Cost of Excellence?

[CurbYourExpectations]

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Found these articles on PPSE, which has been a topic here sometimes.

https://ascopubs.org/doi/10.1200/OP.24.00440
https://ascopubs.org/doi/10.1200/OP-24-00941

And a discussion on it from everyone's favorite RadOnc, Simul:

The Cost of Excellence: Rethinking PPS-Exempt Cancer Centers

How do we balance innovation, financial sustainability, and access to care?

radiationeconomics.substack.com

I am interested in learning more about what people here think. Mods please move to other thread if this doesn't warrant it's own. I don't personally know a lot about the subject, but found it interesting and well spoken about by both authors. (Was honestly surprised it hasn't been posted anywhere)

 

[evilbooyaa]

Fine to have a new thread on it. It's a topic worthy of discussion. PPS-exempt centers have more money funneling to their Rad Onc departments and can get paid for whatever they deliver to an inpatient. Good for an individual center. Probably good for the docs there.

They also get paid many multiples of Medicare so are more expensive than cheaper nearby facilities, so bad from a collective medical expenditure scenario.

 

[Neuronix]

Could PPS exemption be the next DOGE target?

 

[yesmaster]

Could PPS exemption be the next DOGE target?

Lord knows, I hope so.

 

[Lamount]

Could PPS exemption be the next DOGE target?

I think it would need to be an act of congress...

 

[Chartreuse Wombat]

I think it would need to be an act of congress...

Agree. Legislatively created.

 

[Gfunk6]

I think it would need to be an act of congress...

LOL, we are currently living in a post-congressional era. SCOTUS has told us that POTUS is effectively an emperor with unlimited power unless he his checked by Congress which we know will not happen.

Someone who has an X/Twitter account please tag Elon on this. #PPSBoondoggle

 

[RickyScott]

Could PPS exemption be the next DOGE target?

Maybe someone should look up DEI NIH grants awarded to radoncs so we can report them to the DOGE hotline?

 

[Ray D. Ayshun]

Maybe someone should look up DEI NIH grants awarded to radoncs so we can report them to the DOGE hotline?

Department Of Unregulated Corporate HEgemony?

 

[BobbyHeenan]

Chirag Shah, ladies and gentlemen. I would go to war for that dude. He knew then. He knows now.

 

[CurbYourExpectations]

A few questions if anyone can answer:
Can these groups bill higher prices even if they are not seeing/treating the patients within their facilities? Virtually?
Can they bill higher at satellites within or out of states?
What are the limitations of them being able to bill higher?
Do they have a significant advantage over most surrounding groups due to this exemption?
Do they create better docs (looks like they're making about 25% of RadOncs)?

 

[OTN]

Yes, yes, none that I can see, absolutely yes, absolutely not

 

[communitydoc13]

Maybe someone should look up DEI NIH grants awarded to radoncs so we can report them to the DOGE hotline?

Be careful what you wish for. What's the definition of DEI? The language is in many grants I'm sure. I suspect DOGE is using keyword searches.

My wife had to shut down a gay veterans support group at the VA.

Does that sound right?

Keep your eyes on every message, every offer of asylum, every proposed new program from this government. Keep your eyes on the aesthetics.

I'm done with academia being the enemy for now.

 

[RickyScott]

A few questions if anyone can answer:
Can these groups bill higher prices even if they are not seeing/treating the patients within their facilities? Virtually?
Can they bill higher at satellites within or out of states?
What are the limitations of them being able to bill higher?
Do they have a significant advantage over most surrounding groups due to this exemption?
Do they create better docs (looks like they're making about 25% of RadOncs)?

can def bill same rates at satellites. in fact, the 15-20 mile limit on billing hospital rates at satellites does not apply them.

 

[CurbYourExpectations]

Well, that sucks. Thanks for the info. The author seems like a nice dude from what I've seen of him. Looked like it's similar people defending it that are doing the lawsuit stuff to decrease state regulations on virtual stuff. Does this mean it could go nation wide competition wise with increased billing or would that be too outrageous/not possible? Will be interesting to see how all this goes.

 

[RickyScott]

Well, that sucks. Thanks for the info. The author seems like a nice dude from what I've seen of him. Looked like it's similar people defending it that are doing the lawsuit stuff to decrease state regulations on virtual stuff. Does this mean it could go nation wide competition wise with increased billing or would that be too outrageous/not possible? Will be interesting to see how all this goes.

