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

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members do not see this ad.
Reaganite said:
Where we have contracts >100% of Medicare, the private insurer kicks in the remainder up to our negotiated rates, so we end up getting >20%. We do not negotiate a separate rate for straight PPO vs. secondary plans. I suspect hospitals are similar and end up getting enormous payments from the health plans through the secondary insurance. That's the real racket here. It's also why commenting on slight Medicare utilization differences between hospitals and freestanding centers is a red herring...because the hospitals are killing it on the back end with these secondary insurances.



When patients have straight Medicare, the secondary can't deny payment if Medicare pays...they have to follow CMS's lead. Medicare Advantage is different because the patient has essentially assigned his Medicare over to the health plan and that does free up the health plan to some extent. The health plan still technically has to follow Medicare guidelines, but they can restrict their networks so that this service is not offered "in network."
Click to expand...
Thats what I thought. Very few pts have straight medicare with no supplement, and proton centers/MDACC types take very little medicare advantage.

When they do take medicare advantage- here is how the game is played:
United: we want you take our medicare advantage product at 1.1x CMS rates. To sweeten the deal, go ahead and charge the teachers union (where we are just a transaction manager/not at risk) 9 instead of 8 x CMS.
MDACC/MSKCC: ok, but we want to charge them 10 x CMS, and throw in the police union and some large private employers at this rate.
United: deal.
 
RickyScott said:
Thats what I thought. Very few pts have straight medicare with no supplement, and proton centers/MDACC types take very little medicare advantage.

When they do take medicare advantage- here is how the game is played:
United: we want you take our medicare advantage product at 1.1x CMS rates. To sweeten the deal, go ahead and charge the teachers union (where we are just a transaction manager/not at risk) 9 instead of 8 x CMS.
MDACC/MSKCC: ok, but we want to charge them 10 x CMS, and throw in the police union and some large private employers at this rate.
United: deal.
Click to expand...

I'm not a health policy expert, but I do most of our group's contracting, so I've picked up a lot of info along the way. This is a very nuanced issued that is very geographically-dependent. For their non Medicare advantage products, health plans want PREDICTABLY high costs because their profits are limited by the 80/20 ObamaCare rule (85% for large markets). Basically, Obama Care mandates that 80% of money collected through premiums in the individual and small markets (the number rises to 85% in large group plans) go directly to medical expenses. Whatever is left of that 15-20% after admin costs is the health plan's profit. But this doesn't mean the health plans want networks full of high cost providers. High costs usually come from heavily consolidated markets where hospitals have big leverage. In these markets, very high medical costs can outpace premiums leading to medical expenses well above the 80-85% minimum.

Medicare Advantage is completely different. The government gives health plans a pot of money equating to >100% Of Medicare allowable for a typical senior population, and the health plan keeps what it doesn't spend. These plans make money through heavy utilization oversite and limited networks which often exclude big academic types. The profits in these plans are higher than the PPO markets, and there is a heavy push to get seniors into these plans. Insurance brokers are definitely incentivized to push patients to MA plans vs. traditional Medicare. This is particularly relevant to oncology because the incidence of cancer in seniors in 10x non-seniors. The biggest enemy of big cancer centers is the proliferation of MA plans.
 
Reaganite said:
I'm not a health policy expert, but I do most of our group's contracting, so I've picked up a lot of info along the way. This is a very nuanced issued that is very geographically-dependent. For their non Medicare advantage products, health plans want PREDICTABLY high costs because their profits are limited by the 80/20 ObamaCare rule (85% for large markets). Basically, Obama Care mandates that 80% of money collected through premiums in the individual and small markets (the number rises to 85% in large group plans) go directly to medical expenses. Whatever is left of that 15-20% after admin costs is the health plan's profit. But this doesn't mean the health plans want networks full of high cost providers. High costs usually come from heavily consolidated markets where hospitals have big leverage. In these markets, very high medical costs can outpace premiums leading to medical expenses well above the 80-85% minimum.

Medicare Advantage is completely different. The government gives health plans a pot of money equating to >100% Of Medicare allowable for a typical senior population, and the health plan keeps what it doesn't spend. These plans make money through heavy utilization oversite and limited networks which often exclude big academic types. The profits in these plans are higher than the PPO markets, and there is a heavy push to get seniors into these plans. Insurance brokers are definitely incentivized to push patients to MA plans vs. traditional Medicare. This is particularly relevant to oncology because the incidence of cancer in seniors in 10x non-seniors. The biggest enemy of big cancer centers is the proliferation of MA plans.
Click to expand...

