Medicare reimbursement for RO services down 20% in inflation adjusted terms from 2010

[DebtRising]

DEFINE_ME

Thank you to the authors for putting this together.

Big shout out to the Chairs who doubled residency spots over the same time and all the programs that SOAPed this year. Bright futures abound.

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Members don't see this ad.

 

[thecarbonionangle]

All the hellpits filled with warm bodies. These poor souls know not how much they were lied to by their “mentors” and “leaders”

 

[TheWallnerus]

DEFINE_ME

Thank you to the authors for putting this together.

Big shout out to the Chairs who doubled residency spots over the same time and all the programs that SOAPed this year. Bright futures abound.

This is all the more annoying when you read the rationales given by CMS for the RO-APM. In summary, the reasoning for RO-APM in 2023 is: "IMRT cost us [CMS] a hell of a lot of money... between 2003 and 2009."

 

[medgator]

This is all the more annoying when you read the rationales given by CMS for the RO-APM. In summary, the reasoning for RO-APM in 2023 is: "IMRT cost us [CMS] a hell of a lot of money... between 2003 and 2009."

Not having good lobbyists as compared to big pharma wouldn't fly

 

[elementaryschooleconomics]

lol stop being so fringe

 

[radiation]

I think this is an issue that affects all levels of rad onc and is something to fight with a unified front. Rad onc is the one of the most cost effective cancer treatments available. All stakeholders in our field should find a common ground in showing medicare the savings they would get by increasing rad onc utilization and holding drug companies accountable for charging billions for treatments that don't improve quality of life or overall survival.

If all levels of community, academic, big and little rad onc work together on reversing these trends, I think it would go a long way in bringing together more people to the table of policy decisions and make oversupply reform way more feasible. Right now there is clearly an adversarial relationship between big and little rad onc that is not helping anyone move the needle and keeps rad onc fractured and unable to mount an effective response to these sweeping policies

 

[fiji128]

CMS Releases 2023 MPFS and HOPPS Final Rules: Payment cuts continue,
G codes face future scrutiny​

This evening, the Centers for Medicare and Medicaid Services (CMS) released the 2023 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System final rules, with cuts of 4% to radiation oncology due to reductions to the conversion factor and the second year of the clinical labor price update, which shifts resources from specialties to primary care services. Additionally, CMS notes in the MPFS that it is reviewing the current payment policy related to the conventional treatment delivery, IMRT and IGRT “G” codes, which could result in additional payment cuts in future rulemaking. ASTRO remains concerned that the continued payment cuts to radiation therapy services will impact access to care close to home. ASTRO and aligned stakeholders are actively lobbying Congress to address planned payment cuts by year end.

Please contact your member of Congress to oppose Medicare cuts. Additional MPFS and HOPPS analysis of specific code level impact and detailed summaries of both rules will be issued in the coming days.

 

[TheWallnerus]

CMS Releases 2023 MPFS and HOPPS Final Rules: Payment cuts continue,
G codes face future scrutiny​

This evening, the Centers for Medicare and Medicaid Services (CMS) released the 2023 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System final rules, with cuts of 4% to radiation oncology due to reductions to the conversion factor and the second year of the clinical labor price update, which shifts resources from specialties to primary care services. Additionally, CMS notes in the MPFS that it is reviewing the current payment policy related to the conventional treatment delivery, IMRT and IGRT “G” codes, which could result in additional payment cuts in future rulemaking. ASTRO remains concerned that the continued payment cuts to radiation therapy services will impact access to care close to home. ASTRO and aligned stakeholders are actively lobbying Congress to address planned payment cuts by year end.

Please contact your member of Congress to oppose Medicare cuts. Additional MPFS and HOPPS analysis of specific code level impact and detailed summaries of both rules will be issued in the coming days.

I just don’t get how:
Cancer incidence is falling
RT utilization is falling
Long-course radiotherapy is disappearing
RT reimbursement is in a decade long free fall

But radiation oncologist numbers keep expanding. And they’re all getting hired!

It really messes with my desire to make sense of the universe.

