Rad Onc? Burnt Out?

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Gfunk6

And to think . . . I hesitated
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Here’s some advice from a senior medical director from a leading prior auth company.

You know, those guys who make you wait one week to do a P2P because you wanted to do SRS on a solitary brain met and the nurse reviewer said she can authorize it right away if you do it “by 3D.”

Then the P2P guy says, sorry prostate cancer brain mets are excluded from our SRS policy. You can appeal if you’d like.

Those guys have nothing to do with your burn out I’m sure.

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Not to be presumptuous but I will go ahead and answer the two questions he posed:

1. Prior authorization. You used to have to deal with this abomination for HMOs/PPOs only but now we need it for those lovely Medicare Advantage patients.

2. Quit clinical medicine and join Evolent.

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Members don't see this ad.
 
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Wow...the lack of self-awareness is astonishing.
Somebody explain what evolent is. Googling just produces over and over that they connect people with complex medical problems. Huh? Literally what?

Because they don’t present themselves as selling their product to health plan administrators.
 
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Members don't see this ad :)
Somebody explain what evolent is. Googling just produces over and over that they connect people with complex medical problems. Huh? Literally what?

Because they don’t present themselves as selling their product to health plan administrators.
Simple. They act as a middleman between insurance companies and physicians. They are incentivized to deny, deny, deny so that the physicians either get sick of arguing and let the patient die or send them to hospice. Either way, both the middleman and the insurance company get the sick patients premiums without having to pay for health benefits.
 
Simple. They act as a middleman between insurance companies and physicians. They are incentivized to deny, deny, deny so that the physicians either get sick of arguing and let the patient die or send them to hospice. Either way, both the middleman and the insurance company get the sick patients premiums without having to pay for health benefits.

The entire business, including the name and model itsel and the “about us” section on the website sounds like it was only written by chat-gpt. I don’t think a human could have come up with this.

Come up with a name for a company whose business model is to sell services to health insurance companies to try and deny as many claims as possible and come up with a 2 paragraph “about us” section for their website.

Chat gpt:
Company Name: ClaimGuard Solutions

About Us:
At ClaimGuard Solutions, we specialize in providing innovative services tailored to the needs of health insurance companies, empowering them to optimize their claim denial processes. With years of expertise in the healthcare industry, our team is dedicated to assisting insurance providers in maximizing cost savings while maintaining compliance and efficiency. Through our cutting-edge technology and data-driven approach, we enable insurance companies to identify and mitigate potentially fraudulent or unnecessary claims, ultimately ensuring fair and accurate reimbursement practices. At ClaimGuard Solutions, we are committed to revolutionizing the claims management landscape, driving profitability and sustainability for our valued partners in the insurance sector.


Hmm, that’s saying the quiet part out loud.

Come up with a name for a company whose business model is to sell services to health insurance companies to try and deny as many claims as possible and come up with a 2 paragraph “about us” section for their website. But make it seem like they know denying claims has bad optics so make it sound more appealing to the layperson.

Chat-GPT

Company Name: CareGuard Solutions

About Us:
At CareGuard Solutions, we are dedicated to revolutionizing the healthcare industry by ensuring fair and efficient claim adjudication processes for health insurance providers. Our mission is to protect the integrity of insurance plans while maximizing benefits for policyholders. Through our innovative services and advanced analytics, we empower insurance companies to detect and prevent erroneous claims, ultimately enhancing the sustainability of healthcare coverage for all. With a commitment to transparency and ethical practices, CareGuard Solutions strives to build trust and confidence within the healthcare community, driving positive outcomes for insurers, healthcare providers, and patients alike.

Bingo!!
 
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Yeah...this dude is a "fellow doctor" the same way I consider someone with a EdD from a for-profit online school a "fellow doctor".

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Oh this propaganda again eh?

Yes because OF COURSE those are the ONLY TWO THINGS that cause burnout, and they're DEFINITELY NOT SUBJECTIVE EXPERIENCES regardless.

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Well I guess I could go scroll through one of the big job boards and see if there are any Medical Director jobs at insurance companies...
 
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Let's say you were to have a meeting with this guy to discuss his policies (which according to their website seem to be very similar to Evicore), what types of questions would you ask... (hypothetically of course) ;)
 
what the incentive program is, how do they either reward or punish decision making, and if they do not do that, what metrics do they get/are they following on your review process?
 
what the incentive program is, how do they either reward or punish decision making, and if they do not do that, what metrics do they get/are they following on your review process?

Oh sorry, not for a job interview (realize that was unclear). They want us to accept their reviewer services for our practice as part of a larger ploy for our medical system. Their polciies seem overly silly in some places (no IGRT for any 3D, etc)
 
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This guy is a total shmuck. This is the tip of the iceberg of he's holier-than-though approach to denying care, and claiming he's doing God's work. Don't dive too deep into his profile, it only gets worse.
 
