Protons are blowing Rad Onc's boat out the CMS water

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thecarbonionangle said:
With the cancer moonshot 2.0 relaunch announced, i see a lot of MDACC in pics with Biden. I wonder if some proton grift is in the works. Never count Biden or the Chinese out folks!
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Biden’s wag the dog moment?!
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Biden's son Beau apparently had some of his cancer treatment at MDACC, and both Joe Biden and George W Bush helped raise $15 million at the 75th annual gala of MDACC in one night, back in 2016.

I wish my cancer center could raise funds like that.
 
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IonsAreOurFuture said:
Biden's son Beau apparently had some of his cancer treatment at MDACC, and both Joe Biden and George W Bush helped raise $15 million at the 75th annual gala of MDACC in one night, back in 2016.

I wish my cancer center could raise funds like that.
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If you take all the elites with GBM like Beau Biden and Ted Kennedy and take account of all the extremely expensive (PROTON) treatments they received, I am pretty confident that it would be the same as if they were treated at a rural RO center anywhere else in the country.
 
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Family gets a $200M judgement against United Healthcare for denying lung cancer proton therapy... which caused him to die, obv

There's way more data for IMRT in breast than protons for lung cancer, and United/Evicore deny IMRT for breast all the time

Some lawyer somewhere is missing out on a major class action suit on behalf of all breast cancer patients in America

p6Yh83f.png
 
TheWallnerus said:
Family gets a $200M judgement against United Healthcare for denying lung cancer proton therapy... which caused him to die, obv

There's way more data for IMRT in breast than protons for lung cancer, and United/Evicore deny IMRT for breast all the time

Some lawyer somewhere is missing out on a major class action suit on behalf of all breast cancer patients in America

p6Yh83f.png
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there's gotta be more to it than what mentioned
 
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RealSimulD said:
He went to "Texas". There is a cancer center there that ... likes ... protons.
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Sure, and I won't speak ill of people I may or may not have trained with that may or may not make this recommendation. Just seems this isn't enough for a $200M judgement based on what's written. For an attorney to even take this case there must have been more to it. Dying a little over a year after this dx is not a surprise in any circumstance, so hard to come up with damages unless there was something more than just denying protons.
 
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Ray D. Ayshun said:
Sure, and I won't speak ill of people I may or may not have trained with that may or may not make this recommendation. Just seems this isn't enough for a $200M judgement based on what's written. For an attorney to even take this case there must have been more to it. Dying a little over a year after this dx is not a surprise in any circumstance, so hard to come up with damages unless there was something more than just denying protons.
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You're right - it is rampant speculation at this point.

If a "rock star" thoracic radiation oncologist from "Texas" says you need proton RT, you don't get it and then you die... and your family sues, and your "rock star" thoracic buddies calls their friends from NY, Philadelphia, DC and Chicago that also like protons a lot to be their expert witnesses, maybe that does get you $200m? I don't know.
 
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Ray D. Ayshun said:
Sure, and I won't speak ill of people I may or may not have trained with that may or may not make this recommendation. Just seems this isn't enough for a $200M judgement based on what's written. For an attorney to even take this case there must have been more to it. Dying a little over a year after this dx is not a surprise in any circumstance, so hard to come up with damages unless there was something more than just denying protons.
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I’ve wondered whether the proton industry might help with the legal fees in these lawsuits. It is modern medicine’s snake oil
 
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RealSimulD said:
You're right - it is rampant speculation at this point.

If a "rock star" thoracic radiation oncologist from "Texas" says you need proton RT, you don't get it and then you die... and your family sues, and your "rock star" thoracic buddies calls their friends from NY, Philadelphia, DC and Chicago that also like protons a lot to be their expert witnesses, maybe that does get you $200m? I don't know.
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I'm not sure how protons would've helped prevent this guy's '83 Lincoln from exploding when he turned the ignition, as there's no way the guy in that pic died any other way.
 
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RealSimulD said:
You're right - it is rampant speculation at this point.

If a "rock star" thoracic radiation oncologist from "Texas" says you need proton RT, you don't get it and then you die... and your family sues, and your "rock star" thoracic buddies calls their friends from NY, Philadelphia, DC and Chicago that also like protons a lot to be their expert witnesses, maybe that does get you $200m? I don't know.
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Also, more concerning is, can we be sued for not sending this guy to see if he'd benefit from protons?
 
