Medicare cuts radiation oncology payments by 5% effective 1/1/2021

[Bequerel]

I’m sure y’all just got this ASTRO email too. Any idea if this will effect an RVU based physician? I can’t seem to find a 2021 rvu calculator. I know consult and fu rvu’s are going up, but that’s a small fraction of our total rvu’s. I don’t know why I am surprised by this cut...this field can’t catch a break!

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[thesauce]

More good news!

 

[thecarbonionangle]

Yup! The breadlines are a-coming!

 

[elementaryschooleconomics]

 

[Ray D. Ayshun]

Is there a 36 fx prostate regimen so I can split the difference and feel like less of an dingus?

Edit:. Haha, assh*le shows up as dingus

 

[RadOncDoc21]

The good news is that ASTRO won’t raise their membership dues (640 dollars!!). Even though I get reimbursed, I decided this year I will not renew my membership. What am I paying for? At this point I feel like we are paying Trump lawyer’s to defend our field against cuts!

 

[drewdog1973]

Why should the majority of practicing RadOncs pay their ASTRO dues? What a joke.

 

[OTN]

You would think our distinguished thought leaders on Radonc Twitter would be up in arms about this, would be tweeting about it, pressuring CMS, etc. Nope.

 

[scarbrtj]

The good news is that ASTRO won’t raise their membership dues (640 dollars!!). Even though I get reimbursed, I decided this year I will not renew my membership. What am I paying for? At this point I feel like we are paying Trump lawyer’s to defend our field against cuts!

Why should the majority of practicing RadOncs pay their ASTRO dues? What a joke.

You would think our distinguished thought leaders on Radonc Twitter would be up in arms about this, would be tweeting about it, pressuring CMS, etc. Nope.

I have heard, off the record sorta from a congressman, the annual Medicare-is-cutting thing is a total game. Medicare has to appear they're cutting costs. The govt agencies have to appear responsible, and at the same time cast some doom and gloom (the beatings shall continue etc) over the landscape. Then, at the last second, our heroes, the Congress, comes in and saves the day and tells Medicare to hit the bricks. So it has been. So it shall always be? Of course in theory the inevitable can not be forestalled forever; with massive budget deficits, eventually cuts must come. Sort of like rad onc oversupply: eventually the piper must be paid.

 

[medgator]

You would think our distinguished thought leaders on Radonc Twitter would be up in arms about this, would be tweeting about it, pressuring CMS, etc. Nope.

They are too busy themselves cutting via hypofx trials. Double whammy

 

[imhopeful432]

The good news is that ASTRO won’t raise their membership dues (640 dollars!!). Even though I get reimbursed, I decided this year I will not renew my membership. What am I paying for? At this point I feel like we are paying Trump lawyer’s to defend our field against cuts!

We're shooting ourselves in the foot by dropping ASTRO. They haven't been able to achieve all of their policy goals, but we've all probably made literal $10,000s of dollars each since 2015 for helping to enact PAMPA and stopping the free fall in payment cuts from 2015-2020 that was happening from 2009-2014.

I don't love everything ASTRO does (wish the leadership was more forceful on residency expansion early) - but still firmly believe donating to ASTRO PAC and membership dues to ASTRO is probably the biggest ROI I can spend money on.

 

[drewdog1973]

You’re saying that without a counterfactual.

I disagree with ASTRO being our savior as a premise.

Just like ABR, we currently have no choice. And just like their apologists, we have this nonsense. If ACRO had more members and more money, they could do more. Individuals can do a lot. Don’t assume ASTRO is the best option because they are the only option. We can do better.

Trigger warning - Godwin’s Law about to come .. “these Nazis aren’t THAT bad. You should see the new Jetta me and Janey just got”

 

[w00tz]

You’re saying that without a counterfactual

I disagree with ASTRO being our savior as a premise.

If not ASTRO, then who? Or are we just screwed? I am clueless when it comes to advocacy groups for rad onc.

EDIT: Just saw your edit.

 

[thecarbonionangle]

ASTRO seems only one able to advocate for us. No choice. Maybe double down and send 2x contribution to PAC and renew membership? This is a must it seems

 

[scarbrtj]

ASTRO seems only one able to advocate for us. No choice. Maybe double down and send 2x contribution to PAC and renew membership? This is a must it seems

Will Rogers once said "It takes a lot of money just to get beat in an election nowadays." This reminds me of that!

 

[deleted941485]

I have heard, off the record sorta from a congressman, the annual Medicare-is-cutting thing is a total game. Medicare has to appear they're cutting costs. The govt agencies have to appear responsible, and at the same time cast some doom and gloom (the beatings shall continue etc) over the landscape. Then, at the last second, our heroes, the Congress, comes in and saves the day and tells Medicare to hit the bricks. So it has been. So it shall always be? Of course in theory the inevitable can not be forestalled forever; with massive budget deficits, eventually cuts must come. Sort of like rad onc oversupply: eventually the piper must be paid.