 

[Mandelin Rain]

I just don’t get how:
Cancer incidence is falling
RT utilization is falling
Long-course radiotherapy is disappearing
RT reimbursement is in a decade long free fall

But radiation oncologist numbers keep expanding. And they’re all getting hired!

It really messes with my desire to make sense of the universe.

The music ends at some point.

 

[TheWallnerus]

The music ends at some point.

Why I still can’t fathom any good medical student choosing rad onc lest one becomes one’s own cautionary tale about economics, and musical chairs.

 

[fiji128]

A 4% cut in this inflationary environment is more like a functional 12 or 15% cut in one year. But #radonc twitter tells me the future is bright, even KO says its true!

 

[TheWallnerus]

A 4% cut in this inflationary environment is more like a functional 12 or 15% cut in one year. But #radonc twitter tells me the future is bright, even KO says its true!

Ha. Well we now have a pretty good long stretch where some very negative headwinds seem TO HAVE MATTERED ZERO in terms of the rad onc job market. Getting to the point that should I believe these lying lies of validated, published statistics and the lying liars who tell them… or twitter and my eyes.

 

[DebtRising]

CMS wants a Canada style system with less rad onc facilities which will drive down cost. CMS also wants to drive down oncology costs without having to fight the pharma lobby. Radiation Oncology payments have gotten drastically cut and continue to be targeted in future CMS reviews. That the cost savings are inconsequential relative to the cost of the top 2 immunotherapy drug charges is less important - optics matter. Expect continuation of the above bullying.

Our field continues to have record resident numbers in the face of financial cuts AND decreased utilization is a separate group of older rad oncs realizing they can’t fight CMS but can exploit hospital budgets and younger, debt ridden, more desperate graduates for labor during residency and increasingly worse jobs at satellite facilities after. Said satellites operating budgets will demand lower salaries and more work as cuts continue. This provides no benefits to patients or society, with the end result being facilities closer to home with less investment in technology, and physicians under more pressure to produce revenue for the hospital system. Or worse, utilization of longer courses simply to justify existing when shorter courses are superior. Not a flag to debate this for a disease site, just statement of reality.

Radiation is a bear market and it’s due to both unfair / punitive targeting from CMS, which is evidenced from the excellent paper above even before more ongoing cuts, and from older rad oncs selling us out because they couldn’t fight CMS, but can use us to make up the difference for the tail end of their career.

This will continue and the overall makeup of ppl entering the field reflects this. The true crash is when hospital systems consolidate enough regional dominance for their area and close the radiation satellite with 10 on treat because it hasn’t been profitable in sometime and the presence is no longer needed because market share and geography of other services has been established.

 

[A_DeMichele]

satellites with <10 under the beam get shut down all the time… usually, there is enough competition so that another academic system opens theirs nearby

 

[deleted1116990]

Inflation 9% year over year. Public and government can't think because of poor education and rewarding of bad decision making. Want inflation relief checks. That will fix it.

Rad onc reimbursement down 4%.

15% pay decreases every year going forward.

Can somebody do the math and figure out when we will be making minimum wage in 2009 dollars? I would but my attention span is fried from smartphones just like the rest of the population.

 

[TheWallnerus]

Inflation 9% year over year. Public and government can't think because of poor education and rewarding of bad decision making. Want inflation relief checks. That will fix it.

Rad onc reimbursement down 4%.

15% pay decreases every year going forward.

Can somebody do the math and figure out when we will be making minimum wage in 2009 dollars? I would but my attention span is fried from smartphones just like the rest of the population.

Takes roughly 20 years at negative 15% "compound interest" to hit a ~$25K annual salary if initially making $500K.

Long row to hoe!

 

[deleted1116990]

Takes roughly 20 years at negative 15% "compound interest" to hit a ~$25K annual salary if initially making $500K.

Long row to hoe!

So about 10 more years until it makes more sense to just sell chinese junk on amazon and make youtube videos with DollarShaveClub ads. Good to know.

Med students applying for residency that would put them in the job market in 8 years might want to think about that.

 

[OTN]

Inflation 9% year over year. Public and government can't think because of poor education and rewarding of bad decision making. Want inflation relief checks. That will fix it.

Rad onc reimbursement down 4%.

15% pay decreases every year going forward.

