Rad Onc Twitter

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frijoles said:
Surprised to hear this. I have no knowledge of salaries at UPenn but heard rumors that they are one of the academic places (like MDACC) that actually pay academics well. If this is considered a good salary in academics :wow:

Perhaps there is strong incentive / bonus pay?
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No, assistant professor salaries+bonus at the main center are on the low side (well under 300K the last time I looked).
They do have generous time off site for academic pursuits tho
 
Chartreuse Wombat said:
I don't know but is Penn in zipcode for APM?
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I think that NCI-designated cancer centers are exempt from the APM for technical fees, even if they are in an included zip code. Professional fees are still subject to APM... but obviously this is only a small fraction of the total reimbursement. (at least this is how it was explained to me)
 
280k is abysmal. I thought I was underpaid but thats bad. however i have heard that the job (at least main site) is pretty "cush"

i have been seeing a lot of activity about mri guided radiation on twitter. i am not sure it is going to really move the needle but what do you think? it would only reimburse more if adapted right?
 
Gfunk6 said:
Saying that private practice abuses fractionatin/IMRT and so does academics is a false equivalence. It is like trying to equate the morality of a chronic masturbator with a serial killer.
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So what you're saying is, if your admin/contract person/etc could negotiate these rates for your practice you'd turn it down since it's obviously unethical and you'd rather be a serial masturbator.
 
StuDocNet4dummies said:
So what you're saying is, if your admin/contract person/etc could negotiate these rates for your practice you'd turn it down since it's obviously unethical and you'd rather be a serial masturbator.
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No, if you could negotiate these rates, you would buy up practices, and expand your satellites and then come back and negotiate even higher rates now that you have gained more leverage… (and I wouldn’t stop masturbating)
 
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frijoles said:
Surprised to hear this. I have no knowledge of salaries at UPenn but heard rumors that they are one of the academic places (like MDACC) that actually pay academics well. If this is considered a good salary in academics :wow:

Perhaps there is strong incentive / bonus pay?
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280k starting would not be considered a good salary in academics based on most recent ARRO survey data; 75% >300k starting, 31% >350k starting (hospital employed + PP both higher)
 
RickyScott said:
No, if you could negotiate these rates, you would buy up practices, and expand your satellites and then come back and negotiate even higher rates now that you have gained more leverage… (and I wouldn’t stop masturbating)
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So you think it sounds like unethical skullduggery or good business practice? ...ie are you morally offended or jealous.

Seems like this is what the market does. Jeff Bezos is going to space on the tears of small book sellers/then local business owners/then grocers.
 
RickyScott said:
11 pps exempt centers.
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The list is interesting as is what this designation means. The exemption makes no sense to me and probably incentivizes some bad practices as reporting requirements different than for NCI designated centers. It certainly incentivizes financial toxicity. The big 3 are there but the rest of the list is somewhat surprising. Outcomes no better at PPS and this is well studied.

I am away from major metros but close enough to get referrals and deal with 2nd opinions. In my region, I deal with several NCI designated centers with good residencies. They are rarely predatory and refer patients to me routinely. The PPS exempt center near me is completely predatory and often contradicts my recommendations. I have had them retain patients for early stage skin cancers.
 
StuDocNet4dummies said:
So you think it sounds like unethical skullduggery or good business practice? ...ie are you morally offended or jealous.

Seems like this is what the market does. Jeff Bezos is going to space on the tears of small book sellers/then local business owners/then grocers.
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Wrong on so many levels. Amazon is not charging more than the competition (usually much less) such that we pay more for merchandise than every other country in the world. A better analogy would be if the power company was not regulated and could charge you whatever they wanted or a mafia don who makes businesses pay a “ tax.”
 
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MegaVoltagePhoton said:
280k is abysmal. I thought I was underpaid but thats bad. however i have heard that the job (at least main site) is pretty "cush"

i have been seeing a lot of activity about mri guided radiation on twitter. i am not sure it is going to really move the needle but what do you think? it would only reimburse more if adapted right?
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I couldn't get Evicore to let me do a 3D plan for an L-spine 8 Gy in 1 fraction today. You think they'll not catch on that people are doing 10 or more IMRT plans on their MRGRT machine per course of tx? It'll move a needle and then all payors will go "NO NEEDLES FOR YOU."
 
