NIH funding cuts

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wandering star said:
This is hardly a deep dive but according to NIH RePORTER, there are currently 4,553 active NCI R01s, of which 147 originated from RTB. This isn't a dollar-for-dollar accounting but this suggests 3% to me.
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I don’t honestly know how you would find the true number. Not everything that gets funded by RTB is actual radiation related (imaging projects mostly) and not every radiation related application goes to RTB. Heavily clinical studies using radiation sometimes have better luck through CONC than RTB.
 
ramsesthenice said:
RTB gets a worse rep than they deserve. All study sections have turn over and they have had some pretty tough groups, but it’s not unique to them. I will say, I had a good friend get a 13th percentile on their last A1 only to have their next submission get triaged. It’s hard to not feel like something is broken when you see that kind of thing happen.
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This type of outcome suggests the system is random rather than rational. So why not cut out all the study sections/peer review and just have a lottery.
 
Did the CIA say that the NIH indirectly funded gain of function research? Are we taking into account the downstream economic impacts of this decision and in all these papers seen above in this thread? Probably not.
 
medgator said:
The alternative is a field from the 70-90s that no one cared to go into and matched from the bottom of classes

Not sure either option really helps patients or the specialty
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Drawing on plain films with a wax pencil is very different from where we are today. The actual day to day of the specialty is much cooler now.
 
temujim said:
This type of outcome suggests the system is random rather than rational. So why not cut out all the study sections/peer review and just have a lottery.
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i've thought a lot about this, and wouldn't be completely opposed to it.
Let universities make a decision about who they want to have large labs but providing institutional funds - limit PIs to no more than two 5 year grants with start dates separated by a couple years. If you want a large lab - have your department/university pony up the funds
 
just throwing it out there- Institutions are much richer today than at any time in the past because of price gouging their students and patients in their medical systems. Some like Yale, are so wealthy, they employ one administrator per undergraduate student! I really doubt overhead restrictions will put even a small dent in their ill gotten gains. The tax free growth on yales endowment is probably in the range of 3-4 billion per year.

www.thecollegefix.com

Yale University employs nearly one administrator per undergrad | The College Fix

Growth came after Yale instituted a diversity hiring initiative and pledged to expand DEI offices campuswide.
www.thecollegefix.com www.thecollegefix.com

1740073845498.png
 
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RickyScott said:
just throwing it out there- Institutions are much richer today than at any time in the past because of price gouging their students and patients in their medical systems. Some like Yale, are so wealthy, they employ one administrator per undergraduate student! I really doubt overhead restrictions will put even a small dent in their ill gotten gains. The tax free growth on yales endowment is probably in the range of 3-4 billion per year.

www.thecollegefix.com

Yale University employs nearly one administrator per undergrad | The College Fix

Growth came after Yale instituted a diversity hiring initiative and pledged to expand DEI offices campuswide.
www.thecollegefix.com www.thecollegefix.com

View attachment 399283
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now include physician salary changes...
 
Didn’t DJT expand telehealth coverage during COVID? This is just that temporary coverage expiring. Regardless it’s a net positive, while it sucks for the single rad onc centers, it also hurts the big academic places and their dreams of domination so I’m happy about that.
 
yesmaster said:
Didn’t DJT expand telehealth coverage during COVID? This is just that temporary coverage expiring. Regardless it’s a net positive, while it sucks for the single rad onc centers, it also hurts the big academic places and their dreams of domination so I’m happy about that.
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Very short sighted.

Also I think you kind of prove Lamount’s point right that for some of you (and clearly this admin) it’s about revenge and pettiness rather than material improvement.


Im a community doc that does use telehealth sometimes. I’ll obviously survive with it being cut. But what this portends I don’t take as a positive at all.

Oh yeah you’re the same poster who said maybe RFK will only hurt the big guys and not the Little guys.