The other interesting part of MA plans is their efforts at patient selection. They are not allowed to refuse medicare patient's for illness. But they can and do do everything in their power to attract the healthier patients while leaving the sick expensive patients for traditional medicare. That works through targeted advertising (men's health or golf digest is a better bet then TV guide), and gearing their coverage to what healthier people want (free/easy preventative and primary care, gym memberships, fitness/nutrition coaching, etc) at the expense of what sicker people want (expansive formularies no prior auths or utilization review, etc)
 
DoctwoB said:
The other interesting part of MA plans is their efforts at patient selection. They are not allowed to refuse medicare patient's for illness. But they can and do do everything in their power to attract the healthier patients while leaving the sick expensive patients for traditional medicare. That works through targeted advertising (men's health or golf digest is a better bet then TV guide), and gearing their coverage to what healthier people want (free/easy preventative and primary care, gym memberships, fitness/nutrition coaching, etc) at the expense of what sicker people want (expansive formularies no prior auths or utilization review, etc)
Click to expand...
Add to the list hosting events at venues that are tailored to the healthy and require climbing the stairs
 
Reaganite said:
. The biggest enemy of big cancer centers is the proliferation of MA plans.
Click to expand...
Bingo. Many of the large hospital systems (with higher costs) may also offer their own MA plans and the last thing other MA insurers want to do is send business to their competitors' associated health system
 
1627500261513.png
 
This is just so sillly. Makes one regret being a part of “radiation oncology community” 🙂

OTN said:
A story in two links:

www.mdanderson.org

MD Anderson personalized my prostate cancer treatment

After reviewing all of his prostate cancer treatment options, Mike Zenner chose proton therapy for the minimal long-term side effects.
www.mdanderson.org www.mdanderson.org


2013 Choosing Wisely List- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

List display of the 2013 Choosing Wisely statements.
www.astro.org www.astro.org
Click to expand...
 
OTN said:
A story in two links:

www.mdanderson.org

MD Anderson personalized my prostate cancer treatment

After reviewing all of his prostate cancer treatment options, Mike Zenner chose proton therapy for the minimal long-term side effects.
www.mdanderson.org www.mdanderson.org


2013 Choosing Wisely List- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

List display of the 2013 Choosing Wisely statements.
www.astro.org www.astro.org
Click to expand...
Whoa. Just seeing this.
Not cool. How to address this…
Treat cancer “More accurately”?
 
MegaVoltagePhoton said:
Good on @RealSimulD for putting on the pressure. Except for @Dan Spratt and Kishan it does not look like anyone who dumped on Dattoli chimed in this time.
Click to expand...
Nope, it is because they are birds of a feather, flocking together, bullying a private practice doc (although I would say that those claims were pretty far out there). These are the same people who were not cool growing up, but now since they're in academic rad onc (Big rad onc, if you will), feel like they can band together and make fun of a fellow rad onc colleague.

You're right, there was a lot from the Dattoli tweet that still have not shown up for the MD Anderson/Steven Frank tweet:
  • Gerry Hanna
  • Drew Moghanaki
  • Percy Lee
  • Neil Desai
  • Vedang Murthy
  • Dave Fuller
  • Matthew Manning
Surely, they would have to have seen it, some of them live on Twitter. The silence is deafening.
 
Many of them exclude/block me, and it has a lot to do with the inconsistency that’s exposed. I just cannot stand the hypocrisy.

Dan’s head / heart in right place, but he can’t say the same things that he said when he was junior faculty. Amar is a very reasonable person.

There is an unfounded (to me) concern that being open and honest will hurt your career. I think many don’t say anything, fearing repercussions. In a case like this, how is it going to harm you to say “yah, MDACC probably shouldn’t have this on their website”. But, that’s what their mentors and faculty have impressed upon them, so we continue to have insincerity permeate all things.
 
RealSimulD said:
Many of them exclude/block me, and it has a lot to do with the inconsistency that’s exposed. I just cannot stand the hypocrisy.

Dan’s head / heart in right place, but he can’t say the same things that he said when he was junior faculty. Amar is a very reasonable person.

There is an unfounded (to me) concern that being open and honest will hurt your career. I think many don’t say anything, fearing repercussions. In a case like this, how is it going to harm you to say “yah, MDACC probably shouldn’t have this on their website”. But, that’s what their mentors and faculty have impressed upon them, so we continue to have insincerity permeate all things.
Click to expand...
As jobs become more scarce, there will be less speaking out...
 
