Medicare PFS 2026 proposed rule

[medgator]

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When we were in residency a bunch of us tried to create a business model of a linac on a cruise ship.

Old people who like to cruise. Check
Medical toursim. Check
Don't have to shield the hull. Check
Kills fish who swim around the ship that you can scoop up for food. Check
Register ship in Panama and bypass all US medical regulations. Check
No insurance, cash only. Check

Had this same discussion in residency!

Seemed ideal for long course prostate and breast at the time.... Even hypo at 3-5 weeks

 

[Mandelin Rain]

How is much is this gonna impact the rad onc median salaries? And what’s the likelihood it gets finalized?

PPS Exempt Hospitals or Everyone else?

 

[Doctorer]

When we were in residency a bunch of us tried to create a business model of a linac on a cruise ship.

Old people who like to cruise. Check
Medical toursim. Check
Don't have to shield the hull. Check
Kills fish who swim around the ship that you can scoop up for food. Check
Register ship in Panama and bypass all US medical regulations. Check
No insurance, cash only. Check

I think every residency room has had the "Prostate SBRT cruise ship" discussion.

Wonder if that'd pencil out.

 

[TheWallnerus]

I think every residency room has had the "Prostate SBRT cruise ship" discussion.

Wonder if that'd pencil out.

I think it’s gotta be linac on a non populated beach.

Of course. In reality. If you have the referrals. You put your linac under a preschool. If you must.

 

[thesauce]

PPS Exempt Hospitals or Everyone else?

The former will somehow go down as well

 

[CurbYourExpectations]

What kind of generators are you going to need on that boat for a linac? Are we going to use cobalt? How much money are you going to pay therapists to go months long trips? The logistics and overhead would be a nightmare. And I'm in.

 

[allseasons]

Yeah, in Saudia Arabia - for one patient

Is this a reference to something real LMAO

 

[CaesarRO]

Sorry, maybe I missed it. Why are we talking about reimbursement and residency size impact on salaries for hospital employed?

The real emphasis here should be on the impact of these changes on RVUs since that is how most employed physicians actually get paid based on their contracts.

I see a real risk of substantial RVU reductions doing the exact same work based on these changes.

They haven't really seen anything assuage my fears here. Lots of talk on the dollar reimbursement and very little about RVUs

 

[BobbyHeenan]

Sorry, maybe I missed it. Why are we talking about reimbursement and residency size impact on salaries for hospital employed?

The real emphasis here should be on the impact of these changes on RVUs since that is how most employed physicians actually get paid based on their contracts.

I see a real risk of substantial RVU reductions doing the exact same work based on these changes.

They haven't really seen anything assuage my fears here. Lots of talk on the dollar reimbursement and very little about RVUs

Maybe not in this thread but has been discussed.

Certainly biggest wRVU drop is on image guidance charges.

I haven't taken a deep dive, but are there big $/wRVU drops in 77427 or other codes as well?

 

[HolySmokes]

As best as I can tell the "only" effects on wRVUs will be CBCT going from 0.85 to 0.7 and the proposed 2.5% efficiency cuts to every code except 77427 (including the new CBCT code!). I looked at my RVUs from last year and that amounts to a ~4.5% cut for the same work.

 

[Fpg1245]

As best as I can tell the "only" effects on wRVUs will be CBCT going from 0.85 to 0.7 and the proposed 2.5% efficiency cuts to every code except 77427 (including the new CBCT code!). I looked at my RVUs from last year and that amounts to a ~4.5% cut for the same work.

Don’t worry CMS will be back for more next year

 

[TheWallnerus]

Don’t worry CMS will be back for more next year

They do always find a way to get their pound of flesh. Eventually they will hit bone, and you wonder “what then.”

 

[Fpg1245]

They do always find a way to get their pound of flesh. Eventually they will hit bone, and you wonder “what then.”

As long as their enrollees or the electorate don’t care, then they don’t care. They’ll amputate and move onto another limb.

 

[alwaysbeIMRTing]

As long as their enrollees or the electorate don’t care, then they don’t care. They’ll amputate and move onto another limb.

Increasing spending isn't in the cards. 10 more years until I should be able to FIRE out hopefully before the whole system falls apart and severe austerity measures are finally forced. My generation of doctors may or may not squeak by. Gen Z? Hah. Sorry. At least remember who did this and will live large at your expense all the way to the grave (the boomers, vastly accelerated by covid policies benefitting them in every imaginable way).

I wouldn't be surprised if "efficiency" revaluations of RVUs for codes become the new norm every year now that that line has been crossed.
If you're in a hard to recruit area, you can try and make the case to admin that they need to bump your wRVU conversion factor. Anywhere else, you will take the cuts and be thankful they aren't worse.

 

[Fpg1245]

Increasing spending isn't in the cards. 10 more years until I should be able to FIRE out hopefully before the whole system falls apart and severe austerity measures are finally forced. My generation of doctors may or may not squeak by. Gen Z? Hah. Sorry. At least remember who did this and will live large at your expense all the way to the grave (the boomers, vastly accelerated by covid policies benefitting them in every imaginable way).

I wouldn't be surprised if "efficiency" revaluations of RVUs for codes become the new norm every year now that that line has been crossed.
If you're in a hard to recruit area, you can try and make the case to admin that they need to bump your wRVU conversion factor. Anywhere else, you will take the cuts and be thankful they aren't worse.

Yeah judging by the offers in these rural areas. I don’t think it would even be a discussion. They’ll happily fill with locums and wait until the next idiot takes the job.

And as usual, boomers win. They always win.

 

[alwaysbeIMRTing]

The rural and locums market is completely delusional/dysfunctional. Again, boomers are ruining the entire thing.

There is one particularly grating ad I am constantly spammed with from frontierland Nebraska stating "permanent position only -- we do not have locums positions" Oh really? Then who exactly is providing the services in the building 5 days a week right now? This happened because people like me inquired about staffing it part time with a direct contract. This offends them for some reason, so they will silently staff through comphealth until they can find the "idiot" who will move there that they can control fulltime.

 

[vm26]

As long as their enrollees or the electorate don’t care, then they don’t care. They’ll amputate and move onto another limb.

Absolutely. Such a convoluted system, I have been educated a bit but still very confused about 2026. Somehow we apparently received a bump in compensation (upping the conversion factor?) through the spending bill which was more than canceled out by efficiency gains? I'm a diagnostic rad and we are projected to go down 2% for 2026. I am assuming the efficiency gain cuts are the result of budget neutrality?

I have never been a fan/member of the AMA until past few years when CMS reimbursement reform became a major part of their agenda. If I understand correctly, we should expect cuts as long as there is budget neutrality.