You are one funny guy/gal!
 
ramsesthenice said:
This is only somewhat related, but am I the only one who thinks making USMLE step 1 P/F May end up being a bad thing for people going into competitive fields? I get it, the pressure sucked but at least it put emphasis on something you had to do. Now folks still have to study for it to pass AND engage in something else just to stand out. I suspect that something else will more often than not end up being research they only kinda care about. This feels like a well intended idea that will end up creating more work for a lot of folks in my opinion.
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Agree completely.

Wouldn't be surprised if we go back to the old system at some point. Undergrad schools who had previously abandoned the SAT in the hopes of decreasing inequity... only to find that it made inequity worse, as pedigree only became more important. Now they are starting to re-introduce the SAT.

Unless you are a physician scientist...
Med school is about learning medicine... not publishing papers.
Residency is about developing clinical competence... not publishing papers
The first few years as an attending is about developing a practice... not publishing papers

Until you have achieved clinical excellence, you are really shouldn't be expected to put your name at the top of a manuscript, suggesting that clinical practice should change.
 
This won't have any affect on supervision CY 2025 (correct me if I'm wrong as the telehealth CPTs and supervision are different things), but it will affect the possibility of weekly telehealth OTV.
 
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drowsy12 said:
for some of you (and clearly this admin) it’s about revenge and pettiness rather than material improvement

You are one funny guy/gal!
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Good luck explaining to your patients how telehealth OTV’s are a material improvement. Sir or ma’am, you are coming to our clinic for treatment every day but I’m going to manage your side effects remotely. Progress, baby!
 
I don’t routinely/hardly ever do virtual OTVs but I have no problem with practice settings that need it at times.

Why are you so anti physician?

Short sightedness will get you in the end.
 
drowsy12 said:
I don’t routinely/hardly ever do virtual OTVs but I have no problem with practice settings that need it at times.

Why are you so anti physician?

Short sightedness will get you in the end.
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You don't think this would have eventually been used by some centers as a way to gobble up more ground with telehealth services and less on site physicians?
Maybe it would, maybe it wouldn't. But that scenario sounds pretty anti physician to me.
The only argument I ever hear from others is "I never do it myself, but it's good for there to be it." Why? It's super easy to see patients being treated at their treatment times. Why do people care if they never actually use it?
 
yesmaster said:
Good luck explaining to your patients how telehealth OTV’s are a material improvement. Sir or ma’am, you are coming to our clinic for treatment every day but I’m going to manage your side effects remotely. Progress, baby!
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What side effects happen with 6 fractions of 0.5 Gy each to a kneecap?

Or within the few minutes it takes to do 8 Gy/1 fx for heterotopic ossification prophylaxis?

Let's discuss radiobiology, pragmatism, customer service, good patient care, and physician autonomy intelligently... all at the same time... just once!
 
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CurbYourExpectations said:
You don't think this would have eventually been used by some centers as a way to gobble up more ground with telehealth services and less on site physicians?
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I have been open about this topic here and there were many arguments and I agree with you it's a slippery slope

HOWEVER I am also partial to the idea that it's not the job of the govt to artificially expand the job market for reasons like this.

also TELEHEALTH IS MORE THAN VIRTUAL OTVs.

but MOST importantly - this is not why Elon is doing this!!!!!!! It's cost savings measure and people would have to be total idiots to think that the leopard won't eat their face too

I continue to be shocked by the critical thinking ability of some who continue to defend Elon/Trump. the leopard WILL eat your face.
 
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drowsy12 said:
I have been open about this topic here and there were many arguments and I agree with you it's a slippery slope

HOWEVER I am also partial to the idea that it's not the job of the govt to artificially expand the job market for reasons like this.

also TELEHEALTH IS MORE THAN VIRTUAL OTVs.

but MOST importantly - this is not why Elon is doing this!!!!!!! It's cost savings measure and people would have to be total idiots to think that the leopard won't eat their face too

I continue to be shocked by the intelligence level of some who continue to defend Elon/Trump. the leopard WILL eat your face.
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Those supply side regressive tax cuts won't pay for themselves. In fact they never will, but I digress.