CMS finalized the rule. Congress has been almost completely deadlocked for the better part of a decade. No one is getting out of this. If they’ll cut you during a pandemic then there really is. I other scenario in which they don’t cut.

That being said I did call my senator and my congressman and anyone that will listen.

I’m really tired of this BS every year but honestly it has to be done ASTRO or Not.

 

[RickyScott]

Most randocs are employed and I still believe salaries are set by supply and demand not Medicare cuts. Medoncs in my town average around 6-7 k rvus, salaried at about 90$ rvu. Their proffesional billing is a fraction of a starting radonc. Their salary is set by supply. Heard that same is going on with psych.

 

[OTN]

Most randocs are employed and I still believe salaries are set by supply and demand not Medicare cuts. Medoncs in my town average around 6-7 k rvus, salaried at about 90$ rvu. Their proffesional billing is a fraction of a starting radonc. Their salary is set by supply. Heard that same is going on with psych.

Salaries of employed physicians are always set by supply and demand, which is why Hallahan wanted to increase supply, so he could drive down academic salaries.

5% cut in radonc won't have much impact on the demand side in the short-term, I agree. It will, however, factor into retirement decisions/expansion decisions by current practices, so I would guess it will have longer-term impact.

 

[RickyScott]

Almost every radonc I know well, with one exception, is employed. Most work for large systems with negotiated rates several times Medicare on the technical side. Those rates are set by monopolistic leverage, not cms.
I am employed and my salary and mobility set entirely by supply of radoncs- what they can pay the next guy. And here, Astro works against me! Astro’s president just started a residency in West Virginia. Astro has made their position clear on supply and they will take you dues and on balance work against your interests.

 

[Chartreuse Wombat]

Almost every radonc I know well, with one exception, is employed. Most work for large systems with negotiated rates several times Medicare on the technical side. Those rates are set by monopolistic leverage, not cms.
I am employed and my salary and mobility set entirely by supply of radoncs- what they can pay the next guy. And here, Astro works against me! Astro’s president just started a residency in West Virginia. Astro has made their position clear on supply and they will take you dues and on balance work against your interests.

Bingo

 

[deleted941485]

Almost every radonc I know well, with one exception, is employed. Most work for large systems with negotiated rates several times Medicare on the technical side. Those rates are set by monopolistic leverage, not cms.
I am employed and my salary and mobility set entirely by supply of radoncs- what they can pay the next guy. And here, Astro works against me! Astro’s president just started a residency in West Virginia. Astro has made their position clear on supply and they will take you dues and on balance work against your interests.

Medicare plants the seed and soon enough the Blues, Cigna’s, and Aetnas of the world follow.

 

[RadOncDoc21]

Almost every radonc I know well, with one exception, is employed. Most work for large systems with negotiated rates several times Medicare on the technical side. Those rates are set by monopolistic leverage, not cms.
I am employed and my salary and mobility set entirely by supply of radoncs- what they can pay the next guy. And here, Astro works against me! Astro’s president just started a residency in West Virginia. Astro has made their position clear on supply and they will take you dues and on balance work against your interests.

And then nickel and dime you every chance they get. The lectures should be available for all including their coding one. I know we don’t have many choices but if I’m going to be anally probed by somebody, I can at least not pay them for it!

 

[radOresident]

I know we don’t have many choices but if I’m going to be anally probed by somebody, I can at least not pay them for it!

Don't kink shame me

 

[domestique]

I have heard, off the record sorta from a congressman, the annual Medicare-is-cutting thing is a total game. Medicare has to appear they're cutting costs. The govt agencies have to appear responsible, and at the same time cast some doom and gloom (the beatings shall continue etc) over the landscape. Then, at the last second, our heroes, the Congress, comes in and saves the day and tells Medicare to hit the bricks. So it has been. So it shall always be? Of course in theory the inevitable can not be forestalled forever; with massive budget deficits, eventually cuts must come. Sort of like rad onc oversupply: eventually the piper must be paid.

This could be exactly right. Key is to get HR 8702 done.

 

[scarbrtj]

Almost every radonc I know well, with one exception, is employed. Most work for large systems with negotiated rates several times Medicare on the technical side. Those rates are set by monopolistic leverage, not cms.
I am employed and my salary and mobility set entirely by supply of radoncs- what they can pay the next guy. And here, Astro works against me! Astro’s president just started a residency in West Virginia. Astro has made their position clear on supply and they will take you dues and on balance work against your interests.

They (ASTRO) definitely worked against you if you were “unscrupulous” enough to want to go into practice with urologists.

 

[RickyScott]

Medicare plants the seed and soon enough the Blues, Cigna’s, and Aetnas of the world follow.