RickyScott said:
Wrong on so many levels. Amazon is not charging more than the competition (usually much less) such that we pay more for merchandise than every other country in the world. A better analogy would be if the power company was not regulated and could charge you whatever they wanted or a mafia don who makes businesses pay a “ tax.”
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Yeah leave amazon alone! I'm very happy with AMZN 😛
 
medgator said:
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Oh My God Omg GIF by America's Got Talent
 
medgator said:
His sheer ignorance on so many different topics regarding workforce and reimbursement issues is not short of astounding.... Really a true embodiment of everything wrong with "Big Rad Onc"
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To be fair, docs in academics don’t bill. I have absolutely no idea what my department bills insurance. I know they are very good about eating the extra cost for IMRT when I really need it and insurance denies it… but they could be raking the insurance over the coals for all I know.

When we talk about price transparency… are we talking about disclosing the cost billed insurance or the out-of-pocket cost for the patient? I am not sure how many patients are gonna care about the former.
 
Lamount said:
To be fair, docs in academics don’t bill. I have absolutely no idea what my department bills insurance. I know they are very good about eating the extra cost for IMRT when I really need it and insurance denies it… but they could be raking the insurance over the coals for all I know.
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Would you sit there and tweet about it?
 
Lamount said:
To be fair, docs in academics don’t bill. I have absolutely no idea what my department bills insurance. I know they are very good about eating the extra cost for IMRT when I really need it and insurance denies it… but they could be raking the insurance over the coals for all I know.

When we talk about price transparency… are we talking about disclosing the cost billed insurance or the out-of-pocket cost for the patient? I am not sure how many patients are gonna care about the former.
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Price transparency is about what the insurance pays, not the patient’s out of pocket expenses. large employers are typically self insured, so they are the ones actually paying, and the insurance company just takes a percentage. Most radoncs today don’t bill, because most of us are employed.
Destination centers have adopted business models where they bill huge amounts for short courses of treatment- (much more profitable to treat eight sbrt prostates than single patient for eight weeks if machines are at capacity. )Then faculty virtue signal about convenience of hypofrac, when they are actually price gouging society.
 
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medgator said:
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Medicare patients have secondary insurances that kick in the remainder of payment often up to the negotiated amount that an entity has with the private insurer. I don't believe these payments are reflected in the Medicare utilization data academic centers love to quote, but they likely account for the profound differences in reimbursement between freestanding and hospital/academic centers. If I'm treating a medicare/PPO patient, my max reimbursement is determined by the PPO contract, not the Medicare contract. Medicare will pay 80% of "Medicare Allowable," and the PPO kicks in the rest up to our negotiated amount. Our best contracts may hover in the 125-150% of Medicare range, so in a best case scenario, we may get an additional 70% of Medicare allowable (80 + 70= 150). Importantly, none of our contracts have a cap on the secondary payment. If the same reimbursement structure holds true for hospitals/academic centers (esp no cap on the secondary payment), they may be getting 500%+ of Medicare allowable from the secondary insurances, even though they receive only 80% from Medicare. So from a purely Medicare cost standpoint, they may look reasonable, but this doesn't tell the real story because they are gouging on the private end.

As others have pointed out, the real enemy of these places is the Medicare Advantage type plans where the health plan is globally at risk rather than serving as an insurance agent. My neck of the woods has a heavy medicare advantage-type insurance structure, and they are putting a beating on the academic entities. Of course, the academics are trying to set up all sorts of questionable arrangements to circumvent this (one center is essentially treating under 2 separate licenses in the same facility to simultaneously bill hospital and foundation rates depending on the insurance), but so far they've been shut out from a hefty percentage of the business.
 
medgator said:
Would you sit there and tweet about it?
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Nope. The notion of publicity terrifies me so I have posted a total of 2 times on Twitter. Regarding KO, the only point I was making is that… i sleep well at night knowing my patients don’t feel a lot of financial toxicity, and KO may as well. It would be easy for me to erroneously assume that this means I am not causing the system any financial toxicity. We know what happens to our patients… but we don’t know what happens to their insurance.
 
Lamount said:
Nope. The notion of publicity terrifies me so I have posted a total of 2 times on Twitter. Regarding KO, the only point I was making is that… i sleep well at night knowing my patients don’t feel a lot of financial toxicity, and KO may as well. It would be easy for me to erroneously assume that this means I am not causing the system any financial toxicity. We know what happens to our patients… but we don’t know what happens to their insurance.
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How can you be sure you're sparing financial toxicity yourself? Do you practice at the least expensive site of service in your area? You've proven my point about how clueless big rad Onc is these days.... You probably don't even know what your system charts for a daily CBCT... I do for mine
 
medgator said:
How can you be sure you're sparing financial toxicity yourself? Do you practice at the least expensive site of service in your area? You've proven my point about how clueless big rad Onc is these days.... You probably don't even know what your system charts for a daily CBCT... I do for mine
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Your 100% right. I don’t know what we bill for a CBCT. I wasn’t disagreeing with you. I was simply saying KO probably doesn’t know what he doesn’t know.

regarding my patients, I don’t know how our expenses compare to others, but many of my patients are indigent. Whenever any of them has had difficulty with a bill, our department has written it off… but beyond that, it is a black box.
 