The only way to ever justify them is to cut everything they possibly can to the bone without ruining their re-election chances.

The NIH is just good political fodder like NPR, planned Parenthood etc to cut on, even if it won't yield a ton of cost savings... Can't touch the military or Medicare SS where the real money is
 
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yesmaster said:
Didn’t DJT expand telehealth coverage during COVID? This is just that temporary coverage expiring. Regardless it’s a net positive, while it sucks for the single rad onc centers, it also hurts the big academic places and their dreams of domination so I’m happy about that.
Click to expand...
You're happy to lose TH capabilities? I agree with Lamoutn and others, this seems more of a 'cut off my nose to spite my face' situation....

All this means is that patients who can't travel in for an appointment will now get ZERO care from a qualified physician. Unmanaged morbidity will rise. Mortality will likely rise.

There are a large number of patients in rural communities with no access to a local Rad (or Med!) Onc who benefit from being able to do basic TH visits on a f/u basis, rather than have to drive 3 hours each way just to be told their CT scan looks fine. Which means patients just won't do the f/u, which hurts surveillance, which is still a critical part of oncology. Which means that stage I NSCLC that got SBRT'd won't have the CT scan to catch the mediastinal nodal recurrence and instead will present with diffuse metastatic disease.
 
evilbooyaa said:
You're happy to lose TH capabilities? I agree with Lamoutn and others, this seems more of a 'cut off my nose to spite my face' situation....

All this means is that patients who can't travel in for an appointment will now get ZERO care from a qualified physician. Unmanaged morbidity will rise. Mortality will likely rise.

There are a large number of patients in rural communities with no access to a local Rad (or Med!) Onc who benefit from being able to do basic TH visits on a f/u basis, rather than have to drive 3 hours each way just to be told their CT scan looks fine. Which means patients just won't do the f/u, which hurts surveillance, which is still a critical part of oncology. Which means that stage I NSCLC that got SBRT'd won't have the CT scan to catch the mediastinal nodal recurrence and instead will present with diffuse metastatic disease.
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I thought there was a rural exemption?

Through March 31, 2025, you can get telehealth services at any location in the U.S., including your home. Starting April 1, 2025, you must be in an office or medical facility located in a rural area (in the U.S.) for most telehealth services. If you aren't in a rural health care setting, you can still get certain Medicare telehealth services on or after April 1, including:

Monthly End-Stage Renal Disease (ESRD) visits for home dialysis

Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are, including in a mobile stroke unit

Services for the diagnosis, evaluation, or treatment of a mental and/or behavioral health disorder (including a substance use disorder) in your home

I think I'm confused about the first paragraph @TheWallnerus, are they saying only rural docs can perform telehealth?
 
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CurbYourExpectations said:
I thought there was a rural exemption?
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Just so people don't get confused, there was never a rural exemption (in rad onc, which is presumably our focus here) for telehealth. However, there was in theory a rural exemption for direct supervision. That said, I am not aware of any rad onc department, or linac, that existed in a CMS-defined rural area or critical access hospital (if any did/do exist, it's likely single digits).

Telehealth does not equal general supervision* (supervision by telephone, defined thusly for decades) or virtual direct.

* fun supervision fact: port films, CPT 77417, always only required general supervision... the original rad onc telehealth 🙂
 
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CurbYourExpectations said:
I think I'm confused about the first paragraph @TheWallnerus, are they saying only rural docs can perform telehealth?
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the first paragraph of what 🙂
If you mean the first paragraph of this: https://www.medpac.gov/wp-content/u...ce/reports/dec17_physiciansupervision_sec.pdf
This does NOT address telehealth. Again, when Medicare put hospital based RT under general supervision in 2020:
M

Thread 'CMS changes supervision rule. Rad Oncs no longer needed for daily operation of clinics. Med Students. Please read. You deserve to know implications.'