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Ray D. Ayshun said:
there's gotta be more to it than what mentioned
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Severe esophagitis is the only other thing mentioned in the story. No doubt the protonistas lined up to show the beauty of their DVHs.
 
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temujim said:
Severe esophagitis is the only other thing mentioned in the story. No doubt the protonistas lined up to show the beauty of their DVHs.
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In the only randomized trial of photons vs. protons for lung cancer (yes, I know older proton techniques) there was no difference in esophagitis or pneumonitis. If the PTV is touching the esophagus there will be no difference in max esophageal dose. I guess mean may be different with protons or photons. At bragg peak biological dose in esophagus may actually be worse with protons.

Hard to know exactly without looking at all of the case but my first worry from a doc standpoint is like someone else posted above.....?how long until a rad onc gets sued for not referring for protons? The slippery slope "fallacy" is a fallacy.
 
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Also the advertising is so strong with many modalities (not unique to just protons...cyberknife, gamma knife, etc).

I had a guy with major rectal problems from prostate proton therapy (I was seeing him for something else). His comment to me was "just imagine how bad the rectal issues would have been with photons?!?"
 
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BobbyHeenan said:
In the only randomized trial of photons vs. protons for lung cancer (yes, I know older proton techniques) there was no difference in esophagitis or pneumonitis. If the PTV is touching the esophagus there will be no difference in max esophageal dose. I guess mean may be different with protons or photons. At bragg peak biological dose in esophagus may actually be worse with protons.

Hard to know exactly without looking at all of the case but my first worry from a doc standpoint is like someone else posted above.....?how long until a rad onc gets sued for not referring for protons? The slippery slope "fallacy" is a fallacy.
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Totally get it... but try explaining to a jury when you have pretty DVHs and a sad story and a grieving family and a expert proton witnesses telling them otherwise. Not justice, but reality.

Personally know of a lawsuit where a surgeon was sued for not referring to a radiation oncologist, after nerve damage resulted from the operation.
 
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temujim said:
Totally get it... but try explaining to a jury when you have pretty DVHs and a sad story and a grieving family and a expert proton witnesses telling them otherwise. Not justice, but reality.

Personally know of a lawsuit where a surgeon was sued for not referring to a radiation oncologist, after nerve damage resulted from the operation.
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Oh I know. All bets are off with a jury involved.
 
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medgator said:
There's a reason why many cases are settled within policy limits if possible, even if the underlying pathophysiology of the plantiffs case is complete BS
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Doing legal review as side hustle really opens your eyes. Recommend it if only once to get the sense of what goes on.
 
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Canada has now announced protons are coming to Toronto. $5 million Canadian has been allocated by the government for planning a 5 room center affiliated with Princess Margaret Hospital. I think they're tired of sending their pediatric patients out of country and saw how much they can save by not outsourcing to MDACC etc.

Princess Margaret also offers a "Proton Consultation Service", where their affiliated dosimetrist will make a comparison plan for you to quantify the difference from an Xray plan.
 
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IonsAreOurFuture said:
Canada has now announced protons are coming to Toronto. $5 million Canadian has been allocated by the government for planning a 5 room center affiliated with Princess Margaret Hospital. I think they're tired of sending their pediatric patients out of country and saw how much they can save by not outsourcing to MDACC etc.
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Are you sure you are not missing a zero in that amount? 5 vault center should cost tens of millions of dollars
 
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I think that's for the architects, developers and other early "planning" expenses. You're correct about the actual cost of construction. I think MDACC's current expansion with 4 rooms cost $160 M. The machines are getting smaller and cheaper, but construction costs are only going up right now.
 
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I think some kind of scale has now been tipped that the UK has 2 proton centers (and more on the way) which NICE and the NHS will pay for. This is interesting considering how cost-conscious the Brits, Canadians and Australian socialized systems are. The Adelaide proton center is now about halfway through construction, I think.
 
IonsAreOurFuture said:
I think some kind of scale has now been tipped that the UK has 2 proton centers (and more on the way) which NICE and the NHS will pay for. This is interesting considering how cost-conscious the Brits, Canadians and Australian socialized systems are. The Adelaide proton center is now about halfway through construction, I think.
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well every developed country should have proton options. NHS and Canada are doing it right. will serve many many many people.

not like the GOOD DEAR people of the ****hole florida who need a proton in every zip code.
 
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I'm not surprised about UK/Aus/Canada protons. It is needed.

