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Guessing they don't post the actual costs....
Prostate Single Fraction Treatment Discussion
- Thread starter Palex80
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And protons were excluded. Simul's excoriating this paper on Twitter.
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deleted1111261
One of the authors also doesn’t seem to understand the multiplier used for PPS exempt rates. What a disaster of a paper.
Episode will be posted on this tonight - @NotMattSpraker
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Fortunately, I don’t think anyone takes what is published in the red journal too seriously anymore.
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The senior author is from MSKCC, and they use medicare rates to analyze costs in that paper.
MSKCC is receiving far more than medicare rates for their short courses of RT. The freestanding sites are much more likely to be receiving medicare rates or close to it. Also, MSKCC is PPS-exempt which may also have other ramifications for increasing reimbursement.
Therefore the whole premise of cost reduction by doing short courses at big academic centers is false when viewed under the lens that:
1. The academic centers get paid more for short courses
2. Short courses are of benefit to academic centers because patients coming from far away aren't going to stay for long courses
3. Forcing short courses on poor payer mixes at freestanding centers will bankrupt them (also benefiting academic enters)
MSKCC is receiving far more than medicare rates for their short courses of RT. The freestanding sites are much more likely to be receiving medicare rates or close to it. Also, MSKCC is PPS-exempt which may also have other ramifications for increasing reimbursement.
Therefore the whole premise of cost reduction by doing short courses at big academic centers is false when viewed under the lens that:
1. The academic centers get paid more for short courses
2. Short courses are of benefit to academic centers because patients coming from far away aren't going to stay for long courses
3. Forcing short courses on poor payer mixes at freestanding centers will bankrupt them (also benefiting academic enters)
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deleted1111261
I deleted all my tweets on this, because I realized it doesn't matter. These people have an agenda. Hubbard is on this paper. ROCR is mentioned in discussion/conclusion. This is a white paper for ROCR and to **** over freestanding. I just come off as angry/unhinged.
This paper has egregious errors, is poorly done and I cannot believe it was not only accepted, but is being promoted.
Not one of them would respond to any of the errors. They cannot conceive Simul would be able to pick apart a trash paper, because they are Gods and I am a mere mortal.
I am so embarrassed that this is what goes for scholarship. If this was submitted to an economics or business journal, it would have been desk-rejected. It is junior-high level work at best.
Let it all burn to the ground. We are future Sloan/MDACC employees. Just get that KY ready and bend over.
This paper has egregious errors, is poorly done and I cannot believe it was not only accepted, but is being promoted.
Not one of them would respond to any of the errors. They cannot conceive Simul would be able to pick apart a trash paper, because they are Gods and I am a mere mortal.
I am so embarrassed that this is what goes for scholarship. If this was submitted to an economics or business journal, it would have been desk-rejected. It is junior-high level work at best.
Let it all burn to the ground. We are future Sloan/MDACC employees. Just get that KY ready and bend over.
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I'm happy to read your thoughts.
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deleted1111261
Happy to send you our unpublished episode on it. decided against putting it out in the world.
Please don't give up
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deleted1111261
It's not giving up. It's just time to find another route. They will accept shoddy scholarship to make a policy point.
That is too bad, why not publish the episode? like you said, time to find another route, this podcast is your route.
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@RealSimulD
Simul, for what it's worth my ASTRO membership is up for renewal. Based on your advocacy, I'm going to tell them to stuff it. ASTRO has long been antagonsitic to non-academic and non-mega health systems but recent evidence has shown that the Red Journal has turned into a mechanism for social advoacy & repoistory for (mostly) useless science. The fact that all serious RO research is presented at ASCO is probably the main manifestation of this.
Fight on!!!
Simul, for what it's worth my ASTRO membership is up for renewal. Based on your advocacy, I'm going to tell them to stuff it. ASTRO has long been antagonsitic to non-academic and non-mega health systems but recent evidence has shown that the Red Journal has turned into a mechanism for social advoacy & repoistory for (mostly) useless science. The fact that all serious RO research is presented at ASCO is probably the main manifestation of this.