This is kind of buried in multiple threads, but this is a big deal.

CMS just proposed a rule change for supervision level of hospital outpatient therapeutic services from direct to general. This doesn't sound like a big deal, but it is actually a HUGE deal.

What this means functionally, is that a radiation oncologist will not need to be present to treat patients in hospital settings (i.e. the majority of jobs currently). This means a single Rad Onc can provide supervision for 2-3 hospitals simultaneously. It has been, that the vast majority of clinics have required a radiation oncologist...
  • Like
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... this did not mean rad oncs were then doing telehealth.
 
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TheWallnerus said:
the first paragraph of what 🙂
If you mean the first paragraph of this: https://www.medpac.gov/wp-content/u...ce/reports/dec17_physiciansupervision_sec.pdf
This does NOT address telehealth. Again, when Medicare put hospital based RT under general supervision in 2020:
M

Thread 'CMS changes supervision rule. Rad Oncs no longer needed for daily operation of clinics. Med Students. Please read. You deserve to know implications.'

This is kind of buried in multiple threads, but this is a big deal.

CMS just proposed a rule change for supervision level of hospital outpatient therapeutic services from direct to general. This doesn't sound like a big deal, but it is actually a HUGE deal.

What this means functionally, is that a radiation oncologist will not need to be present to treat patients in hospital settings (i.e. the majority of jobs currently). This means a single Rad Onc can provide supervision for 2-3 hospitals simultaneously. It has been, that the vast majority of clinics have required a radiation oncologist...
  • Like
  • Angry
  • Sad
... this did not mean rad oncs were then doing telehealth.
Click to expand...
lol sorry I should have clarified, the first paragraph in what I posted talking about "you must be in an office...", but it looks like @OTN says this might just be some fake news anyways
 
drowsy12 said:
I have been open about this topic here and there were many arguments and I agree with you it's a slippery slope

HOWEVER I am also partial to the idea that it's not the job of the govt to artificially expand the job market for reasons like this.

also TELEHEALTH IS MORE THAN VIRTUAL OTVs.

but MOST importantly - this is not why Elon is doing this!!!!!!! It's cost savings measure and people would have to be total idiots to think that the leopard won't eat their face too

I continue to be shocked by the critical thinking ability of some who continue to defend Elon/Trump. the leopard WILL eat your face.
Click to expand...
What do you think is the necessary debt to GDP ratio to fund everything and avoid financial insolvency?
 
Not sure what is going on regarding CMS and telehealth presently. There are concerns either way IMO. It is a valuable tool when used properly. I end up billing phone calls (next to nothing) for old patients and if it were a substantial part of my work that would be a problem.

Regarding mental health services...the demand is so great relative to supply that telehealth services are an absolute societal life line.

I can also see large entities hoping to dissolve existing state licensure rules to allow their remote services to be offered nationally without the licensure barrier. Not good for most of us.

What there is no doubt about however, is that there are mandates to return to office for basically all of VA staff working remotely, including folks who are performing telehealth services from their home office and now will be asked to come into an office to perform telehealth services...that is just plain punitive BS. Many of these folks took jobs under a remote work contract (those were the terms under which they were hired).

This is an executive mandate reneging on prior contracts for remote work. No one is expecting respite via unions or other mechanisms.

I do agree with the buckle up sentiment...I'm a big critic of PPSE, but this seems like a provincial concern in the present environment. Medicare reimbursement is going to be where big savings will be found and the cost of healthcare administration....not research spending...has been a significant driver of deficit (as has regressive in time tax policy IMO).