The true tell will be what cases they DON'T treat on them. Via negativa.
 
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jondunn said:
well every developed country should have proton options. NHS and Canada are doing it right. will serve many many many people.

not like the GOOD DEAR people of the ****hole florida who need a proton in every zip code.
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I am half expecting Gov Santis to sign in a "Don't Say Photons" law in FL. If any patient is recommended to have photon-based therapy by their physician, anyone can anonymously report this and sue the physician for monetary damages. Since there are no government officials involved in this process it is totally kosher and cannot be appealed to a higher court.

Win!
 
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There have been a few interesting legal actions against insurers for proton denials now.

In addition to the United Healthcare $200 M judgment for the Las Vegas patient above, Aetna has a class action suit against it for breast and prostate cancer:

www.beckerspayer.com

Cancer patients win lawsuit against Aetna over denied treatment

A Florida judge ruled against Aetna in a class-action lawsuit over the payer's denied coverage of proton beam radiation therapy for cancer patients.
www.beckerspayer.com www.beckerspayer.com

There was also the 2018 Oklahoma verdict against Aetna for a Head & Neck cancer patient, a $25.5 M award:

www.ajmc.com

Jurors' Decision Against Aetna Highlights Proton Beam Therapy in Cancer Care

An Oklahoma verdict against Aetna highlights insurer reluctance to pay for proton beam therapy.
www.ajmc.com www.ajmc.com

United Healthcare is also facing a class action lawsuit:

www.reuters.com

IN BRIEF: UnitedHealthcare can’t zap cancer survivors’ lawsuit over proton therapy

A federal judge in Boston on Monday allowed three cancer survivors to proceed with their potential class action against UnitedHealthcare Insurance, alleging it “deceptively and unfairly administered their ERISA plans by refusing to cover Proton Beam Radiation Therapy (PBRT) … because it is more...
www.reuters.com www.reuters.com

and has had legal problems from judges and lawyers with prostate cancer:

www.cnn.com

Judge rips insurance company for 'immoral, barbaric' cancer denials | CNN

A federal judge blasted UnitedHealthcare last month for its "immoral and barbaric" denials of treatment for cancer patients. He made the comments in recusing himself from hearing a class-action lawsuit because of his own cancer battle -- and in so doing thrust himself into a heated debate in the...
www.cnn.com www.cnn.com

One of the arguments in legal cases has to do with age-based discrimination, because protons are a standard benefit for patients under 19 (Medicaid) and over 65 (Medicare). There is no medical reason why turning 19 or 65 would suddenly qualify or disqualify someone for a particular treatment type, e.g. protons for craniospinal in a 22 year old with medulloblastoma, which I've seen denied.
 
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IonsAreOurFuture said:
There have been a few interesting legal actions against insurers for proton denials now.

In addition to the United Healthcare $200 M judgment for the Las Vegas patient above, Aetna has a class action suit against it for breast and prostate cancer:

www.beckerspayer.com

Cancer patients win lawsuit against Aetna over denied treatment

A Florida judge ruled against Aetna in a class-action lawsuit over the payer's denied coverage of proton beam radiation therapy for cancer patients.
www.beckerspayer.com www.beckerspayer.com

There was also the 2018 Oklahoma verdict against Aetna for a Head & Neck cancer patient, a $25.5 M award:

www.ajmc.com

Jurors' Decision Against Aetna Highlights Proton Beam Therapy in Cancer Care

An Oklahoma verdict against Aetna highlights insurer reluctance to pay for proton beam therapy.
www.ajmc.com www.ajmc.com

United Healthcare is also facing a class action lawsuit:

www.reuters.com

IN BRIEF: UnitedHealthcare can’t zap cancer survivors’ lawsuit over proton therapy

A federal judge in Boston on Monday allowed three cancer survivors to proceed with their potential class action against UnitedHealthcare Insurance, alleging it “deceptively and unfairly administered their ERISA plans by refusing to cover Proton Beam Radiation Therapy (PBRT) … because it is more...
www.reuters.com www.reuters.com

and has had legal problems from judges and lawyers with prostate cancer:

www.cnn.com

Judge rips insurance company for 'immoral, barbaric' cancer denials | CNN

A federal judge blasted UnitedHealthcare last month for its "immoral and barbaric" denials of treatment for cancer patients. He made the comments in recusing himself from hearing a class-action lawsuit because of his own cancer battle -- and in so doing thrust himself into a heated debate in the...
www.cnn.com www.cnn.com

One of the arguments in legal cases has to do with age-based discrimination, because protons are a standard benefit for patients under 19 (Medicaid) and over 65 (Medicare). There is no medical reason why turning 19 or 65 would suddenly qualify or disqualify someone for a particular treatment type, e.g. protons for craniospinal in a 22 year old with medulloblastoma, which I've seen denied.
Click to expand...
This is a really interesting argument but I've been yelling at EvilCore (tm) for years now exclaiming, "Medicare covers it, why don't you?"

