Rad Onc Twitter

[thecarbonionangle]

Which makes it all the more perplexing that Obama/RomneyCare was not more embraced on the right. Probably the closest we'll ever have gotten to any kind of consensus on healthcare reform.

Basically emtala was an unfunded mandate and those who refuse to buy health insurance are freeloaders in essence on that mandate

because the democrats are terrible at politics. They sold it on feelings instead should have sold it based on personal responsability, stop mooching in the ER and get insured with help, close the loop on the already existing one sided mandate, etc. democrats always bring a rock to a gun fight and the healthcare battle was no Different.

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[RickyScott]

That is certainly possible, but I predict there would be far less outrage. This isn’t a secret today (hence this convo), just not spoken about it officially. If the rates persist, it people are going there despite paying more.

The official answer from them would be something like: The higher prices fund our research mission. Patients come here knowing not only will they get world class care, they are helping to advance the field for future cancer victims.


Unofficially, everyone will just assume the increased cost is justified by better quality care.

If the last few years has taught me one lesson, it is to never count on someone’s shame kicking in if it hasn’t already.

Mskcc and mdacc based on their location and their research and training mission are certainly justified in charging more.
But how much more is the question? Off the top of my head 30-40% seems reasonable, but what if they are charging 300-500%. I suspect that in reality it is something scandalous and there may be a real reckoning with price transparency. Right now they are like a pharmaceutical company and can pretty much set prices where they want.

 

[RickyScott]

because the democrats are terrible at politics. They sold it on feelings instead should have sold it based on personal responsability, stop mooching in the ER and get insured with help, close the loop on the already existed on sided mandate, etc. democrats always bring a rock to a gun fight and the healthcare battle was no Different.

At a basic level health insurance is not “insurance” since we will all need medical care at some point.
Insurance is something you use to hedge against an unlikely event.
The argument for public medical insurance is that we end up paying one way or another if someone comes in through the er and it would have been cheaper if you had delivered preventative care. Whether Health Care is a right or not, the state is still going to end up paying in the end whether you have insurance or not.

 

[thecarbonionangle]

At a basic level health insurance is not “insurance” since we will all need medical care at some point,
Insurance is something you use hedge against an unlikely event.
The argument for public medical insurance is that we end up paying one way or another if someone comes in through the er and it would have been cheaper if you had delivered preventative care. Whether Health Carr is a right or not, the state is still going to end up paying in the end whether you have insurance or not.

there is no free lunch. When an uninsured advanced H&N shows up in ER with Bilateral N3 nodes and is urgently started on chemo XRT, after extractions, trach, this is not free and someone is paying. You’re paying, we all are to some extent. Its a silly issue.

 

[RadOncDoc21]

That is certainly possible, but I predict there would be far less outrage. This isn’t a secret today (hence this convo), just not spoken about it officially. If the rates persist, it people are going there despite paying more.

The official answer from them would be something like: The higher prices fund our research mission. Patients come here knowing not only will they get world class care, they are helping to advance the field for future cancer victims.


Unofficially, everyone will just assume the increased cost is justified by better quality care.

If the last few years has taught me one lesson, it is to never count on someone’s shame kicking in if it hasn’t already.

I’m too lazy to verify this story but heard it once when I was young and so it’s a “true story” regardless. A famous, now rich person could not sell her cookies for cheap but when she raised the price, everyone assumed it was a “better” brand. I think transparency would be useful and as you stated, people will use that as a way to justify why they are paying more. In the end, it’s better than our current model.

 

[elementaryschooleconomics]

This Twitter thread sure took a hard turn

 

[medgator]

This Twitter thread sure took a hard turn

It's related to this tweet that started everything i think

 

[OTN]

Mskcc and mdacc based on their location and their research and training mission are certainly justified in charging more.
But how much more is the question? Off the top of my head 30-40% seems reasonable, but what if they are charging 300-500%. I suspect that in reality it is something scandalous and there may be a real reckoning with price transparency. Right now they are like a pharmaceutical company and can pretty much set prices where they want.

Houston is not expensive. They’re getting paid for training residents already, and they get grants for research. Their 5x cost differential between their product and ours is not justifiable.

 

[xrthopeful]

Houston is not expensive. They’re getting paid for training residents already, and they get grants for research. Their 5x cost differential between their product and ours is not justifiable.

It’s 5 Times more out of pocket?

 

[medgator]

It’s 5 Times more out of pocket?

If mayo is charging $60k for sbrt cash price, i could believe that

 

[scarbrtj]

It’s 5 Times more out of pocket?

Very likely not. It sure isn’t for the most common rad onc patients, Medicare patients, as those prices are govt fixed/set. And for priv insurance patients once a deductible is met usually that’s the max OOP. Since this is usu met already antecedent XRT, and/or rad onc pre-tx planning charges are high-ish, some of the financial toxicity discussions in regards to OOP and fraction number (and deltas between institutions) become moot. Cost to ins companies, to society, and personal lining of pockets thereof a different issue than OOP costs. “Cost” discussions are actually tough and inscrutable IMHO. Even the 8/1 vs 30/10 “shaming.” Not easy to say 8/1 “costs” less than 30/10, or is more convenient, etc., once we factor in much higher re-tx risk with 8/1. 8/1 is the right choice for every patient that didn’t need a re-tx; otherwise 30/10 woulda been better. How to calculate OOP cost of that?