I'm pretty sure we should be investing more in research...wish I was doing it. Below is a down to earth primer of science funding and potential impact:

Bonus | Cuts to Science Funding and Why They Matter – Sean Carroll

www.preposterousuniverse.com www.preposterousuniverse.com

xrt123 said:
What do you think is the necessary debt to GDP ratio to fund everything and avoid financial insolvency
Click to expand...
No idea, but data out there to see where we compare with other wealthy countries. Tax revenue to GDP numbers also out there...certainly the US is a very good place to be wealthy and tax revenue to GDP pretty low...I'm not against lowering the deficit...interest payment is 13% and I would like it lower. I am certainly not opposed to raising taxes on the well to do (I'm expecting a tax cut under Trump). The research budget is among the last places I would look for savings (but I would look at the cost of healthcare administration...look out).

The populists have somehow sold that the professional crowd/academics/civil servants are among the enemies of the people and not the people wielding capital and not actually doing the thing.
 
xrt123 said:
What do you think is the necessary debt to GDP ratio to fund everything and avoid financial insolvency?
Click to expand...
Having zero formal education in macroeconomics… would guess that if we see our long term GDP grow at a quicker rate than our interest payments grow, the ratio wouldn’t matter
 
Lamount said:
Having zero formal education in macroeconomics… would guess that if we see our long term GDP grow at a quicker rate than our interest payments grow, the ratio wouldn’t matter
Click to expand...
It’s not though. The trajectory is indeed bad and tough decisions need to be made. The longer we wait, the less appealing the options will become. However, as I said above, it is disingenuous at best for anyone to praise drastic budget cuts as a solution to debt when the spending cuts are immediately offset by proposed tax cuts. The proposals out there by the party in charge will not shrink the debt. No one from either side has shown they are actually serious about reducing our debt. We are constantly told to believe that increased spending or tax cuts will invigorate the economy and magically pay for themselves.

But let’s stay with the specific topic being discussed so we don’t get deleted by the mods. It seems like most of us agree the key problem right now is the process. Decisions like these require thought and input from people who have some understanding of the process. Oh, and there is this little thing called the constitution. There is a reason its framers didn’t think one person (in their last term with nothing to lose no less) should be able to make unilateral decisions regarding spending that is already appropriated by congress.
 
drowsy12 said:
I'm not sure that 'what did people expect' is a rational argument. I can tell you that most voters probably didn't expect another wanton firing of air traffic regulators just a week or two after the first fatal crash in over a decade. Just one such example. At any rate, even if people 'expected' this cut it doesn't mean we can't question the means and the ends.

I think you're missing the general concern that cutting infrastructure is not just going to get rid of 'fat' but will severely handicap the ability for institutions to support research. That's a huge missing variable in your 62.5 -->86.9 math. I don't think anyone believes that will happen, so I'm surprised to see you put forth that argument.
Click to expand...

Just like the government, universities are going to have to learn to operate in a more lean fashion.

Uncomfortably cuts were inevitable if we ever hoped to get our debt under control.
 
thesauce said:
Just like the government, universities are going to have to learn to operate in a more lean fashion.

Uncomfortably cuts were inevitable if we ever hoped to get our debt under control.
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The other option is to solicit more donations, however mandatory. There's enough expendable income at the tippy top to tolerate that
 
thesauce said:
Just like the government, universities are going to have to learn to operate in a more lean fashion.

Uncomfortably cuts were inevitable if we ever hoped to get our debt under control.
Click to expand...

Doctors will ‘have to learn to operate in a more lean fashion’ soon too. Just you wait.
 
ramsesthenice said:
It’s not though. The trajectory is indeed bad and tough decisions need to be made. The longer we wait, the less appealing the options will become. However, as I said above, it is disingenuous at best for anyone to praise drastic budget cuts as a solution to debt when the spending cuts are immediately offset by proposed tax cuts. The proposals out there by the party in charge will not shrink the debt. No one from either side has shown they are actually serious about reducing our debt. We are constantly told to believe that increased spending or tax cuts will invigorate the economy and magically pay for themselves.