I don't see any private payors caving in to this - it is far cheaper to pay these occasional lawsuits than to start approving protons across the board.
 
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Gfunk6 said:
This is a really interesting argument but I've been yelling at EvilCore (tm) for years now exclaiming, "Medicare covers it, why don't you?"

I don't see any private payors caving in to this - it is far cheaper to pay these occasional lawsuits than to start approving protons across the board.
Click to expand...
This interesting thing is how United changed their policy for prostate cancer January 1, 2019 (in the absence of any new evidence).
 
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Gfunk6 said:
This is a really interesting argument but I've been yelling at EvilCore (tm) for years now exclaiming, "Medicare covers it, why don't you?"

I don't see any private payors caving in to this - it is far cheaper to pay these occasional lawsuits than to start approving protons across the board.
Click to expand...
 
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Gfunk6 said:
This is a really interesting argument but I've been yelling at EvilCore (tm) for years now exclaiming, "Medicare covers it, why don't you?"

I don't see any private payors caving in to this - it is far cheaper to pay these occasional lawsuits than to start approving protons across the board.
Click to expand...

United/Evicore has no problems paying these ridiculous lawsuits, yet I have to do a peer to peer to get a PET approved for an esophageal cancer or IMRT for a left sided chest wall with mean heart dose of 8Gy.

Infuriating
 
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Chartreuse Wombat said:
This interesting thing is how United changed their policy for prostate cancer January 1, 2019 (in the absence of any new evidence).
Click to expand...

I have not looked into this, but I was told verbally some of this had to do with United being an investor in a proton endeavor (?a proton center or something?). Could be complete hearsay but would be curious if true.
 
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medgator said:
Would that be legal? Wouldn't be totally shocked if it was.
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I have no clue. Heard it around 2020ish from someone in the know on proton insurance issues.

I *think* it was in relation to a major market (?NY or Chicago? ) proton center.

Probably wouldn’t be hard to verify or refute. Of course the funder wouldn’t be listed as “United health” on the documents, but could be figured out.

It’s obviously tin foil hat material, but would not surprise me either way.
 
Gfunk6 said:
This is a really interesting argument but I've been yelling at EvilCore (tm) for years now exclaiming, "Medicare covers it, why don't you?"

I don't see any private payors caving in to this - it is far cheaper to pay these occasional lawsuits than to start approving protons across the board.
Click to expand...

Right now, if an icd10 code is included in the cms covered list of diagnoses for imrt you will get paid. Its almost on your honor that you are appropriately utilizing. However, if you get audited they could do a deeper dive into your cases and nail you even for an approved icd10 they already paid for. People mistake cms paying for a code to mean its "approved" in all cases. The private insurers are just more explicit in their guidelines. At the end of the day the guidelines have to hold up to legal scrutiny, and given how actuarially driven these companies are im sure they are confident in their policies.
 
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TheWallnerus said:
Family gets a $200M judgement against United Healthcare for denying lung cancer proton therapy... which caused him to die, obv

There's way more data for IMRT in breast than protons for lung cancer, and United/Evicore deny IMRT for breast all the time

Some lawyer somewhere is missing out on a major class action suit on behalf of all breast cancer patients in America

p6Yh83f.png
Click to expand...

“United Healthcare “. Couldn’t have happened to a more deserving group of f*****s.
 
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Gfunk6 said:
I am half expecting Gov Santis to sign in a "Don't Say Photons" law in FL. If any patient is recommended to have photon-based therapy by their physician, anyone can anonymously report this and sue the physician for monetary damages. Since there are no government officials involved in this process it is totally kosher and cannot be appealed to a higher court.

Win!
Click to expand...

This would be an absolute hoot to have as a hobby as a very well off, retired, Florida physician who was a big-time cancer
patient with rad rx etc ( done with that bs thank goodness)
 
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