you guys are all right, but it certainly doesn't feel that way right now.

Anyway, good discussion and you'll never find my disagreeing with the notion that our specialty has been criminally mishandled by the powers that be. I just continue to have an experience that is in almost direct contradiction to what is accepted as common knowledge on this board.
 
Pointless said:
I also see a disturbing trend of younger patients coming in with new diagnoses and I wonder if we aren't starting to see the tip of an iceberg of increased cancer incidence owing to pollution, poor diet, pesticides, etc.
Click to expand...

I am this close to locking my polyester clothes in a box and replacing my wardrobe with 100% cotton, wool, and cashmere which I’m told is fancy wool from fancy goats. Only thing in the kitchen is glass, stainless steel, organic food, and reverse osmosis water. Floors natural stone and wood. Sometimes I vacuum the ceiling.

What else can we do to mitigate environmental contamination besides colonoscopies at 40 and hitting the gym? TBH I’m more worried about cv/metabolic impacts from our environment than cancer risk.
 
yesmaster said:
I am this close to locking my polyester clothes in a box and replacing my wardrobe with 100% cotton, wool, and cashmere which I’m told is fancy wool from fancy goats. Only thing in the kitchen is glass, stainless steel, organic food, and reverse osmosis water. Floors natural stone and wood. Sometimes I vacuum the ceiling.

What else can we do to mitigate environmental contamination besides colonoscopies at 40 and hitting the gym? TBH I’m more worried about cv/metabolic impacts from our environment than cancer risk.
Click to expand...

Do you have a radon detector in your home 😊
 
Pointless said:
That's fine, and that may be true, all I'm saying is that's not what the quoted study says is happening. It IS obvious that consolidation is happening; small hospitals are being absorbed by larger hospitals at an increasing rate. It has happened in my own practice, but the actual substance of my job has not changed one bit, just the name on the door.

My personal experience is that I am busier than ever and that is consistent with the other people I keep in touch with in private/hospital based practices. So for all of the hypofractionation/elimination of radiation, it feels like we are replacing with complex re-treats of patients who are living longer and doing better than would have been reasonably expected 5-10 years ago. We are getting better at managing cancer and it shows in these kinds of cases.

I also see a disturbing trend of younger patients coming in with new diagnoses and I wonder if we aren't starting to see the tip of an iceberg of increased cancer incidence owing to pollution, poor diet, pesticides, etc. There is a non-zero chance that cancer incidences will rise significantly in the coming years, both due to the aging population and for as-of-yet undefined reasons amongst younger patients. I hope that is not the case and you guys are all right, but it certainly doesn't feel that way right now.

Anyway, good discussion and you'll never find my disagreeing with the notion that our specialty has been criminally mishandled by the powers that be. I just continue to have an experience that is in almost direct contradiction to what is accepted as common knowledge on this board.
Click to expand...


Fully agree and I think many people do, to be honest.
 
yesmaster said:
I am this close to locking my polyester clothes in a box and replacing my wardrobe with 100% cotton, wool, and cashmere which I’m told is fancy wool from fancy goats. Only thing in the kitchen is glass, stainless steel, organic food, and reverse osmosis water. Floors natural stone and wood. Sometimes I vacuum the ceiling.

What else can we do to mitigate environmental contamination besides colonoscopies at 40 and hitting the gym? TBH I’m more worried about cv/metabolic impacts from our environment than cancer risk.
Click to expand...
Not sure if sarcastic (you lost me at ceiling vacuuming), but I otherwise do many of the same things (e.g. organic food, minimizing plastic, RO water). The struggle is real 🤣
 
yesmaster said:
I am this close to locking my polyester clothes in a box and replacing my wardrobe with 100% cotton, wool, and cashmere which I’m told is fancy wool from fancy goats. Only thing in the kitchen is glass, stainless steel, organic food, and reverse osmosis water. Floors natural stone and wood. Sometimes I vacuum the ceiling.

What else can we do to mitigate environmental contamination besides colonoscopies at 40 and hitting the gym? TBH I’m more worried about cv/metabolic impacts from our environment than cancer risk.
Click to expand...
Radon! More people die just from radon causing lung cancer (independent of tobacco) than the total number of gastric cancer deaths.

Doesn’t explain young folks getting cancer but, depending on where you live and your lifestyle, having your basement inspected for radon is probably the most important way to mitigate risk of dying from cancer.
 
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