More RT cuts coming

[Ursus Martimus]

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Today, July 8, 2013, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS). The final rule is expected on November 1st and will become effective January 1, 2014. A further more detailed analysis will be forthcoming.

Key changes in payment policy outlined in the Proposed Rule include the combined impact for the following specialties:

-1% hematology/oncology
-5% radiation oncology
-2% urology
+1% gastroenterology
-3% rheumatology

 

[Gfunk6]

 

[OTN]

My wife does radiation billing consulting, and she's been working through the numbers a bit. Looks like hospital-based IMRT is going to be bundled with several other services, which is going to result in a substantial hit for hospital reimbursement. Nothing like that on the freestanding side from what she can tell.

 

[thesauce]

This will be an annual battle until the fee schedule is fixed

 

[medgator]

My wife does radiation billing consulting, and she's been working through the numbers a bit. Looks like hospital-based IMRT is going to be bundled with several other services, which is going to result in a substantial hit for hospital reimbursement. Nothing like that on the freestanding side from what she can tell.

Freestanding took those hits the last several years

 

[medgator]

Hot off the astro press

https://www.astro.org/Web-Exclusive...g-centers-cut-again-for-significant-cuts.aspx

Up to 30-38% cuts proposed for some planning charges

Seems like freestanding will get hit more.....business as usual

From CMS:

CMS believes that hospitals incur greater costs than physician offices or freestanding radiation oncology centers. Therefore, CMS proposes that physician office / freestanding center payment rates should not exceed corresponding hospital outpatient rates. In the proposed 2014 rule, CMS generally reduces Medicare payment rates in physician offices / freestanding centers to less than the total Medicare payment for the same service provided in a hospital setting.

 

[Seldon1985]

Wow, TC getting hit hard...

 

[radiadouken]

the fact that gastroenterology is getting an increase while rheumatology is getting a decrease indicates how little pragmatic thought is going to these fee adjustments. Especially after this NY times article. I suspect a lot of politics at play.

 

[Ursus Martimus]

CMS believes that hospitals incur greater costs than physician offices or freestanding radiation oncology centers. Therefore, CMS proposes that physician office / freestanding center payment rates should not exceed corresponding hospital outpatient rates. In the proposed 2014 rule, CMS generally reduces Medicare payment rates in physician offices / freestanding centers to less than the total Medicare payment for the same service provided in a hospital setting.

As a conspiratory theorist I think these changes are part of a greater scheme to distribute wealth. If you pay a hospital then the money goes to pay security guards, patient transporters, cafeteria workers, etc. A free standing center can provide services more efficiently put doesn't do well at distributing wealth beyong the owners. Of course free standing centers don't have the offset the costs of ER visits from uninsured needle junkies either, thereby distibuting funds from cancer patients to these patients.

 

[Neuronix]

As a conspiratory theorist I think these changes are part of a greater scheme to distribute wealth.

Distribute wealth? I have a different conspiracy theory. There are hospital administrators or other high ups in hospital systems on the CMS panel. They are interested in increasing the salaries and power of hospital administrators over physicians.

No matter what the hospital gets paid, the low level staff are probably going to number the same and still going to get paid the same. The people who are going to take the swings in pay are the owners and administrators. In private practice the owners and administrators are physicians. In hospitals they are MBAs and other non-physicians. If the physicians lose the power by taking away pay from physician owned practices, the MBAs who are in charge of hospital systems will gain power. The business-trained managers will likely do to the physicians what has been done in every other industry--push down the wages of everyone below them, treat patients as customers/revenue generators, and treat physicians as just another replaceable widget.

 

[Tanner]

Seems like the hospital lobbyists have done a good job at minimizing the losses to the hospitals while non-hospital based freestanding centers suffer as much if not more than the hospitals. And somewhere out there stems is cheering them on 😛

 

[stems]

Seems like the hospital lobbyists have done a good job at minimizing the losses to the hospitals while non-hospital based freestanding centers suffer as much if not more than the hospitals. And somewhere out there stems is cheering them on 😛

Lol, I just don't want to see cuts happening. For either hospital or non-hospital based physicians. It's folly to believe that if you cut hospital based physicians reimbursements the non-hospital based groups will get more.

 

[medgator]

Lol, I just don't want to see cuts happening. For either hospital or non-hospital based physicians. It's folly to believe that if you cut hospital based physicians reimbursements the non-hospital based groups will get more.

IMO just level the playing field instead of preferentially giving the hospitals more $$$ for doing the same thing. It's promoting more and more hospital ownership of physician practices leading to less choice for patients and higher costs for the healthcare system as a whole

 

[bronx43]

I used to think there was some rhyme or reason to these CMS cuts, but GI with an increase? I want to know what good sh** they're smoking.