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The dangerous narrative that some of them say is ‘you want me on that wall, trust me I have your back, the others dont’
 
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Members don't see this ad :)
This guy is a total shmuck. This is the tip of the iceberg of he's holier-than-though approach to denying care, and claiming he's doing God's work. Don't dive too deep into his profile, it only gets worse.
disgraceful. Similarly insidious are big radonc programs/astro leadership who created many of the problems with our field offering advice on how to address the burnout that they forment. Do you endure a malignant, highly political department and cant change jobs without moving your family across the country....Someone from astro will lead a yoga session to help your stress or a "how to say no" to your chairman seminar.
 
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If we're talking burnout, probably a good place to talk about the most recent ASTRO to CMS letter re: supervision:

 
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This guy is a total shmuck. This is the tip of the iceberg of he's holier-than-though approach to denying care, and claiming he's doing God's work. Don't dive too deep into his profile, it only gets worse.
The “but I’m different” argument is slightly annoying. Who you trying to convince?

It’s like Whitney Houston getting pissed off because somebody accused her of smoking her cocaine instead of snorting it. How dare you accuse of me of smoking it, what kind of degenerate do you think I am?!!
 
ASTRO is doing what they think they need to do to protect the job market. I know this is a controversial topic. But Bridge Oncology is standing by ready to pounce, as are others who see money signs in their eyes.
 
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There's the ASTRO shill...

Not even a dues paying member.

Should be able to talk about this stuff without attacks, my friend.

I just think groups and people do things that make sense from their perspective, for better or worse.

Not sure why else ASTRO would care about this other than protecting the role of rad onc and need for rad onc is quite literally in their job description. That must be their rationale. If you have another one to share, I'm open to ideas.

They aren't doing this because they get off on annoying you and other free standing folks.
 
Not even a dues paying member.

Should be able to talk about this stuff without attacks, my friend.

I just think groups and people do things that make sense from their perspective, for better or worse.
"Protecting the job market" by expanding programs and slots like crazy?

Does not compute. Unless you mean trying to justify jobs for all of the extra residents they are training. But not sure that = "protecting the job market"
 
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"Protecting the job market" by expanding programs and slots like crazy?

I figured that would be a reply and you are not wrong.

but keep in mind there are two issues - supply and demand.

Supply is a problem, and ASTRO has gone as far as to soft stabilize, but they have not done major cuts, and I don't see it happening.

however DEMAND is also an issue that has to be protected.

I have posted about this a lot here, so I understand there is a spectrum of opinions. I think things like Bridge Oncology are real dangers that have to be watched. It is my opinion we need Guard rails of SOME type. Direct supervision rules of some type do make places hire rad oncs that could avoid doing it if we did not have them. We haven't seen even a small percentage of what the future could hold if the floodgates open on this.

Maybe it doesn't need to be 5 days a week, maybe there need to be allowances to allow physician flexibility.

but tell me why else ASTRO would write this letter if not to protect demand? Again I am open to ideas.
 
but tell me why else ASTRO would write this letter if not to protect demand? Again I am open to ideas.
They want to make it cost prohibitive to run small community centers that they (they being the large academic networks that own ASTRO) either 1.) have to compete with for patients or 2.) would want to buy and jack up their payor rates.

Consolidation is the goal.
 
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I figured that would be a reply and you are not wrong.

but keep in mind there are two issues - supply and demand.

Supply is a problem, and ASTRO has gone as far as to soft stabilize, but they have not done major cuts, and I don't see it happening.

however DEMAND is also an issue that has to be protected.

I have posted about this a lot here, so I understand there is a spectrum of opinions. I think things like Bridge Oncology are real dangers that have to be watched. It is my opinion we need Guard rails of SOME type. Direct supervision rules of some type do make places hire rad oncs that could avoid doing it if we did not have them. We haven't seen even a small percentage of what the future could hold if the floodgates open on this.

Maybe it doesn't need to be 5 days a week, maybe there need to be allowances to allow physician flexibility.

but tell me why else ASTRO would write this letter if not to protect demand? Again I am open to ideas.
You're not wrong re: ASTRO's ulterior motive.

But it's insulting that ASTRO is taking a stance that trounces on physician autonomy and ruins current rad oncs' qualities of life so medical students who want to be future rad oncs have jobs. Ironically, and counter to ASTRO's ulterior motive, 100% physical presence will dissuade, not encourage, medical students to choose rad onc.

What's the saying? They're peeing on our heads and telling us it's raining.
 
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You're not wrong re: ASTRO's ulterior motive.

But it's insulting that ASTRO is taking a stance that trounces on physician autonomy and ruins current rad oncs' qualities of life so medical students who want to be future rad oncs have jobs. Ironically, and counter to ASTRO's ulterior motive, 100% physical presence will dissuade, not encourage, medical students to choose rad onc.