Honestly what we need is a large survey, where patients are individually studied, across disease sites, practice patterns, insurances, and institutions, where we precisely measure OOP costs. Even down to gas/transportation. We could then develop a model, a “dollars nomogram” if you will, where you could plug in a bunch of factors (including fraction number!) and it would spit out the patient’s estimated OOP cost.

 

[scarbrtj]

If mayo is charging $60k for sbrt cash price, i could believe that

This is pretty respectable. Real upper percentile stuff. I know a large very good rep academic place that was (still is?) charging 25K for a one day radiosurgery.

 

[xrthopeful]

Very likely not. It sure isn’t for the most common rad onc patients, Medicare patients, as those prices are govt fixed/set. And for priv insurance patients once a deductible is met usually that’s the max OOP. Since this is usu met already antecedent XRT, and/or rad onc pre-tx planning charges are high-ish, some of the financial toxicity discussions in regards to OOP and fraction number (and deltas between institutions) become moot. Cost to ins companies, to society, and personal lining of pockets thereof a different issue than OOP costs. “Cost” discussions are actually tough and inscrutable IMHO. Even the 8/1 vs 30/10 “shaming.” Not easy to say 8/1 “costs” less than 30/10, or is more convenient, etc., once we factor in much higher re-tx risk with 8/1. 8/1 is the right choice for every patient that didn’t need a re-tx; otherwise 30/10 woulda been better. How to calculate OOP cost of that?

Honestly what we need is a large survey, where patients are individually studied, across disease sites, practice patterns, insurances, and institutions, where we precisely measure OOP costs. Even down to gas/transportation. We could then develop a model, a “dollars nomogram” if you will, where you could plug in a bunch of factors (including fraction number!) and it would spit out the patient’s estimated OOP cost.

Nice post. Agree on the out of pocket being most important thing that matters

 

[medgator]

Very likely not. It sure isn’t for the most common rad onc patients, Medicare patients, as those prices are govt fixed/set.

Until they aren't

Eleven U.S. cancer centers get to charge more for care

For several decades, certain cancer centers have been allowed by the U.S. government to charge more for the care they give. A new study finds the care given at these centers isn't very different from that received at other top-notch facilities.

www.reuters.com

 

[scarbrtj]

Until they aren't

Eleven U.S. cancer centers get to charge more for care

For several decades, certain cancer centers have been allowed by the U.S. government to charge more for the care they give. A new study finds the care given at these centers isn't very different from that received at other top-notch facilities.

www.reuters.com

True. Although just those 11 special dispensation (as the Catholics say) places.

Here is a question. Let’s say Moffit gets to charge CMS $1000 for a tx but hospital across street just $100. We know Moffit will get $800 from the govt and the other place just $80. What will patient be on hook for at Moffit vs other place? If $200 at Moffit “that ain’t right.” Honestly almost a constitutional violation, equal protection and what not.

 

[Burt Radnolds]

Nice post. Agree on the out of pocket being most important thing that matters

Every dollar changing hands comes from somewhere. If Medicare or private insurer is paying more to certain entities, even if the patient escapes the cost, that is a burden on the system that will eventually manifest in a negative way.

 

[OTN]

It’s 5 Times more out of pocket?

No.

Private insurers have shared their data with us. We are 5-fold cheaper than MDACC/MSKCC with identical survival outcomes.

The local academically-affiliated hospital-based Cyberknife practice in town charged a mutual patient $240,000 for a five-fraction course of intracranial radiosurgery. Insurance paid $160,000. I saw the bill.

 

[medgator]

Nice post. Agree on the out of pocket being most important thing that matters

Why?

When insurers pay more than they should, what do you think happens to everyone's premiums?

 

[scarbrtj]

Why?

When insurers pay more than they should, what do you think happens to everyone's premiums?

In general I agree. However... what is “more than they should” REALLY mean. The “should” is a Medicare rate. No one charges less than Medicare. Should they? Medicare price setting is a kind of collusion we’ve all fallen for.*

*The Economics of Innocent Fraud by Galbraith as further (actually quick) reading...

 

[RickyScott]

Nice post. Agree on the out of pocket being most important thing that matters

I don’t like to focus on out of pocket. As I understand it, macroscopically real systemic wide financial toxicity occurs when out of pocket expenses are limited.

Many large employers/unions have limited out of pocket expenses and that’s when mdacc and mskcc really jack up the prices and the real damage comes into play because pt is divorced from expense. pt don’t care that mdacc is 5x more if it doesn’t hit their Wallet.

 

[RickyScott]

Why?

When insurers pay more than they should, what do you think happens to everyone's premiums?

And in most cases it’s employers paying more than they should. Insurers are just taking transaction/management fee.