 

[deleted4401]

This is some real ****. They are using this type of behavior to divide and conquer. It's definitely a way to turn us into hospital employees. Doctors themselves have to shoulder some of the blame for looking so short term.

This thread just shows it's working. You have people accusing those that work in freestanding centers to be money grubbing and treating bone mets to 50 Gy and others saying that hospital based physicians are the devil. Well done, Medicare. Just like the primary care vs specialists deal, now you're positioning specialists vs specialists. And then just to throw a wrench in, raise GI pay. What in the world. Reminds me of a quote I saw over the holidays: "I gave half my staff iPads and the other half switchblades. Let the fun begin." GI and hospital based rad oncs got the iPads, but the freestanding guys didn't even get switchblades. Grrr.

My thought is that we should look out for each other, not try to cut each other down. This change will not only hurt incomes. It will further the imbalance in the quality/quantity of radiation oncology in our rural communities. It's tragic and unparalleled, but the effects will be seen rapidly.

 

[MOHS_01]

As a conspiratory theorist I think these changes are part of a greater scheme to distribute wealth. If you pay a hospital then the money goes to pay security guards, patient transporters, cafeteria workers, etc. A free standing center can provide services more efficiently put doesn't do well at distributing wealth beyong the owners. Of course free standing centers don't have the offset the costs of ER visits from uninsured needle junkies either, thereby distibuting funds from cancer patients to these patients.

They don't give two ****s about those people listed -- it's the suits. Suits are lapdog ******, easy to work with and easy to drag along... just throw them a bone or two, scratch each others backs, etc...

They're doing the same to multiple specialties.

 

[MOHS_01]

Distribute wealth? I have a different conspiracy theory. There are hospital administrators or other high ups in hospital systems on the CMS panel. They are interested in increasing the salaries and power of hospital administrators over physicians.

No matter what the hospital gets paid, the low level staff are probably going to number the same and still going to get paid the same. The people who are going to take the swings in pay are the owners and administrators. In private practice the owners and administrators are physicians. In hospitals they are MBAs and other non-physicians. If the physicians lose the power by taking away pay from physician owned practices, the MBAs who are in charge of hospital systems will gain power. The business-trained managers will likely do to the physicians what has been done in every other industry--push down the wages of everyone below them, treat patients as customers/revenue generators, and treat physicians as just another replaceable widget.

This is some real ****. They are using this type of behavior to divide and conquer. It's definitely a way to turn us into hospital employees. Doctors themselves have to shoulder some of the blame for looking so short term.

This thread just shows it's working. You have people accusing those that work in freestanding centers to be money grubbing and treating bone mets to 50 Gy and others saying that hospital based physicians are the devil. Well done, Medicare. Just like the primary care vs specialists deal, now you're positioning specialists vs specialists. And then just to throw a wrench in, raise GI pay. What in the world. Reminds me of a quote I saw over the holidays: "I gave half my staff iPads and the other half switchblades. Let the fun begin." GI and hospital based rad oncs got the iPads, but the freestanding guys didn't even get switchblades. Grrr.

My thought is that we should look out for each other, not try to cut each other down. This change will not only hurt incomes. It will further the imbalance in the quality/quantity of radiation oncology in our rural communities. It's tragic and unparalleled, but the effects will be seen rapidly.

Word. 👍

 

[thesauce]

This is some real ****. They are using this type of behavior to divide and conquer. It's definitely a way to turn us into hospital employees. Doctors themselves have to shoulder some of the blame for looking so short term.

This thread just shows it's working. You have people accusing those that work in freestanding centers to be money grubbing and treating bone mets to 50 Gy and others saying that hospital based physicians are the devil. Well done, Medicare. Just like the primary care vs specialists deal, now you're positioning specialists vs specialists. And then just to throw a wrench in, raise GI pay. What in the world. Reminds me of a quote I saw over the holidays: "I gave half my staff iPads and the other half switchblades. Let the fun begin." GI and hospital based rad oncs got the iPads, but the freestanding guys didn't even get switchblades. Grrr.

My thought is that we should look out for each other, not try to cut each other down. This change will not only hurt incomes. It will further the imbalance in the quality/quantity of radiation oncology in our rural communities. It's tragic and unparalleled, but the effects will be seen rapidly.

Excellent post, Simul.

ASTRO and ACRO are obviously going to vehemently fight these new cuts as they always have. If cuts were proposed to hospital-based radonc services, my guess would be that they would do the same.

Despite the other thread which may have given the impression that we are at odds. I hope and believe we all realize we're in this together. I want to support my friends in FSCs (you!) as much as my friends working for the hospitals.

 

[lazers]

IMO just level the playing field instead of preferentially giving the hospitals more $$$ for doing the same thing. It's promoting more and more hospital ownership of physician practices leading to less choice for patients and higher costs for the healthcare system as a whole

Lets work together to raise both reimbursements.