Reaganite said:
Medicare patients have secondary insurances that kick in the remainder of payment often up to the negotiated amount that an entity has with the private insurer. I don't believe these payments are reflected in the Medicare utilization data academic centers love to quote, but they likely account for the profound differences in reimbursement between freestanding and hospital/academic centers. If I'm treating a medicare/PPO patient, my max reimbursement is determined by the PPO contract, not the Medicare contract. Medicare will pay 80% of "Medicare Allowable," and the PPO kicks in the rest up to our negotiated amount. Our best contracts may hover in the 125-150% of Medicare range, so in a best case scenario, we may get an additional 70% of Medicare allowable (80 + 70= 150). Importantly, none of our contracts have a cap on the secondary payment. If the same reimbursement structure holds true for hospitals/academic centers (esp no cap on the secondary payment), they may be getting 500%+ of Medicare allowable from the secondary insurances, even though they receive only 80% from Medicare. So from a purely Medicare cost standpoint, they may look reasonable, but this doesn't tell the real story because they are gouging on the private end.

As others have pointed out, the real enemy of these places is the Medicare Advantage type plans where the health plan is globally at risk rather than serving as an insurance agent. My neck of the woods has a heavy medicare advantage-type insurance structure, and they are putting a beating on the academic entities. Of course, the academics are trying to set up all sorts of questionable arrangements to circumvent this (one center is essentially treating under 2 separate licenses in the same facility to simultaneously bill hospital and foundation rates depending on the insurance), but so far they've been shut out from a hefty percentage of the business.
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This was my impression in terms of Medicare, with the supplement making up the difference between the 80% Medicare pays and the negotiated price.
 
Reaganite said:
.

As others have pointed out, the real enemy of these places is the Medicare Advantage type plans where the health plan is globally at risk rather than serving as an insurance agent.
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Seems like the biggest growth for evilcore has been the advantage plans lately. A big Medicare advantage provider in our area went to evilcore last year
 
RickyScott said:
Wrong on so many levels. Amazon is not charging more than the competition (usually much less) such that we pay more for merchandise than every other country in the world. A better analogy would be if the power company was not regulated and could charge you whatever they wanted or a mafia don who makes businesses pay a “ tax.”
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No. Not really. The Penn's of the world are leveraging size to negotiate price and dominate the market. My question remains unanswered so I'll rephrase it in the hypothetical:

If you and GFunk were in the same city. Your hospital system negotiated a rate that is 10x medicare rates for United HC and you find out GFunks crap negotiator only got 5x medicare for UHC. RickyScott...do you call your hospital with the concern that UHC is overpaying for the service you provide?
 
StuDocNet4dummies said:
No. Not really. The Penn's of the world are leveraging size to negotiate price and dominate the market. My question remains unanswered so I'll rephrase it in the hypothetical:

If you and GFunk were in the same city. Your hospital system negotiated a rate that is 10x medicare rates for United HC and you find out GFunks crap negotiator only got 5x medicare for UHC. RickyScott...do you call your hospital with the concern that UHC is overpaying for the service you provide?
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That depends...is RickyScott part of an academic department which claims to care about financial toxicity for its patients?
 
StuDocNet4dummies said:
No. Not really. The Penn's of the world are leveraging size to negotiate price and dominate the market. My question remains unanswered so I'll rephrase it in the hypothetical:

If you and GFunk were in the same city. Your hospital system negotiated a rate that is 10x medicare rates for United HC and you find out GFunks crap negotiator only got 5x medicare for UHC. RickyScott...do you call your hospital with the concern that UHC is overpaying for the service you provide?
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That's why UHC probably doesn't offer their medicare advantage/medicaid plans with the hospital and only the cheaper, free-standing option. Have seen it a lot.
 