Fight on!!!
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ASCO is boring, come to ESMO! 😝
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deleted1111261
It's embarrassing that these people think it's good. Or proud of getting something accepted to the Red Journal. Other than a few sections (radbio, GI, physics), I just don't get how the editorial staff and chief feel that it's high quality. I'm mesmerized by what gets through. And, obviously harped about this - I know others agree - but then the same people cheer it on. It's so interesting how people talk to me to my face or on phone about how they feel about the state of affairs and then publicly say it's amazing.
For a medical student to have pride in work that frankly isn't good - it's not fair to them. At some point, someone is going to let them know that all of this was useless and not high level scholarship. It's the "everyone gets a trophy" mentality. If all the social justice/environment/bad econ work gets through b/c the reviewers don't have the sklil set / experience to properly critique it, none of it has meaning or value.
For a medical student to have pride in work that frankly isn't good - it's not fair to them. At some point, someone is going to let them know that all of this was useless and not high level scholarship. It's the "everyone gets a trophy" mentality. If all the social justice/environment/bad econ work gets through b/c the reviewers don't have the sklil set / experience to properly critique it, none of it has meaning or value.
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The reviewers likely have “experience” in these types of papers…meaning they’re from huge academic centers where these findings support their mission.
They know the issues with the paper…they just don’t care.
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I'll say that I wish you hadn't. You have a platform to criticize this and a pretty captive audience. If not on Twitter, then on SDN. You, along with the Becktas and Storeys and Scarborough's of the world need to continue calling this out for what it is.
But, forget the authors. The conclusions do make sense - more freestanding places do longer fractionation schemes (> 30fx for prostate, > 20fx for breast) than hospital affiliated - including but not limited to PPS-exempt centers. And, SCRT at all centers will be cheaper than LCRT at all centers.
BUT, there is no controlling for cost of hospital affiliated. Lots of hospitals getting paid higher rates than freestanding on a per fraction basis. Literally the definition of HOPPS. Ignored.
I don't see anyone cheering this on though on SoMe... just people mostly being negative and PPS-exempt attendings being mostly milquetoast in their support of it.
As we are all seeing now across multiple domains, the search for Truth is no longer the mission of academia.
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Is there anything we can do to fight the ROCR? It is disgusting that Astro leadership is pushing this self-serving piece of legislation. This is a negative externality at its finest - akin to me asking everyone else to pay my bills while I sit back and sip good scotch (that you also pay for).
Here’s a novel idea: how about you ROCRers learn to compete with other centers by your own efforts and merits, not by rigging the system through gas-lighting the public and politicians.
Here’s a novel idea: how about you ROCRers learn to compete with other centers by your own efforts and merits, not by rigging the system through gas-lighting the public and politicians.
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deleted1111261
For prostate protons, all the requests come from academic centers and they ask for 44 fx.
Community docs more likely to do LDR - the cheapest form of RT.
They exclude the most expensive / longest course (majority done at HOP) and the least expensive (majority done in community). It's actively stacking the deck.
The numbers are all jacked up.
Look at the percentages of patients getting short course breast / prostate at hospitals/freestanding. They cut and paste the exact same numbers.
They do not mention prior authorization even once. This is the driver, I have internal data that shows this.
The people with their names on this paper didn't even TRY to think about what they were saying. ASTRO wanted a message, so they wrote it.
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Not sure about this.
The overwhelming majority of well intended research appears mostly useless. Our retrospective reviews and database studies are close to useless. Most basic science research is of marginal value to those outside of the esoteric culture of the researchers. Most exciting research is not reproducible.
To me, the issue with much DEI and medical economics research is that there are an infinite number of analyses to be performed for problems that sometimes have relatively simple solutions.
