Big Rad Onc performing TH consults

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Gfunk6

And to think . . . I hesitated
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I thought you guys would find this very interesting.


Long-story short, California mandates that physicians who perform telehealth services on Califorina residents need to be licensed in the state. This runs afoul of an MSKSCC Rad Onc who used to perform TH consults on CA patients, but can no longer do so because of said legislation. The claimant in the lawsuit is licensed in NY, but not in CA and (apprently has no desire/capacity to do so).

The restrictions also affect out-of-state medical specialists whose care is critical to their patients in California. This includes Dr. Sean McBride, a respected radiation oncologist at Memorial Sloan Kettering Cancer Center in New York. He uses telehealth to consult with his out-of-state patients, and to discuss whether they should travel to New York for advanced in-person treatments. He also uses telehealth to follow up with his patients upon their return home after treatment.

Of course, California being the backward-ass state that it is has absolutely no capacity to provide the same level of care as MSKCC (*cough* UCSF *cough* Stanford *cough* USC *cough* UCLA *cough* COH *cough* UCSD). Maybe MSKCC ought to be allowed to convince rich patients to fly out to Manhattan so they can get eight weeks of protons for their low-risk prostate cancer?

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I thought you guys would find this very interesting.


Long-story short, California mandates that physicians who perform telehealth services on Califorina residents need to be licensed in the state. This runs afoul of an MSKSCC Rad Onc who used to perform TH consults on CA patients, but can no longer do so because of said legislation. The claimant in the lawsuit is licensed in NY, but not in CA and (apprently has no desire/capacity to do so).



Of course, California being the backward-ass state that it is has absolutely no capacity to provide the same level of care as MSKCC (*cough* UCSF *cough* Stanford *cough* USC *cough* UCLA *cough* COH *cough* UCSD). Maybe MSKCC ought to be allowed to convince rich patients to fly out to Manhattan so they can get eight weeks of protons for their low-risk prostate cancer?
Hmmm.

So in a universe where ASTRO gets everything it wants, and this suit is successful:

A physician sitting in their office at a PPS-exempt center as "doc of the day" providing direct supervision to the 8+ linacs running at once

Can perform a virtual consult in any of the 50 states

And convince a patient to fly to their center to receive the most expensive version of any radiotherapy regimen, proton or not.

Alternatively

In the same scenario, one doc on site, 8+ linacs humming

Virtual consult

Can sell the patient on flying to their hospital for a 1-5 treatment course of SBRT

Reimbursed under ROCR for the same amount as if the patient had gotten treatment at their local hospital 5 minutes from their house.

Maybe the local doc had recommended something barbaric, such as Canadian fractionation for breast.

Good thing the telehealth doc at the bigger academic institution is there to save the day, with their 5 fraction regimen!

[Cue Terminator music]
 
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Hmmm.

So in a universe where ASTRO gets everything it wants, and this suit is successful:

A physician sitting in their office at a PPS-exempt center as "doc of the day" providing direct supervision to the 8+ linacs running at once

Can perform a virtual consult in any of the 50 states

And convince a patient to fly to their center to receive the most expensive version of any radiotherapy regimen, proton or not.

Alternatively

In the same scenario, one doc on site, 8+ linacs humming

Virtual consult

Can sell the patient on flying to their hospital for a 1-5 treatment course of SBRT

Reimbursed under ROCR for the same amount as if the patient had gotten treatment at their local hospital 5 minutes from their house.

Maybe the local doc had recommended something barbaric, such as Canadian fractionation for breast.

Good thing the telehealth doc at the bigger academic institution is there to save the day, with their 5 fraction regimen!

[Cue Terminator music]
Does the costs of patient travel mentioned in ROCR help to defray the costs of private jets to Rochester, Houston, and NYC? If not, could we *at least* convince the feds to pay for carbon offsets???
 
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Grey zone on what constitutes a formal consult.
Cant prohibit someone from talking to someone else, then later when they fly in in-person provide the ‘consult’ then. Unless I am misunderstanding something. The above happens often.
 