But let’s stay with the specific topic being discussed so we don’t get deleted by the mods. It seems like most of us agree the key problem right now is the process. Decisions like these require thought and input from people who have some understanding of the process. Oh, and there is this little thing called the constitution. There is a reason its framers didn’t think one person (in their last term with nothing to lose no less) should be able to make unilateral decisions regarding spending that is already appropriated by congress.
Click to expand...

Funny how all of the ‘tough decisions’ never include raising taxes, they even said no last week for those 10 million plus incomes.

Nothing to see here, folks! Let’s just fire some more park rangers and air traffic controllers.

Let’s privatize national parks actually.

YellowstoneX
 
drowsy12 said:
Funny how all of the ‘tough decisions’ never include raising taxes, they even said no last week for those 10 million plus incomes.

Nothing to see here, folks! Let’s just fire some more park rangers and air traffic controllers.

Let’s privatize national parks actually.

YellowstoneX
Click to expand...
only way to address the deficit is by cutting Medicare and social security. Making sure billionaires pay taxes is the right thing to do, but won’t have a substantive impact.
 
pikachu said:
Nor will marginal cuts at the NIH and elsewhere but that’s not really the point is it?
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My guess is that the cap on institutional overhead (which does not reduce spending) comes from jay bhattacharya who is all to well acquainted w/ ideologically toxic and flawed present academic system. He was condemned by the Stanford senate, and targeted by Francis Collins, for what was a very reasonable take on Covid. At least from podcasts, it appears that prassad, Marty makary, John Ionnidis and jay all travel in the same circle.

How did these institutions manage in the 90s when tuition and endowments were 10 x less, overhead was only 30%, and their hospital systems, -then a fraction of the size- were only charging CMS rates?
 
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RickyScott said:
How did these institutions manage in the 90s when tuition and endowments were 10 x less, overhead was only 30%, and their hospital systems, -then a fraction of the size- were only charging CMS rates?
Click to expand...

Research and Development: U.S. Trends and International Comparisons | NSF - National Science Foundation

Investment in research and development (R&D) is essential for a country’s success in the global economy and for its ability to address challenges and opportunities. R&D contributes to innovation and competitiveness. In 2021, the business sector was the leading performer and funder of U.S. R&D...
ncses.nsf.gov ncses.nsf.gov

Please refer to figure RD-5 on research funding intensity (normalized to GDP). The raw expenditure numbers are not that meaningful IMO.

Intensity of fed research expenditure reached peak in "Sputnik" era. It is significantly lower now than in 1992. Private sector research has grown.

Academia is the mechanism by which the US Gvt does most foundational research...that's it. It's been this way since we started putting money into research federally (which has undeniably benefitted us).

There are other ways to do it, and academia obviously has other issues outside of their research endeavors, particularly cost to student IMO, but it's not obvious to me that convoluting these things is that meaningful.

Certainly state funding for higher education has gone down significantly over the past two decades...facts. Much of academia has been working leaner for a long time. Hospitals?

How all of these things fit together for our collective economic health is unclear to me...but I can tell you that Elon's messaging is dumb AF. Countries don't "go bankrupt", although there are folks holding the bag when Gvts default on debt. We are a long way from defaulting on debt in a major way.

The impact on regional economies by some of these initiatives regarding federal employees are potentially devastating. Forced migration for employment...devastating and apparently happening now. Certainly many real people are experiencing angst and pain due to behavior of this admin right now.

The perceived (experienced by real people) economic health from 2016-2020 was largely a function of record increasing debt (cutting taxes without cutting spending) in the setting of a healthy inherited economy IMO.
 
communitydoc13 said:

Research and Development: U.S. Trends and International Comparisons | NSF - National Science Foundation

Investment in research and development (R&D) is essential for a country’s success in the global economy and for its ability to address challenges and opportunities. R&D contributes to innovation and competitiveness. In 2021, the business sector was the leading performer and funder of U.S. R&D...
ncses.nsf.gov ncses.nsf.gov

Please refer to figure RD-5 on research funding intensity (normalized to GDP). The raw expenditure numbers are not that meaningful IMO.