If you're worried about improving the value of radonc (already relatively cheap AF aside from certain high dollar ventures) and want to reduce excess fractions, go ahead with your case based payment model, just don't provide exceptions. It's simple.
If you want to get rid of health care disparities across class...well that's complicated, but the first thing you can do is give away health care to those who can't afford it.
I don't think the notable personalities in our field are really interested in the simple solutions...why? Because it means sacrifice.
The search for truth is tough, and truth as it relates to human behavior can be almost too harsh to bear. Large medical school/academic hospitals are more corporatist than ever. This is what the problem is IMO regarding medical academics, the corporate influence in academia, not any nefarious academic narrative. Regarding academics outside of medicine? Not really applicable to us.
Is anyone publishing "An analysis of savings expected with elimination of the PPS exempt system of cancer centers" or "A comparative analysis of ROCR with and without proton exemption in terms of total cost of care"?
Those would be brave papers.
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deleted1111261
I like this a lot. This is the kind of discussion that these "thought leaders" should be having. I am so deeply disappointed. Maybe this seems dramatic. But I had respect for nearly all of the authors on that paper. But, I was wrong. Shills. Cheerleaders. Whatever you want to call them. But, this is not academic, meaningful or helpful. It's shoddy, shoddy work. And then saying "led by a PGY3". Don't do that to that kid. That's not fair. What resident is truly "leading" these types of efforts?
ROCR - yes, do it, no exceptions. Fixes fractionation problem, saves a little money
Free care - sure, that's one way to do it. Probably the easiest. But, people don't like other people getting free stuff, especially if they have to pay for it themselves.
Brave papers for sure. No one in the academy has the courage to write them. Very few in community have resources and infrastructure.
I see this paper as a line in the sand. I thought these people - at least some of them - were on the side of right. They most certainly are not.
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Papers like these make me wish the peer reviews were open. Hard to comprehend how/why they didnt adjust for location/geography; or even mention it in the Limitations
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Everyone should read this paper from Rad Oncs, it's a great one, often shared: https://ascopubs.org/doi/full/10.1200/OP.21.00241
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I will gladly fund someone to write them if anyone knows of anyone willing to do it.
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deleted1111261
But, here lies the problem
Red Journal is ASTRO. ROCR is ASTRO. If you write something, anonymized, that is negative towards ROCR or ASTRO, it is simply not going to get published.
The reviewers are actively selected. They know who is going to favorable towards it or unfavorable. If it's about OA and for whatever reason the editor is excited about it, it may come to a guy like me. If they don't care for it, maybe it will go some academic that treats prostate that has zero interest in actually learning about it, review it, and say "there is no evidence, no reason to publish".
So, you write something like that about PPS-exemption, it won't get published in RJ. But, it may in JCO. But, JCO actually reviews things well and has far higher standards.
This sort of thing is why I'm despondent. The circle-jerk mentality is hard to break. They all reference each other. They don't want to be 'less wrong'. They could care less about the truth. It's about them, not the science.
Red Journal is ASTRO. ROCR is ASTRO. If you write something, anonymized, that is negative towards ROCR or ASTRO, it is simply not going to get published.
The reviewers are actively selected. They know who is going to favorable towards it or unfavorable. If it's about OA and for whatever reason the editor is excited about it, it may come to a guy like me. If they don't care for it, maybe it will go some academic that treats prostate that has zero interest in actually learning about it, review it, and say "there is no evidence, no reason to publish".
So, you write something like that about PPS-exemption, it won't get published in RJ. But, it may in JCO. But, JCO actually reviews things well and has far higher standards.
This sort of thing is why I'm despondent. The circle-jerk mentality is hard to break. They all reference each other. They don't want to be 'less wrong'. They could care less about the truth. It's about them, not the science.
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Baller paper...
For anyone wondering what the future holds, where the field stands, and is looking for some tea leaves...check out Royce's Linkedin
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I don't think it is, I feel the same but not quite sure how to articulate the specific issues.
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And this is why
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