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Does the costs of patient travel mentioned in ROCR help to defray the costs of private jets to Rochester, Houston, and NYC? If not, could we *at least* convince the feds to pay for carbon offsets???
In the bill there is an ICD 10 for travel hardship and once that is entered into the patient’s chart the patient will be eligible for travel credits, for health equity’s sake (this is in the health equity section of the bill).
 
In the bill there is an ICD 10 for travel hardship and once that is entered into the patient’s chart the patient will be eligible for travel credits, for health equity’s sake (this is in the health equity section of the bill).

It seems like its a one time payment of $500 added to technical per patient.

Right now, this will really, really help my patients and center. We give a lot of travel funds and they are all grant supported or hospital foundation supported. When they run out they are gone. Every time my patient has had this, we are the closest linac by the way.

Now, Im also ready to be very disappointed if this $500 doesnt actually make it back into the patients pocket. Could totally see that happening at many centers.

Im not sure this is really a competitive advantage because everyone is eligible.... except when you combine it with exclusion of protons and the administrative disadvantage driving consolidation in my opinion.
 
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I thought you guys would find this very interesting.


Long-story short, California mandates that physicians who perform telehealth services on Califorina residents need to be licensed in the state. This runs afoul of an MSKSCC Rad Onc who used to perform TH consults on CA patients, but can no longer do so because of said legislation. The claimant in the lawsuit is licensed in NY, but not in CA and (apprently has no desire/capacity to do so).



Of course, California being the backward-ass state that it is has absolutely no capacity to provide the same level of care as MSKCC (*cough* UCSF *cough* Stanford *cough* USC *cough* UCLA *cough* COH *cough* UCSD). Maybe MSKCC ought to be allowed to convince rich patients to fly out to Manhattan so they can get eight weeks of protons for their low-risk prostate cancer?

*cough* ANY community cancer center
 
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I thought you guys would find this very interesting.


Long-story short, California mandates that physicians who perform telehealth services on Califorina residents need to be licensed in the state. This runs afoul of an MSKSCC Rad Onc who used to perform TH consults on CA patients, but can no longer do so because of said legislation. The claimant in the lawsuit is licensed in NY, but not in CA and (apprently has no desire/capacity to do so).



Of course, California being the backward-ass state that it is has absolutely no capacity to provide the same level of care as MSKCC (*cough* UCSF *cough* Stanford *cough* USC *cough* UCLA *cough* COH *cough* UCSD). Maybe MSKCC ought to be allowed to convince rich patients to fly out to Manhattan so they can get eight weeks of protons for their low-risk prostate cancer?
This lawsuit is BS.

It's well established in Radiology that you must be licensed where the patient's scans were acquired. If all 50 states consider rendering a radiology interpretation as "practice of medicine", telling people what they cancer treatment options are is just as equally medical care.
 
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as someone who has gone through the pain of getting licensed in multiple states - I’m for this lawsuit. It’s anti physican and serves US no purpose to have to get medical licenses for each individual state. This goes way beyond rad onc. This is a long time coming in my view, and I have no idea of the likelihood of success of the lawsuit but I’m glad attention is being called to a ridiculous system.

I hope eventually it is one more brick that falls in the ridiculous bureaucracy of medicine

I’m sure that there’s too much money to be made from licensing though and it’s too big to fail.
 
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as someone who has gone through the pain of getting licensed in multiple states - I’m for this lawsuit. It’s anti physican and serves US no purpose to have to get medical licenses for each individual state. This goes way beyond rad onc. This is a long time coming in my view, and I have no idea of the likelihood of success of the lawsuit but I’m glad attention is being called to a ridiculous system.

I hope eventually it is one more brick that falls in the ridiculous bureaucracy of medicine

I’m sure that there’s too much money to be made from licensing though and it’s too big to fail.
Once you go through the process in a state, relatively easy to keep. My take is this lawsuit going to fail pretty quickly. What's stopping Dr. MGH or MSKCC from getting licensed in California or wherever? If they're so great, should be easy to get. Optics are poor as well, denigrating the entire medical establishment in other states.

