- Joined
- Apr 16, 2004
- Messages
- 4,751
- Reaction score
- 5,458
Some salient points:
1. Virtual vs Direct Supervision
ONC: The move to end virtual supervision for radiotherapy has sparked debate. What was the rationale behind the decision?
Dr. Kavadi: There was a well-established set of guidelines on supervision that had been in place for several years. As a result of the pandemic, many of those rules were relaxed. Frankly, we are grateful as oncologists that the rules were relaxed. The thought process was, now that the pandemic was over and that public health emergency was no longer in play, “Well, those pandemic-era waivers, we don’t need those anymore. Let’s go back to how things used to be.” At a core level, that’s really what it was. In the process, the thought was, “Well, there was a different set of rules for different practice settings, and did that necessarily make sense?” There was an attempt to change that. If we think through what ASTRO’s position was, it was nothing more than, “Let’s go back to how things were.”
In the process of doing that, clearly it created some anxiety. And I understand that. Certainly, I work in a community practice, and the direct supervision presence is difficult to manage every hour of the day, every day of the week. I certainly understand that. Different practices have employed different techniques in fulfilling that requirement. As we talked through this, there was consideration to those needs for flexibility when the original statement went out. Then, after that original statement went out, which was really [indicating] a desire to go back to a prepandemic state, we did hold a town hall and engaged in a direct dialogue with our membership. As a result of our initial internal conversations and the useful and important feedback that we got from the membership, we did submit a revised letter. That was based on a task force that was put together, which was a large group of people representing a variety of practice settings and a variety of practices, so that it was not indicative of only one subgroup.
That task force came back with recommendations for the board. The board had an internal conversation again about this and decided to issue a modified statement, which was still keeping with the principles of the original statement. And that is that physician participation in the care of cancer patients is important. That physician presence is important. That for patient benefit and patient safety, these are critical factors. We do not want a world in which our specialty is treating patients exclusively virtually. I think that is a harm for cancer patients.
But we do recognize that not all services have the same level of physician involvement and that not all settings are identical. Therefore, some understanding of the nature of the service and the importance and participation of the physician should be taken into consideration. The practical delivery of care and the ability to run a department should be taken into consideration.
I think the revised position is a thoughtful balance between all these different components. At a core level, we do feel that physician involvement in the care of the patient, as manifested by physical presence, is important. To lose that would be losing something quite important in the care of cancer patients.
2. How to remain financailly viable in private practice - ASTRO's role
ONC: What strategies do you propose to help these practices remain viable despite these cuts and other challenges?
Dr. Kavadi: Radiation is a highly capital-intensive specialty. In order to practice our trade, we need advanced technology. The advanced technology that we need is quite expensive. It is based on investment in assets that have a lifespan of 10, 15 years. When you’re looking at making those capital investments, the critical need is predictability and stability. If you spend $2–$4 million today, then you need to know that, during the lifespan of that investment, which is 10 or 15 years, that capital outlay can be funded with revenue that is generated from that investment.
If that revenue is variable and decreasing year over year, then any type of forecasting in your budgeting process becomes suspect. When that happens, it is hard to make those investments. That has happened. I think in the freestanding world – in the community world, it has become very, very difficult to make the capital investments necessary to continue to advance our specialty. I think that’s the biggest challenge facing the smaller community-based and rural providers. What we really need is a sense of stability.
Hence, what we are proposing with our Radiation Oncology Case Rate approach is to be able to create that level of predictability. If you know what the rules of the game are, and you know what the parameters will be, then you can plan accordingly. If you can have stability but lose 50% of your reimbursement, that is not a viable solution. To have a reimbursement that is fair and stable then allows for continued operational efficiencies and delivery of high-quality care. But we’re not in that environment today. We’re in an environment where we don’t have that.
Vivek was the Chief of Rad Onc for US Oncology - I am cautiously optimisitic about his tenure. However, I'm afraid that he will not be able to push back against the inertia of years and years of boneheaded decisions by ASTRO. Time will tell.
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