Can somebody do the math and figure out when we will be making minimum wage in 2009 dollars? I would but my attention span is fried from smartphones just like the rest of the population.

Dirty secret: If everyone's wage went up the same rate as inflation (including all jobs, not just radonc), then we would never be able to leave the inflationary spiral.

Loss of purchasing power is better than loss of an entire country, which is what happens when hyperinflation begins. In addition, if the US doesn't protect its unique position as the issuer of the world's reserve currency, we will lose it and quickly understand what incredible benefits it brings.

We're all in this together, unfortunately. Does not excuse cuts in reimbursement, however, but I don't think we should at all expect them to keep up with the current inflation rate.

 

[TheWallnerus]

Dirty secret: If everyone's wage went up the same rate as inflation (including all jobs, not just radonc), then we would never be able to leave the inflationary spiral.

Loss of purchasing power is better than loss of an entire country, which is what happens when hyperinflation begins. In addition, if the US doesn't protect its unique position as the issuer of the world's reserve currency, we will lose it and quickly understand what incredible benefits it brings.

We're all in this together, unfortunately. Does not excuse cuts in reimbursement, however, but I don't think we should at all expect them to keep up with the current inflation rate.

The old wise doctors when I first started out would always tell me “You will never again make as much money as you did today.” Wise indeed!

 

[deleted1116990]

Dirty secret: If everyone's wage went up the same rate as inflation (including all jobs, not just radonc), then we would never be able to leave the inflationary spiral.

Loss of purchasing power is better than loss of an entire country, which is what happens when hyperinflation begins. In addition, if the US doesn't protect its unique position as the issuer of the world's reserve currency, we will lose it and quickly understand what incredible benefits it brings.

We're all in this together, unfortunately. Does not excuse cuts in reimbursement, however, but I don't think we should at all expect them to keep up with the current inflation rate.

No, I agree with you. That was my point with the joke about inflation relief checks.
Inflation is a result an oversupply of money. Fixing that requires making money harder to come by, which is politically unpopular when people are competing for votes.

Real inflation is probably in the 15-20% range over the past year. I'm aware that most people aren't making 20% more than they used to a few years ago from COL raises. But a lot of them are making 5-10% more. Physicians? Holding steady would be bad enough, but our overlords want to cut.

Would love to see an update to the above for 2022. But that Y-axis going to have to go up.

The old wise doctors when I first started out would always tell me “You will never again make as much money as you did today.” Wise indeed!

I'm guessing you made at least double in inflation-adjusted dollars. I know someone who was making about quadruple in NON inflation adjusted dollars in the early 00s compared to what I was making when I started a few years ago (and that was in the upper half of MGMA too!)

 

[medgator]

No, I agree with you. That was my point with the joke about inflation relief checks.
Inflation is a result an oversupply of money. Fixing that requires making money harder to come by, which is politically unpopular when people are competing for votes.

Real inflation is probably in the 15-20% range over the past year.

Inflation hits everyone differently.... Someone renting a house with a gas guzzling SUV is feeling it a lot differently than the tree hugger running whole house solar on a house they've owned for awhile with a cheap mortgage, driving a Tesla and eating from their veggie garden etc

 

[deleted1111261]

Well, this is interesting.

Are the rest of us taking a haircut to pay for raises for the elite?

 

[Chartreuse Wombat]

"Inflation is always and everywhere a monetary phenomenon"

Uncle Milty

Old Joe says he is not in charge anymore but I am not so sure

 

[medgator]

"Inflation is always and everywhere a monetary phenomenon"

Uncle Milty

Old Joe says he is not in charge anymore but I am not so sure

Last guy presided over the largest increase in money supply in recent history, of that I am sure.

 

[Chartreuse Wombat]

Last guy presided over the largest increase in money supply in recent history, of that I am sure.

My observation is not partisan. Simple economics.

 

[Mandelin Rain]

View attachment 361652

Well, this is interesting.

Are the rest of us taking a haircut to pay for raises for the elite?

This has to go on Twitter.

MSKCC: “I drink your milkshake. I DRINK IT UP!!!”

Perhaps we’ll get another publication on cost of parking at this institution?

 

[communitydoc13]

View attachment 361652

Well, this is interesting.