OTN said:
That depends...is RickyScott part of an academic department which claims to care about financial toxicity for its patients?
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If I didn’t call out my hospital for predatory practices , that would just make me a hypocrite not invalidate the fact that large systems are engaging in monopolistic practices. Leveraging size to hurt the consumer is a legal standard for monopoly. When companies/airlines get larger they make the argument that their efficiency is saving the consumer money since to do the opposite is illegal.
What I would never do, is publically virtue signal hypofractionation on social media.
 
OTN said:
That depends...is RickyScott part of an academic department which claims to care about financial toxicity for its patients?
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...because I like to argue

I would suggest that financial toxicity related to out-of-pocket expenses differs from that of financial toxicity to the "system". In my view, making a patient decide between going broke and dying is an awful thing to do. On the other hand... while I wouldn't personally be thrilled about raking insurance companies over the coals by claiming my services are far more valuable than others', claiming that one has a better product to justify a higher price more-or-less the essence of capitalism. You may argue that capitalism would demand market transparency... and you would be right. However, I am pretty sure that that payers know what they are paying... and know when they are paying 10x what medicare reimburses.

I acknowledge that this argument may be informed by my ignorance of how radonc billing works (because I never do it)... and I also acknowledge that it may not be possible to screw insurance companies WITHOUT also screwing the patient (again, I just don't know how these things work).
 
Lamount said:
...because I like to argue

I would suggest that financial toxicity related to out-of-pocket expenses differs from that of financial toxicity to the "system". In my view, making a patient decide between going broke and dying is an awful thing to do. On the other hand... while I wouldn't personally be thrilled about raking insurance companies over the coals by claiming my services are far more valuable than others', claiming that one has a better product to justify a higher price more-or-less the essence of capitalism. You may argue that capitalism would demand market transparency... and you would be right. However, I am pretty sure that that payers know what they are paying... and know when they are paying 10x what medicare reimburses.

I acknowledge that this argument may be informed by my ignorance of how radonc billing works (because I never do it)... and I also acknowledge that it may not be possible to screw insurance companies WITHOUT also screwing the patient (again, I just don't know how these things work).
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You may already know all this, but in case it is new information for some:

Yes, I am sure the folks at insurance companies are quite aware they are paying 10x what medicare reimburses. They are smart. It's not really a monopoly in the sense that these huge health systems are forcing the payers' hands. It is more collusion between health system and insurance company. Regulations dictate that x% of premiums have to go towards medical care, leaving (100-x)% to line the pockets of the insurance companies.
How do both sides make more money for themselves? Agree on *outrageous* prices for services. Suddenly, insurance company goes from seeing 10% of $10K to 10% of 100K. Since the big hospital is the dominant game in town, the insurance companies turn around to their customers and have to raise their premiums.
Insurance Company: Aw shucks guys, if you want us to keep University of Fancy in our network, looks like you'll have to pay way more $/month.

As an outrageously-priced academic center, are you screwing an individual patient with those prices? Not usually. They are pretty good about making sure insurance approves things before you get the treatment. Are you screwing over the insurance company? Certainly not, they are going to make their money one way or another. In fact, they would love for you to charge 10X Medicare for your new tech. Are you screwing the entirety of population that pays those premiums and mostly lining the pockets of administrator-types? Absolutely.
 
DireMoose said:
You may already know all this, but in case it is new information for some:

Yes, I am sure the folks at insurance companies are quite aware they are paying 10x what medicare reimburses. They are smart. It's not really a monopoly in the sense that these huge health systems are forcing the payers' hands. It is more collusion between health system and insurance company. Regulations dictate that x% of premiums have to go towards medical care, leaving (100-x)% to line the pockets of the insurance companies.
How do both sides make more money for themselves? Agree on *outrageous* prices for services. Suddenly, insurance company goes from seeing 10% of $10K to 10% of 100K. Since the big hospital is the dominant game in town, the insurance companies turn around to their customers and have to raise their premiums.
Insurance Company: Aw shucks guys, if you want us to keep University of Fancy in our network, looks like you'll have to pay way more $/month.

As an outrageously-priced academic center, are you screwing an individual patient with those prices? Not usually. They are pretty good about making sure insurance approves things before you get the treatment. Are you screwing over the insurance company? Certainly not, they are going to make their money one way or another. In fact, they would love for you to charge 10X Medicare for your new tech. Are you screwing the entirety of population that pays those premiums and mostly lining the pockets of administrator-types? Absolutely.
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yes. Yes. YES. YAAASSSS!!!!!!
 
If you buy your own insurance policy and pay ever higher premiums, you are experiencing financial toxicity from these outrageous prices.

If you haven't received routine COL pay raises because your employer has to pay ever higher premiums for your insurance, you are experiencing financial toxicity from these outrageous prices.