This seems less an Anderson thing and more a individual physician thing…
 
TheWallnerus said:
Incredible Tales from the MDACC website
rJRz3sp.jpg

Bo0L7Fs.png

OByrKIq.png

KFwqoTv.png

vg3AuB9.png


Especially dig "the holy grail" part, just like that choosing wisely scene from Indiana Jones...
Click to expand...

Holup.

They "customize" the proton beam to the target's location, size and shape? I don't understand what they are talking about. I've been treating prostate cancer with an open four field box for the last 10 years . . .
 
RealSimulD said:
But… the real question. Is MARS better than DART??

Click to expand...


*Citation needed*

RealSimulD said:
Many of them exclude/block me, and it has a lot to do with the inconsistency that’s exposed. I just cannot stand the hypocrisy.

Dan’s head / heart in right place, but he can’t say the same things that he said when he was junior faculty. Amar is a very reasonable person.

There is an unfounded (to me) concern that being open and honest will hurt your career. I think many don’t say anything, fearing repercussions. In a case like this, how is it going to harm you to say “yah, MDACC probably shouldn’t have this on their website”. But, that’s what their mentors and faculty have impressed upon them, so we continue to have insincerity permeate all things.
Click to expand...

Most academics in RO either work at MDACC, know a guy/gal who works at MDACC, or want to be able to work at MDACC in the future. Thus, none will criticize MDACC non-anonymously.

SubserviantToABR said:
Nope, it is because they are birds of a feather, flocking together, bullying a private practice doc (although I would say that those claims were pretty far out there). These are the same people who were not cool growing up, but now since they're in academic rad onc (Big rad onc, if you will), feel like they can band together and make fun of a fellow rad onc colleague.

You're right, there was a lot from the Dattoli tweet that still have not shown up for the MD Anderson/Steven Frank tweet:
  • Gerry Hanna
  • Drew Moghanaki
  • Percy Lee
  • Neil Desai
  • Vedang Murthy
  • Dave Fuller
  • Matthew Manning
Surely, they would have to have seen it, some of them live on Twitter. The silence is deafening.
Click to expand...

Off the top of my head:
Percy and Dave work at MDACC so can't expect them to criticize.
Neil Desai at UTSW may want to move to MDACC in future.
Drew thinks academicians are best and community is filled with idiots
Vedang Murthy is in India so is probably innocent in all this, just doesn't know or probably care about proton therapy

Idk who Gerry Hanna or Matthew Manning are, don't really care to google them.
 
  • Like
Reactions: OTN
@RealSimulD How do you feel about the Multicare Cyberknife page?
www.multicare.org

Radiation Therapy - Cancer Treatment Options - MultiCare

You can access radiation therapy treatment at multiple MultiCare locations across the Pacific Northwest.
www.multicare.org www.multicare.org

The first and only dedicated radiosurgery device? Elekta would like to have a word. Honest question, when we start to compare each other's marketing pages, isn't that just another version of virtue signaling? "Oh my center would never oversell a marketable rad onc device". How many centers can really say that?

1627944704595.png
 
Thank you for picking up on this!

Will talk to the team.

The wording ABSOLUTELY needs to be fixed. Appreciate it.

Will post an update 🙂

addendum: I was certain we would have things on our website that need changing and figured someone would point it out to me. I think when that copy was written, it was the first and only dedicated robotic radiosurgery device that treated extra and intra cranially. I think that’s a little different than what I was pointing out. That being said, I will have this up to date ASAP.
 
Last edited by a moderator:
RAD ONC TRUTH IN ADVERTISING

In our center, we have up-to-date equipment. It is no better, but no worse, than anyone else's radiation machine in the region. We have cured many people with the equipment. Sometimes people have side effects from radiation no matter how great the equipment is though. We feel like our radiation machines are wholly adequate and have no convincing data that our machines cure people more often or give less side effects than other radiation machines anywhere else. Doctors control how these machines give radiation, and if one of our doctors (or physicists) doesn't aim in the right area or gives you too much radiation, it doesn't matter how fancy the equipment is... you can get hurt.

Please come see us. We are kind and promise to treat you like family.
 
Man, I read our whole CyberKnife section. This was the worst "gotcha" ever.

If we change "is the first and only" to "was the first and only" or somehow clarify that other radiosurgery platforms that treat extra/intracranial tumors exist, then there is nothing on that site I take issue with. It's actually really factual/objective - none of this "MOAR BETTER THAN YOUR OLD TYPE OF BRACHYTHERAPY" or "PROTONS: WAY BETTER THAN RADIATION".