Are the rest of us taking a haircut to pay for raises for the elite?

WTF?

COA Statement on Destructive 2023 PFS and HOPPS Final Rules

CMS Will Grossly Overpay Large 340B Health Systems While Devastating Independent Practices and Small Rural and Urban Hospitals

communityoncology.org

 

[deleted1111261]

Last guy presided over the largest increase in money supply in recent history, of that I am sure.

That was 2020.. blowing it out of the water now

The Biden Administration Has Approved $4.8 Trillion of New Borrowing | Committee for a Responsible Federal Budget

2022-09-13-Prior to the pandemic, the U.S. national debt was on an unsustainable path.

www.crfb.org

 

[Fpg1245]

View attachment 361652

Well, this is interesting.

Are the rest of us taking a haircut to pay for raises for the elite?

These elite institutions pay their faculty even less. Talk about exploitation. Every one of those institutions is a criminal organization.

 

[thecarbonionangle]

The field continues to circle the drain/toilet. The “leaders” are in their own world. The sycophant rasputin boot licking throne sniffers continue to tell the emperor he looks great despite no clothes. The worst isn't here yet.

 

[Fpg1245]

The field continues to circle the drain/toilet. The “leaders” are in their own world. The sycophant rasputin boot licking throne sniffers continue to tell the emperor he looks great despite no clothes. The worst isn't here yet.

Can’t wait for that new ASTRO APM proposal to hit the market! Oh I’m sure protons and big RO will be spared.

 

[thecarbonionangle]

Can’t wait for that new ASTRO APM proposal to hit the market! Oh I’m sure protons and big RO will be spared.

You better believe it! Take it to the bank! Cha-ching.

 

[Fpg1245]

You better believe it! Take it to the bank!

Just one additional FU to community rad onc.
I’ve never met a group of weirdos so committed to killing their field or have such contempt for private practice than RO man.

 

[radoncftw]

View attachment 361652

Well, this is interesting.

Are the rest of us taking a haircut to pay for raises for the elite?

holy crap

simul, please light em up.

 

[Fpg1245]

holy crap

simul, please light em up.

Been going on for ages. This is why they can afford to poo poo community practice. They’ll always get a raise and you won’t.

As George Carlin used to say: it’s a big club and you ain’t in it!

 

[thecarbonionangle]

Been going on for ages. This is why they can afford to poo poo community practice. They’ll always get a raise and you won’t.

As George Carlin used to say: it’s a big club and you ain’t in it!

He also said “think of how stupid the average person is, and realize half of them are stupider than that”. The field is “led” by people who matched when any warm body could walk into the field. Now think about the average bufoon “leader” and now realize half of them are stupider than that!

 

[deleted1111261]

holy crap

simul, please light em up.

 

[fiji128]

When these giant institutions have people on staff that endless and breathless virtue signal and publish on this and that equity thing of the moment, it all comes off as just being extremely hypocritical. Usually the response will end up being, "well I know so and so and they are just so fantastic and care so much." It all reminds me of "green washing" in the esg space.

 

[OTN]

When these giant institutions have people on staff that endless and breathless virtue signal and publish on this and that equity thing of the moment, it all comes off as just being extremely hypocritical. Usually the response will end up being, "well I know so and so and they are just so fantastic and care so much." It all reminds me of "green washing" in the esg space.

I think, deep down, they know. They have to. They see the makeup of their patient populations. They know they're not treating that many minorities or impoverished patients. If they don't know they're perpetuating a system of inequity, they're willfully putting their heads in the sand to avoid having to deal with it.

My patients are of non-white majority and I have a two patients on treatment right now who are minorities who I am treating for free. It makes me feel good to not have to virtue signal, as I can allow my actions to speak for themselves, and it makes me feel good to help those who didn't have anywhere else to go.

 

[RickyScott]

Just one additional FU to community rad onc.
I’ve never met a group of weirdos so committed to killing their field or have such contempt for private practice than RO man.

To think that Aileen chen and ben smith were allowed to give input into the adoption of the apm! Almost worse than Iran being on the UN women's rights council.