Anyone know if city of hope is billing pps rates at former cancer centers of America locations? ( Georgia, Arizona, Illinois etc)

 

[NotMattSpraker]

Well, that sucks. Thanks for the info. The author seems like a nice dude from what I've seen of him. Looked like it's similar people defending it that are doing the lawsuit stuff to decrease state regulations on virtual stuff. Does this mean it could go nation wide competition wise with increased billing or would that be too outrageous/not possible? Will be interesting to see how all this goes.

I really appreciated these pieces in JCO. I wish we had more of this kind of stuff, too many afraid to be Chirag. That guy is such a gift to our specialty, and now hes a chair! I dont agree with Sean's arguments for PPSE, but it was a really well written rebuttal and appreciate him for doing it.

I happen to agree with Sean's opinion on telemedicine because I think it's good for a new generation of patients, but am suspicious what MSKCC will do with that new clearance.

Other non PPSE centers also charge a lot and are literally showing you in academic papers how they will spread their services even beyond the US.

Certainly will be interesting, I agree.

 

[StealthTech]

I really appreciated these pieces in JCO. I wish we had more of this kind of stuff, too many afraid to be Chirag. That guy is such a gift to our specialty, and now hes a chair! I dont agree with Sean's arguments for PPSE, but it was a really well written rebuttal and appreciate him for doing it.

I happen to agree with Sean's opinion on telemedicine because I think it's good for a new generation of patients, but am suspicious what MSKCC will do with that new clearance.

Other non PPSE centers also charge a lot and are literally showing you in academic papers how they will spread their services even beyond the US.

Certainly will be interesting, I agree.

Aren't they working on lifting telehealth restrictions nationwide so they can capture patients nationwide?

Wonder if many outside of a pps exempt institution support pps exempt institutions...

 

[BobbyHeenan]

I really appreciated these pieces in JCO. I wish we had more of this kind of stuff, too many afraid to be Chirag. That guy is such a gift to our specialty, and now hes a chair! I dont agree with Sean's arguments for PPSE, but it was a really well written rebuttal and appreciate him for doing it.

I happen to agree with Sean's opinion on telemedicine because I think it's good for a new generation of patients, but am suspicious what MSKCC will do with that new clearance.

Other non PPSE centers also charge a lot and are literally showing you in academic papers how they will spread their services even beyond the US.

Certainly will be interesting, I agree.

At minimum, if you work at a PPSE center you should not be allowed to weigh in or be in any ROCR policy /committee that doesn’t impact you.

The PPSE needs to go. But if it stays I want these folks no where near any policy with zero skin in the game.

You want special rules then play in your own sand box.

 

[Gfunk6]

At minimum, if you work at a PPSE center you should not be allowed to weigh in or be in any ROCR policy /committee that doesn’t impact you.

The PPSE needs to go. But if it stays I want these folks no where near any policy with zero skin in the game.

You want special rules then play in your own sand box.

Welcome to academic Rad Onc - consequence free leadership! What a deal!

 

[evilbooyaa]

Anyone know if city of hope is billing pps rates at former cancer centers of America locations? ( Georgia, Arizona, Illinois etc)

can def bill same rates at satellites. in fact, the 15-20 mile limit on billing hospital rates at satellites does not apply them.

My understanding that PPS-Exemption only applied to the main campus of a hospital, or perhaps the 15-20 mile rule.

@RickyScott evidence for your statement above?

 

[RickyScott]

My understanding that PPS-Exemption only applied to the main campus of a hospital, or perhaps the 15-20 mile rule.

@RickyScott evidence for your statement above?

I have 0 info regarding COH. i can tell you that in my neck of the words the PPS exempt center does not abide by the 15-20 mile rule and bills those rates at satellite centers 30-40 miles away per their interpretation of the rules. My understanding is that the 15-20 mile rule applies for hospital rates, but some centers feel the pps exmeption allows them to bill such rates further away.

 

[CurbYourExpectations]

This is worrisome if true.

I did read some of the recent lawsuit stuff and it seems like the courts are holding on the side of individual state law. What defines providing care/treatment? What is the benefit of this? For example are these groups providing better care than say Hopkins or any of these solid specialists in California? Anyone know more about these lawsuits?

Not sure what the motives are etc, the people seem nice from what I've heard and I'm sure ultimately it's probably well intentioned. If it was a peds doc in an undersupplied area pushing for it, yeah that I can get down with easier. It seems a little weird to me that it is coming from RadOncs (felt to be the most oversupplied field, by many in the field) in one of the most oversupplied parts of the whole world (northeastern US, tough job market) while producing the most candidate RadOncs. It seems like most states should have a lot of great access to care, especially California. Hopefully I will get to learn more about these issues from people who know more. If there is a possibility of pushing higher billing into other areas, even if not intended, that is concerning.