For most of their products, Blues, Cigna’s and Aetneas benefit from higher not lower rates. They earn their commission by managing the transaction between the employer and the hospital and law sets their profit somewhere between 10-20%. As Vinay Prassad recently said- they want the biggest pizza possible if they only get one slice.

 

[Reaganite]

For most of their products, Blues, Cigna’s and Aetneas benefit from higher not lower rates. They earn their commission by managing the transaction between the employer and the hospital and law sets their profit somewhere between 10-20%. As Vinay Prassad recently said- they want the biggest pizza possible if they only get one slice.

Can you post the link to this?

I agree the 80/20 rule incentivizes insurers to charge higher premiums, but there has to be a limit. I've been told including high-cost, big-name centers in their networks is at least in part a marketing strategy to attract higher end patients and employers who will pay higher premiums to have access to those centers. The goal is still to carefully manage utilization and cost because you don't want your outlays to exceed what you collect in premiums (and I'm guessing that can happen real fast if every patient is seeking care at a tertiary care center). I'm sure there are some geographic nuances here as well. I can tell you in my area, all the PPOs are actively trying to form narrow networks that exclude high cost tertiary care centers. I am constantly receiving memos regarding network restrictions on radiology services, for example. Similarly, the PPOs continue to generate stricter and stricter IMRT policies, and why in the world would they use Evicore if their goal is to jack up costs?

 

[RickyScott]

For most health insurance products, the employer is paying the bill and the insurance company is only managing the transaction, so they really dont care about the price/premium etc. It is in their financial interest that the medical bill/size of the pie is as large as possible. Ex: if you work for apple, apple pays your medical bill, and blue cross etc just manages the transaction and takes a commission. There are products where the insurance company takes on some risk/capitation, but majority of health care is paid by employers. This is why both insurance companies and hospitals are so opposed to price transparency! It is a misconception that the business model of medical insurance involves collecting premiums and then trying to save money by paying as little as possible for medical expenses. Some capitated/hmo products work this way, but not the bulk of medical insurance.

here is a great podcast with vinay prassad where he makes that point at the end

#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy - Peter Attia

“The more you practice medicine, the more you realize that it's an art. . .You're going to have to make decisions today with less than perfect information.” —Vinay Prasad

peterattiamd.com

 

[medgator]

For most health insurance products, the employer is paying the bill and the insurance company is only managing the transaction, so they really dont care about the price/premium etc. It is in their financial interest that the medical bill/size of the pie is as large as possible. Ex: if you work for apple, apple pays your medical bill, and blue cross etc just manages the transaction and takes a commission. There are products where the insurance company takes on some risk/capitation, but majority of health care is paid by employers. This is why both insurance companies and hospitals are so opposed to price transparency! It is a misconception that the business model of medical insurance involves collecting premiums and then trying to save money by paying as little as possible for medical expenses. Some capitated/hmo products work this way, but not the bulk of medical insurance.

here is a great podcast with vinay prassad where he makes that point at the end

#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy - Peter Attia

“The more you practice medicine, the more you realize that it's an art. . .You're going to have to make decisions today with less than perfect information.” —Vinay Prasad

peterattiamd.com

Evicore and aim are used by many of the big private players and Medicare advantage plans. Definitely reduces billing amount for rad Onc. The insurer still gets to collect the full premiums but pay out less in services

 

[Mandelin Rain]

Evicore and aim are used by many of the big private players and Medicare advantage plans. Definitely reduces billing amount for rad Onc. The insurer still gets to collect the full premiums but pay out less in services

While shifting some of their profits to Evicore (who they also own, but pay as a contractor) to stay right at 20% profit to meet ACA requirements.

 

[Reaganite]

For most health insurance products, the employer is paying the bill and the insurance company is only managing the transaction, so they really dont care about the price/premium etc. It is in their financial interest that the medical bill/size of the pie is as large as possible. Ex: if you work for apple, apple pays your medical bill, and blue cross etc just manages the transaction and takes a commission. There are products where the insurance company takes on some risk/capitation, but majority of health care is paid by employers. This is why both insurance companies and hospitals are so opposed to price transparency! It is a misconception that the business model of medical insurance involves collecting premiums and then trying to save money by paying as little as possible for medical expenses. Some capitated/hmo products work this way, but not the bulk of medical insurance.

here is a great podcast with vinay prassad where he makes that point at the end

#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy - Peter Attia

“The more you practice medicine, the more you realize that it's an art. . .You're going to have to make decisions today with less than perfect information.” —Vinay Prasad

peterattiamd.com

Man, took me forever to find it, but I like what he says...insurers want predictable high costs they can pass on to employers. We end up on the chopping block to make way for expensive drugs they will be mandated to cover.

 

[yesmaster]

For student lurkers wondering why certain folks sold out their own specialty, it's because they haven't been a radiation oncologist for over a decade. They are 95% administrator, 4% businessman, 1% scientist, and their actions and rhetoric reflect those interests.