What's the saying? They're peeing on our heads and telling us it's raining.
Reminds me of the standard response in Goodfellas when it comes time to collect.

You want to see the dentist over lunch? F-you supervise.
Your kid threw up this morning? F-you supervise.
Need to catch a Friday afternoon flight? F-you.... SUPERVISE!
 
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Consolidation is the goal.

oh well I agree on that, that's clear but that is way bigger than astro. astro has no power to enact consolidation.

Rather, corporate consolidation has further empowered ASTRO because it creates pillars of power in large hospital based systems (again, this is really completely agnostic to academic or non-academic. we all know major hospital systems benefit from this). and these hospital systems donate to astro but also have leaders (including chairs of academics dept) that thereby represent their shared interests.

corporate consolidation happens in C-suites, not the effing basement. and rad onc is just one tiny part of it.
 
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oh well I agree on that, that's clear but that is way bigger than astro. astro has no power to enact consolidation.

Rather, corporate consolidation has further empowered ASTRO because it creates pillars of power in large hospital based systems (again, this is really completely agnostic to academic or non-academic. we all know major hospital systems benefit from this). and these hospital systems donate to astro but also have leaders (including chairs of academics dept) that thereby represent their shared interests.

corporate consolidation happens in C-suits, not the effing basement. and rad onc is just one tiny part of it.
Eh... plenty of community rad onc departments have been swallowed by the nearby academic center whilst the rest of the hospital remains independent. The goal is to make that department economically non-viable without boosted rates/large network coverage.

Two community centers an hour apart. Both treating 12 patients. One PSA doc could easily (and safely) cover these sites (likely in 4 days per week) and collect idk... ~900k pending payor mix? Of course, some of that comes off the top for expenses, but would still be a nice living for one doc. Supervise virtually when away or hire a locums as needed.

Make those two sites require two docs 5 days/week with 100% coverage? The private doc can't make ends meet with that arrangement and moves on. The hospitals try to hire, but probably now need 2.5-3 docs for such coverage. They can't make the numbers work with their location, at that volume, with their contracts. Centers close, patients forced to drive 1.5 hours each way to nearest large network center at higher rates (or God forbid PROTONS).

This is the goal. This is always the goal.
 
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But it's insulting that ASTRO is taking a stance that trounces on physician autonomy and ruins current rad oncs' qualities of life so medical students who want to be future rad oncs have jobs.


Were you a residency program director pushing for expansion in 2005-2015?

;)
 
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Eh... plenty of community rad onc departments have been swallowed by the nearby academic center whilst the rest of the hospital remains independent.


yes, know some of these very intimately. But again - when that decision happens, it's in the C-suite, far above rad onc.

any hospital c-suite worth its salt can do simple math and know if they capture another freestanding center and turn it to hospital affiliated by buying them, even if the numbers fall, they'll make money. they also know if they buy another hospital's machine, they can charge higher rates than they were likely charging before, or centralize the billing and lower other operational costs.

there are massive incentives to consolidation in rad onc due to high technical fees, and the advantages some have in what they can bill.
 
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yes, know some of these very intimately. But again - when that decision happens, it's in the C-suite, far above rad onc.
Gotta disagree. The chairpersons of rad onc are fully in on those decisions, often driving them. Seen it first hand, multiple time. It's not like a suit shows up in the basement one day and says, "your department will start staffing Community Center X next month."
 
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Gotta disagree. The chairpersons of rad onc are fully in on those decisions, often driving them. Seen it first hand, multiple time. It's not like a suit shows up in the basement one day and says, "your department will start staffing Community Center X next month."

Fair. What I have seen is the opposite. Hospital X buying Hospital Y and someone telling the chair - figure it out.

I dont know how many rad onc chairs you have met but not many of them are exactly sharks.
 
Gotta disagree. The chairpersons of rad onc are fully in on those decisions, often driving them. Seen it first hand, multiple time. It's not like a suit shows up in the basement one day and says, "your department will start staffing Community Center X next month."
Upenn
 
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I wonder how many rad oncs work as locums at least 30 days a year
 
Reminds me of the standard response in Goodfellas when it comes time to collect.

You want to see the dentist over lunch? F-you supervise.
Your kid threw up this morning? F-you supervise.
Need to catch a Friday afternoon flight? F-you.... SUPERVISE!
@drowsy12

APPs are allowed to directly supervise per ASTRO already and they are reportedly pushing for advanced RTTs so this new direct supervision letter by no means protects physician jobs
 
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This guy is a total shmuck. This is the tip of the iceberg of he's holier-than-though approach to denying care, and claiming he's doing God's work. Don't dive too deep into his profile, it only gets worse.
This is what they all say, even the ones who have posted on sdn
 
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