Hopefully someone smarter than me can correct me about this stuff.

 

[medgator]

This is worrisome if true. I did read some of the recent lawsuit stuff and it seems like the courts are holding on the side of individual state law versus these elite groups. What defines providing care/treatment? What is the benefit of this? For example are these groups providing better care than say Hopkins or any of these solid specialists in California? Anyone know more about these lawsuits?

Not sure what the motives are etc. It does seem weird to me that it is coming from RadOncs (felt to be the most oversupplied field) in the most oversupplied parts of the whole world (northeastern US) while producing the most candidate RadOncs. When you dig into it some you will notice these are the areas with the lowest wRVU per RadOncs. This worries me that instead of considering supply and over hiring, they are pushing towards expansion into other regions. If there is a possibility of pushing higher billing into other areas, that is very concerning.

If it was a peds doc in an undersupplied area pushing for it, yeah that I can get down with easier. Higher billing facilities in oversupplied regions with production of the most supply in the field. Does this seem weird?
Hopefully someone smarter than me can correct me about this stuff.

Weird? More like bad. Really really bad

And you wonder why I'm concerned for the future of the specialty?

Our specialty has no competent leadership in this regard unlike what happened in the 90s when training was extended by a year and programs and spots were closed/cut

 

[StealthTech]

Weird? More like bad. Really really bad

And you wonder why I'm concerned for the future of the specialty?

Our specialty has no competent leadership in this regard unlike what happened in the 90s when training was extended by a year and programs and spots were closed/cut

Might be time to do that again

 

[medgator]

Might be time to do that again

It's been time for awhile. Ain't happening

 

[Chartreuse Wombat]

It's been time for awhile. Ain't happening

ASTRO is a membership organization. Income increases with more members. Not gonna happen

 

[medgator]

ASTRO is a membership organization. Income increases with more members. Not gonna happen

Ralph W says more residents will increase demand and prestige of the specialty

 

[Reaganite]

Have a friend who competes with several ppse places. Was told they preferentially use ppse rates depending on market. They start in community at non ppse rates to give the illusion of value, attempt to buy out referring groups or bring in their own surgeons and med oncs, and if that fails to generate the referrals they just flip the satellite to ppse rates and are paid so much it's almost impossible to fail. Some have even tried hybrid models where some insurers are billed ppse and others are billed non ppse in the same facility.

 

[OTN]

Have a friend who competes with several ppse places. Was told they preferentially use ppse rates depending on market. They start in community at non ppse rates to give the illusion of value, attempt to buy out referring groups or bring in their own surgeons and med oncs, and if that fails to generate the referrals they just flip the satellite to ppse rates and are paid so much it's almost impossible to fail. Some have even tried hybrid models where some insurers are billed ppse and others are billed non ppse in the same facility.

Fraud, plain and simple

 

[TheWallnerus]

Have a friend who competes with several ppse places. Was told they preferentially use ppse rates depending on market. They start in community at non ppse rates to give the illusion of value, attempt to buy out referring groups or bring in their own surgeons and med oncs, and if that fails to generate the referrals they just flip the satellite to ppse rates and are paid so much it's almost impossible to fail. Some have even tried hybrid models where some insurers are billed ppse and others are billed non ppse in the same facility.

Fraud, plain and simple

To paraphrase Napoleon (and Trump), "If the PPS-Exempt facility hath provided the care, it breaks no law."

 

[yesmaster]

Boy: “But papa, can’t we use our PPSE money to help our postdocs and research faculty at our mothership?”

Hospital CEO: “No my boy, they’re on their own if these NIH cuts go through and they don’t have their own training grants. We’re not a charity.”

Boy: “But papa, we get paid more than the community hospital and community cancer centers. We’re supposed to support research.”

Hospital CEO: “No no, the PPSE money is earmarked for many other things.”

Boy: “What things?”

Hospital CEO: “Well, hmm. You know to be honest we just kept grabbing money from the government and from insurers and from patients using every excuse and virtue signal in the book, “research, education, and my favorite in the last few years, diversity initiatives”. We really just love the money spigots and we’re going to fight and lawyer those rich bastards every step of the way if they try to spoil our fun.

Boy: “Aren’t we rich too, papa?”

Hospital CEO: “Yes, well it's all relative isn't it. Now, daddy has to go write some letters demanding payment from our non-performing assets, err, patients."