Not sure, but I think 85ish% of America falls into one of those categories in some way, shape, or form.
 
insurances overall are a total scam. The same thing happens with home insurances. High deductible plans are super lucrative for companies because they inflate their estimate then “eat” your deductible and still make more money on the back end than they would if you didnt have it
 
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DireMoose said:
You may already know all this, but in case it is new information for some:

Yes, I am sure the folks at insurance companies are quite aware they are paying 10x what medicare reimburses. They are smart. It's not really a monopoly in the sense that these huge health systems are forcing the payers' hands. It is more collusion between health system and insurance company. Regulations dictate that x% of premiums have to go towards medical care, leaving (100-x)% to line the pockets of the insurance companies.
How do both sides make more money for themselves? Agree on *outrageous* prices for services. Suddenly, insurance company goes from seeing 10% of $10K to 10% of 100K. Since the big hospital is the dominant game in town, the insurance companies turn around to their customers and have to raise their premiums.
Insurance Company: Aw shucks guys, if you want us to keep University of Fancy in our network, looks like you'll have to pay way more $/month.

As an outrageously-priced academic center, are you screwing an individual patient with those prices? Not usually. They are pretty good about making sure insurance approves things before you get the treatment. Are you screwing over the insurance company? Certainly not, they are going to make their money one way or another. In fact, they would love for you to charge 10X Medicare for your new tech. Are you screwing the entirety of population that pays those premiums and mostly lining the pockets of administrator-types? Absolutely.
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Would agree with all of this... and to be honest, I have no idea what my department charges. I only have so much RAM... and that seems like a thankless and futile battle.

@Mandelin Rain you point is well taken regarding the cost of non-employer funded insurance.

The point I was trying to make was that the situation is a little more murky... and there may not often be a direct correlation between what an academic (or any) center charges insurance and "financial toxicity" as experienced by the patient. I would also point out that, in the grand scheme of oncology care, overcharging by academic rad onc departments is probably a miniscule fraction of the financial burden placed on the health care system as compared to IO and TKIs. While it is certainly hypocritical for academics to rail against "financial toxicity" while overcharging for the same treatments... does this practice really have that much of a practical impact?
 
Lamount said:
does this practice really have that much of a practical impact?
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I think it has a big impact on our field although maybe not as big an impact on insurance premiums. How academics compensate, hire, expand, create regional monopsonies and then face financial incentives to treat their hires in a certain way. Potters was somewhat right with his "more money more problems take". The irony.

For small hospitals that are going to be acquired, I think the potential financials of the radonc department are no small thing.
 
DireMoose said:
You may already know all this, but in case it is new information for some:

Yes, I am sure the folks at insurance companies are quite aware they are paying 10x what medicare reimburses. They are smart. It's not really a monopoly in the sense that these huge health systems are forcing the payers' hands. It is more collusion between health system and insurance company. Regulations dictate that x% of premiums have to go towards medical care, leaving (100-x)% to line the pockets of the insurance companies.
How do both sides make more money for themselves? Agree on *outrageous* prices for services. Suddenly, insurance company goes from seeing 10% of $10K to 10% of 100K. Since the big hospital is the dominant game in town, the insurance companies turn around to their customers and have to raise their premiums.
Insurance Company: Aw shucks guys, if you want us to keep University of Fancy in our network, looks like you'll have to pay way more $/month.

As an outrageously-priced academic center, are you screwing an individual patient with those prices? Not usually. They are pretty good about making sure insurance approves things before you get the treatment. Are you screwing over the insurance company? Certainly not, they are going to make their money one way or another. In fact, they would love for you to charge 10X Medicare for your new tech. Are you screwing the entirety of population that pays those premiums and mostly lining the pockets of administrator-types? Absolutely.
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There are 2 types of insurance policies. 1) where the insurer acts as transaction manager taking a commission like a real estate agent, and the employer/pension etc is actually paying the medical bills. Since they are getting a set percentage, it is in their interest that the medical bill is as high as possible. Insurance companies prefer this line of business since they are always guaranteed a profit with no risk. Almost all of us, large unions , corporations fall under this system.

At risk insurance products is what we typically think of as health insurance where the insurance company is hyper focused on cost control. Managed Medicare/Medicare advantage etc . I am sure there is a lot of horse trading when insurers negotiate with the likes of UPenn : we will help you charge the teachers union 10x cms prices and in return you will take our managed Medicare product at 1.1 x cms rates?
 
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