Carry on, and find more stuff on our website to change - it is appreciated. This was on our list for the fall to update the website, but no time like now!
 
TheWallnerus said:
RAD ONC TRUTH IN ADVERTISING

In our center, we have up-to-date equipment. It is no better, but no worse, than anyone else's radiation machine in the region. We have cured many people with the equipment. Sometimes people have side effects from radiation no matter how great the equipment is though. We feel like our radiation machines are wholly adequate and have no convincing data that our machines cure people more often or give less side effects than other radiation machines anywhere else. Doctors control how these machines give radiation, and if one of our doctors (or physicists) doesn't aim in the right area or gives you too much radiation, it doesn't matter how fancy the equipment is... you can get hurt.

Please come see us. We are kind and promise to treat you like family.
Click to expand...
Could throw something in there about the 3As and it would be perfect
 
TheWallnerus said:
RAD ONC TRUTH IN ADVERTISING

In our center, we have up-to-date equipment. It is no better, but no worse, than anyone else's radiation machine in the region. We have cured many people with the equipment. Sometimes people have side effects from radiation no matter how great the equipment is though. We feel like our radiation machines are wholly adequate and have no convincing data that our machines cure people more often or give less side effects than other radiation machines anywhere else. Doctors control how these machines give radiation, and if one of our doctors (or physicists) doesn't aim in the right area or gives you too much radiation, it doesn't matter how fancy the equipment is... you can get hurt.

Please come see us. We are kind and promise to treat you like family.
Click to expand...
This level of truth burns my soul. Is it Witchcraft? ARE YOU A WITCH?
 
RealSimulD said:
Man, I read our whole CyberKnife section. This was the worst "gotcha" ever.

If we change "is the first and only" to "was the first and only" or somehow clarify that other radiosurgery platforms that treat extra/intracranial tumors exist, then there is nothing on that site I take issue with. It's actually really factual/objective - none of this "MOAR BETTER THAN YOUR OLD TYPE OF BRACHYTHERAPY" or "PROTONS: WAY BETTER THAN RADIATION".

Carry on, and find more stuff on our website to change - it is appreciated. This was on our list for the fall to update the website, but no time like now!
Click to expand...
The point of the post was not a "gotcha". It was to point out that most rad onc marketing when truly scrutinized is mostly always going to be on some level misleading/overselling. Why even have a Cyberknife section of the website? Why just call it a radiosurgery? Do you have dedicated website for your Truebeams that do SBRT too?

There are also levels to "little" rad onc and "littler" rad onc. Imagine if you are another center in the Puget sound that doesn't have a "dedicated robotic radiosurgery system " and a patient of yours is asking about the accuracy to the "width of the hair" of a Cyberknife. Imagine they pull up that website and start asking you some questions. What if they ask if they should stick your regular ol linac, or go get treated on the Cyberknife, do you think they might feel some kind of way?
 
radiation said:
The point of the post was not a "gotcha". It was to point out that most rad onc marketing when truly scrutinized is mostly always going to be on some level misleading/overselling. Why even have a Cyberknife section of the website? Why just call it a radiosurgery? Do you have dedicated website for your Truebeams that do SBRT too?

There are also levels to "little" rad onc and "littler" rad onc. Imagine if you are another center in the Puget sound that doesn't have a "dedicated robotic radiosurgery system " and a patient of yours is asking about the accuracy to the "width of the hair" of a Cyberknife. Imagine they pull up that website and start asking you some questions. What if they ask if they should stick your regular ol linac, or go get treated on the Cyberknife, do you think they might feel some kind of way?
Click to expand...
Fact of the matter is that you brought up his website (for a position that he just started in the near past), and he saw it, he owned it, and he is committed to changing it. That's leadership.

The difference between most of the marketing, in general, versus what MD Anderson said is that MD Anderson has spent hundreds of millions of dollars (see citation above) on protons, treated many, many patients with protons under the auspices of protons being better than photons without any credible evidence, and claiming that protons are more accurate than photons.

I'm at a shop where I have Cyberknife. I have a good relationship with the other rad oncs in town who don't have the same equipment. They will occasionally send me a referral to see if CK may be fit for them. I usually send them back to the original rad onc for the overwhelming majority of cases. Once in a blue moon, depending on the clinical situation, I'll recommend treatment on the CK...but like I said, once in a blue moon.