Intensity of fed research expenditure reached peak in "Sputnik" era. It is significantly lower now than in 1992. Private sector research has grown.

Academia is the mechanism by which the US Gvt does most foundational research...that's it. It's been this way since we started putting money into research federally (which has undeniably benefitted us).

There are other ways to do it, and academia obviously has other issues outside of their research endeavors, particularly cost to student IMO, but it's not obvious to me that convoluting these things is that meaningful.

Certainly state funding for higher education has gone down significantly over the past two decades...facts. Much of academia has been working leaner for a long time. Hospitals?

How all of these things fit together for our collective economic health is unclear to me...but I can tell you that Elon's messaging is dumb AF. Countries don't "go bankrupt", although there are folks holding the bag when Gvts default on debt. We are a long way from defaulting on debt in a major way.

The impact on regional economies by some of these initiatives regarding federal employees are potentially devastating. Forced migration for employment...devastating and apparently happening now. Certainly many real people are experiencing angst and pain due to behavior of this admin right now.

The perceived (experienced by real people) economic health from 2016-2020 was largely a function of record increasing debt (cutting taxes without cutting spending) in the setting of a healthy inherited economy IMO.
Click to expand...
to be clear, I support more dollars for research and do not support blind cuts by Elon. academic institutions have changed for the worse and are not what they were in the 90s. I would not give a cent to my undergrad or medschool and this sentiment is common amongst the ivies, where most are badly failing to meet their fundraising targets.
That being said, Harvard and yales endowment could easily reach 100 bill in 10 years on returns alone.
 
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evilbooyaa said:
Having a rural exemption to allow for TH is just as useless and non-beneficial to patients as having a rural exemption to allow for direct supervision.
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Interesting take. Rural exemption for TH would include the ability for ROs to talk to patients in areas without access, which would incorporate many people wouldn't it? I would think it would help patients in actual need to be seen by docs. Exemption of direct supervision in a grossly oversupplied field just allows for those with bargaining power to have an advantage. I assume you don't think direct supervision should just be avoided in rural areas, sorry if wrong. What am I missing? Maybe a lot.
 
Telehealth going away will have a huge impact on rural patients where i practice, especially for lung cancer survivors treated with RT. Much of the follow up for folks treated with SBRT for early stage/oligometastatic disease is reviewing imaging (with the occasional phone call to their local pulm/cardiologist, asking them to reoptomize COPD/CHF meds). Currently, a lot of these patients get scans locally and I request the images for our telephone follow up. Sure, I could just refer them to their local oncologist for follow up after I treat them, but he/she won't look at the CTs and the local radiologists have a bad habit of thinking stable post-treatment fibrosis is "concerning for developing neoplastic process" -so everyone has a heart-attack q3months. Frankly, I don't care if I am allowed to bill for these, but my hopsital does... and they have been toying with the idea eliminating telehealth across the board if these policy changes stand. Obviously, some will just blame this on my hospital (which isn't unreasonable)... but from my point of view, in instances where you can coordinate most of the care on the telephone, there really isn't a good reason why telehealth SHOULDN'T be available to medicare patients.
 
I work at an academic center in a rural midwest state that doesn't allow us to do any telehealth and I think its a mistake. I also think the arguments against it typically follow the tired excuses that reflect a basic resistance to change. "You can't really evaluate a patient without laying your hands on them." Like everything in the world, its a balance. Not everything is probably appropriate for virtual evaluation/supervision. But many of our run of the mill cases, especially palliative...I have yet to hear a coherent argument that holds water to support universal opposition. And lets be honest, if there were a 20% telehealth surcharge, it would magically be the biggest breakthrough to advance patient access. Overnight.
 
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