 

[deleted1111261]

I think, deep down, they know. They have to. They see the makeup of their patient populations. They know they're not treating that many minorities or impoverished patients. If they don't know they're perpetuating a system of inequity, they're willfully putting their heads in the sand to avoid having to deal with it.

My patients are of non-white majority and I have a two patients on treatment right now who are minorities who I am treating for free. It makes me feel good to not have to virtue signal, as I can allow my actions to speak for themselves, and it makes me feel good to help those who didn't have anywhere else to go.

MUCH MUCH easier to treat indigent patients in private practice. Very hard when I was at non-profit hospital based positions. Then, I got to this for-profit system. Now, interestingly, we were more community oriented and understanding about this population and can figure things out for struggling patients.

 

[CaesarRO]

I think, deep down, they know. They have to. They see the makeup of their patient populations. They know they're not treating that many minorities or impoverished patients. If they don't know they're perpetuating a system of inequity, they're willfully putting their heads in the sand to avoid having to deal with it.

My patients are of non-white majority and I have a two patients on treatment right now who are minorities who I am treating for free. It makes me feel good to not have to virtue signal, as I can allow my actions to speak for themselves, and it makes me feel good to help those who didn't have anywhere else to go.

Love to see it and 100% commend you and your practice for doing it.

Curious though -- how do you decide who you're gonna help? Is there a formal program in place?

 

[OTN]

Love to see it and 100% commend you and your practice for doing it.

Curious though -- how do you decide who you're gonna help? Is there a formal program in place?

Yep, we have a formalized process for patients without insurance. We look into their financial information and charge only what they can afford. If they can't afford anything then we can write off the entire treatment.

It's simply a smart business choice. You want your referrings to think "I'll send this patient to OTN's practice, as I know no matter what he's going to make sure they're treated." I don't want referrings to ever have to think about who the patient's payor is and whether we will be able to treat. Gotta grease the slide as much as possible to get consults in.

 

[medgator]

Yep, we have a formalized process for patients without insurance. We look into their financial information and charge only what they can afford. If they can't afford anything then we can write off the entire treatment.

It's simply a smart business choice. You want your referrings to think "I'll send this patient to OTN's practice, as I know no matter what he's going to make sure they're treated." I don't want referrings to ever have to think about who the patient's payor is and whether we will be able to treat. Gotta grease the slide as much as possible to get consults in.

How does that work on the MO side? Free drug? I guess most of the concurrent regimens are generic anyways

 

[OTN]

How does that work on the MO side? Free drug? I guess most of the concurrent regimens are generic anyways

We work with pharma to get supply. Not always successful, but more than you would think

 

[Mandelin Rain]

If anyone at "Institution 69.2" specializes in financial toxicity or affordability of health care... please look into this and let us know your thoughts.

 

[CaesarRO]

Do I understand correctly that the way the PPS exemption works, is they get paid for their expenses? Doesn't that design encourage these centers to be wasteful? Is the difference between these centers how much excess spending it takes to treat a patient?

Edited for phrasing

 

[RickyScott]

Do I understand correctly that the way the PPS exemption works, is they get paid for their expenses? Doesn't that design encourage these centers to be wasteful? Is the difference between these centers how much excess spending it takes to treat a patient?

Edited for phrasing

Pps exemption also applies to sattelites within 30 miles, but this has been challenged by some of the centers who apply it to all satellites.

 

[Fpg1245]

Pps exemption also applies to sattelites within 30 miles, but this has been challenged by some of the centers who apply it to all satellites.

I think they canned that but the distance rule I think is still a thing

 

[BobbyHeenan]

When these giant institutions have people on staff that endless and breathless virtue signal and publish on this and that equity thing of the moment, it all comes off as just being extremely hypocritical. Usually the response will end up being, "well I know so and so and they are just so fantastic and care so much." It all reminds me of "green washing" in the esg space.

To me it’s not as much about them getting that funding.

It’s about who is at the table and influencing the powers that be about big issues related to the field. Those PPS exempt centers should not be there. They do not have the same skin in the game as 95% of the rest of us. At best they don’t have a realistic sense of challenges, and (?more likely?) there are perverse incentives.

MDA faculty getting any where near an APM policy steering meeting (that doesn’t apply to them) is flat criminal.