We all have to promote ourselves, from the littlest to the biggest rad onc out there...it's how we do it that matters. But misrepresenting protons is not okay.
 
radiation said:
The point of the post was not a "gotcha". It was to point out that most rad onc marketing when truly scrutinized is mostly always going to be on some level misleading/overselling. Why even have a Cyberknife section of the website? Why just call it a radiosurgery? Do you have dedicated website for your Truebeams that do SBRT too?

There are also levels to "little" rad onc and "littler" rad onc. Imagine if you are another center in the Puget sound that doesn't have a "dedicated robotic radiosurgery system " and a patient of yours is asking about the accuracy to the "width of the hair" of a Cyberknife. Imagine they pull up that website and start asking you some questions. What if they ask if they should stick your regular ol linac, or go get treated on the Cyberknife, do you think they might feel some kind of way?
Click to expand...
Gizmo idolatry

jamanetwork.com

Gizmo Idolatry

It seems that “gizmo idolatry” now exists in the practice of medicine. “Gizmo” is defined by the American Heritage Dictionary as “a mechanical device or part whose name is forgotten or unknown; a gadget.” In this article, gizmo is used to refer to a mechanical device or procedure for which the...
jamanetwork.com jamanetwork.com

Money quote

"In the medical marketplace, some combination of avarice, hucksterism, credulity, genuine need, and gizmo idolatry impart considerable momentum to the early and unconsidered use of many unproven technologies."
 
Are you trying to make a pedantic point or do you equate this with the other examples?
Sincerely asking. You don’t see anything saying “Dr. Parikh said my cancer would be better treated with SPRT, his trademarked robotic surgery system.”

Yes, the copy exists. You know what? I got here 5 weeks ago, I’ve addressed that it needs updates. I have a meeting about it upcoming. There are no clinical comparisons. There are no doctors saying anything. No patients saying anything. And.. no excuses or weak defense.

You preference is we don’t list our technology at Multicare? Come get my job! You can do that. I plan on factually listing what we have. I think it is different than staying “x is better” “y is safer”

You brought up my site. I’m listening. I’m making changes. What are they doing?
 
RealSimulD said:
Are you trying to make a pedantic point or do you equate this with the other examples?
Sincerely asking. You don’t see anything saying “Dr. Parikh said my cancer would be better treated with SPRT, his trademarked robotic surgery system.”

Yes, the copy exists. You know what? I got here 5 weeks ago, I’ve addressed that it needs updates. I have a meeting about it upcoming. There are no clinical comparisons. There are no doctors saying anything. No patients saying anything. And.. no excuses or weak defense.

You preference is we don’t list our technology at Multicare? Come get my job! You can do that. I plan on factually listing what we have. I think it is different than staying “x is better” “y is safer”

You brought up my site. I’m listening. I’m making changes. What are they doing?
Click to expand...
Protons are unproven, probably harmful for prostate, and much more expenisve. These are key differences.
 
radiation said:
The point of the post was not a "gotcha". It was to point out that most rad onc marketing when truly scrutinized is mostly always going to be on some level misleading/overselling. Why even have a Cyberknife section of the website? Why just call it a radiosurgery? Do you have dedicated website for your Truebeams that do SBRT too?

There are also levels to "little" rad onc and "littler" rad onc. Imagine if you are another center in the Puget sound that doesn't have a "dedicated robotic radiosurgery system " and a patient of yours is asking about the accuracy to the "width of the hair" of a Cyberknife. Imagine they pull up that website and start asking you some questions. What if they ask if they should stick your regular ol linac, or go get treated on the Cyberknife, do you think they might feel some kind of way?
Click to expand...
I just tell them I “cyberknife” the cancer also.
 
RickyScott said:
saw pt who treated at INOVA with protons for lumbar met from lung cancer. Told that because she was on keytruda for her lung cancer protons were needed to reduce side effects.
Click to expand...
Definitely explains the need for them to offer a proton fellowship... that's a lot of potential cases!!
 
RickyScott said:
As jobs become more scarce, there will be less speaking out...
Click to expand...
Jobs are already very scarce especially the ones were sophistos in academia can sit and comfortably judge all other practitioners. The best you can hope from then is they either leave the field, conform, or burn it all to the ground in one last act of frustration and defiance
 
You must log in or register to reply here.

Similar threads

C
CMS Innovation
Replies
3
Views
742
TheWallnerus
TheWallnerus
uchihastan
Rad Onc vs. Heme/Onc
Replies
16
Views
3K
medgator
M
Gfunk6
Rad Onc? Burnt Out?
Replies
36
Views
4K
thecarbonionangle
thecarbonionangle
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
7K
RickyScott
R
Top