Disagree on a single national licensing authority. Would prefer some yahoo in eg sacramento for 1 state, vs a bureaucrat in DC deciding for all 50.
 
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Disagree on a single national licensing authority. Would prefer some yahoo in eg sacramento for 1 state, vs a bureaucrat in DC deciding for all 50.
Also, the political climate in the US including 6-3 conservative Supreme Court majority means that States rights will hold primacy for a long time.
 
COH already has an airport limo service for patients, so I could see them adding on telehealth and flying patients to one of their regional “centers of excellence” staffed with ex-ctca docs for world class cancer care.
 
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as someone who has gone through the pain of getting licensed in multiple states - I’m for this lawsuit. It’s anti physican and serves US no purpose to have to get medical licenses for each individual state. This goes way beyond rad onc. This is a long time coming in my view, and I have no idea of the likelihood of success of the lawsuit but I’m glad attention is being called to a ridiculous system.

I hope eventually it is one more brick that falls in the ridiculous bureaucracy of medicine

I’m sure that there’s too much money to be made from licensing though and it’s too big to fail.
So much of politics injects itself into medicine.. just look at RvW and the Dobbs decision. No way you ever see a national medical license
 
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Teleconsult is such a lazy way to eval pt for radiation… even know a guy who does video consult for cervical brachy eval
 
It’s complicated evaluating a patient. Probably should legislate at least 3 in-person visits before permitting a CT sim, or any kind of medical management really.
 
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Sometimes the brachy pts are coming from farther away, maybe saves them one less trip 🤷🏽
yes but don’t you want to know if anatomy will permit placing an implant (and what type of implant)
 
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as someone who has gone through the pain of getting licensed in multiple states - I’m for this lawsuit. It’s anti physican and serves US no purpose to have to get medical licenses for each individual state. This goes way beyond rad onc. This is a long time coming in my view, and I have no idea of the likelihood of success of the lawsuit but I’m glad attention is being called to a ridiculous system.

I hope eventually it is one more brick that falls in the ridiculous bureaucracy of medicine

I’m sure that there’s too much money to be made from licensing though and it’s too big to fail.
I have 6+ licenses now.

Some states make it unnecessarily painful. Others actually want our presence. I have a range of 6 months to 2 days (shout to FL on that one).

But the best money I ever spent was getting a letter of qualification from the IMLCC. I got a notoriously tough state license in 1 day after my LOQ was finalized.
 
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I have 6+ licenses now.

Some states make it unnecessarily painful. Others actually want our presence. I have a range of 6 months to 2 days (shout to FL on that one).

But the best money I ever spent was getting a letter of qualification from the IMLCC. I got a notoriously tough state license in 1 day after my LOQ was finalized.
2 days is amazing for FL.

Usually they are one of the longer ones. Their dental boards, in particular, (until recently supposedly) were notoriously rigorous and required an in person practical etc in state to weed out older docs trying to come down and semi retire.

State Rights and politics affect everything and medical licensure is no different.
 
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2 days is amazing for FL.

Usually they are one of the longer ones. Their dental boards, in particular, (until recently supposedly) were notoriously rigorous and required an in person practical etc in state to weed out older docs trying to come down and semi retire.

State Rights and politics affect everything and medical licensure is no different.
When I applied, I checked this new page which had expected turnaround times. It was 1-2 days for medical license when I hit submit.

And I got it in that timeframe. Seems they’ve done something right. It’s 9-11 now so maybe I got lucky. Still way better than other states I have which literally won’t even look at your application until 12 weeks elapses.

 
COH already has an airport limo service for patients, so I could see them adding on telehealth and flying patients to one of their regional “centers of excellence” staffed with ex-ctca docs for world class cancer care.
But, they don't have protons...
 
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