 

[scarbrtj]

I don’t like to focus on out of pocket. As I understand it, macroscopically real systemic wide financial toxicity occurs when out of pocket expenses are limited.

Many large employers/unions have limited out of pocket expenses and that’s when mdacc and mskcc really jack up the prices and the real damage comes into play because pt is divorced from expense. pt don’t care that mdacc is 5x more if it doesn’t hit their Wallet.

There was a recent Cosmos episode about how we only are willing to hurt or ignore those we don’t feel a kinship with (as a kind of glitch of human evolution). I feel much more kinship with patients than I do CMS or Blue Cross. This is a limited not too smart viewpoint but I am a product of evolution!

 

[xrthopeful]

And in most cases it’s employers paying more than they should. Insurers are just taking transaction/management fee.

You act like employers are willingly paying more than they should

 

[medgator]

. No one charges less than Medicare.

They certainly accept less than Medicare though, from what I've seen/heard with some of the Medicaid/HMO plans, esp in saturated areas

 

[RickyScott]

You act like employers are willingly paying more than they should

They have to because of geographic monopolies and prestige. Can an major employer in nocal shun sutter health very easily or upitt in pitt?

 

[radoncgrad2019]

No.

Private insurers have shared their data with us. We are 5-fold cheaper than MDACC/MSKCC with identical survival outcomes.

The local academically-affiliated hospital-based Cyberknife practice in town charged a mutual patient $240,000 for a five-fraction course of intracranial radiosurgery. Insurance paid $160,000. I saw the bill.

not sure why people choose to go to the Kirby Glen center if it costs that much!

when it comes to cancer care, Baylor not exactly known for excellence. Wonder who is getting that money.

 

[xrthopeful]

They have to because of geographic monopolies and prestige. Can an major employer in nocal shun sutter health very easily or upitt in pitt?

Agree, it is not willingly.

Even more reason that insurance should not be tied to employment

 

[medgator]

Agree, it is not willingly.

Even more reason that insurance should not be tied to employment

It's a good idea to dissociate those two, but not sure how that fixes monopolistic healthcare systems in NorCal or W Pa.

 

[thecarbonionangle]

The now failed CPMC residency was affiliated with Sutter

 

[RickyScott]

Agree, it is not willingly.

Even more reason that insurance should not be tied to employment

Still learning about insurances, but again it seems most health insurers would prefer not to be in the business of "insurance"- they serve as transaction managers/ and just take a commission between the employer and the hospital. This is their most profitable product. No risk and the money just rolls in.

[/QUOTE]
No.

Private insurers have shared their data with us. We are 5-fold cheaper than MDACC/MSKCC with identical survival outcomes.

The local academically-affiliated hospital-based Cyberknife practice in town charged a mutual patient $240,000 for a five-fraction course of intracranial radiosurgery. Insurance paid $160,000. I saw the bill. [/QUOTE]

Based on my anecdotal experience, it is very possible/likely that this kind of reimbursement \at top cancer centers/regional monopolies among certain insurance plans.

 

[RadRadRad]

Redirect Notice

www.google.com

The second half of this article discusses what happened when the state of Indiana allowed employees to choose healthcare plan where they had higher deductible but the amount of the deductible was placed in their hsa. Anything leftover in the hsa each year stayed in the employees name/hsa account for following years. Marked reduction in rx drug costs, er use, etc.

 

[RickyScott]

Redirect Notice

www.google.com

The second half of this article discusses what happened when the state of Indiana allowed employees to choose healthcare plan where they had higher deductible but the amount of the deductible was placed in their hsa. Anything leftover in the hsa each year stayed in the employees name/hsa account for following years. Marked reduction in rx drug costs, er use, etc.

thanks for the article. On a fundamental level, it is so unamerican to hide prices.

I also believe there is a huge link between prices and administrative costs, which are huge component of the problem, second only to prices. When health care systems - non profits in name that have to spend the cash- are able to achieve such high prices and the money comes rolling in, some gets doled out in excess salaries to senior execs, but a lot goes toward "administrators hiring more staff to do their jobs/minimize their workload/magnify their importance/ justify raises etc " US has huge multiple of administrators/administrative costs compared to the rest of the world.

 

[radoncgrad2019]

thanks for the article. On a fundamental level, it is so unamerican to hide prices.

I also believe there is a huge link between prices and administrative costs, which are huge component of the problem, second only to prices. When health care systems - non profits in name- are able to achieve such high prices and the money comes rolling in, some gets doled out in excess salaries to senior execs, but a lot goes toward "administrators hiring more staff to do their jobs/minimize their workload/magnify their importance/ justify raises etc " US has huge multiple of administrators/administrative costs compared to the rest of the world.

agreed, admin bloat is a huge portion of healthcare costs. both in hospitals AND insurance companies.

shut em down

 

[RickyScott]

not sure why people choose to go to the Kirby Glen center if it costs that much!

when it comes to cancer care, Baylor not exactly known for excellence. Wonder who is getting that money.

I know nothing about the houston market but maybe baylor can charge employers/insurance excess across the board prices because of their reputation in specialties other than cancer. Not sure if Baylor is part of texas heart- Debakey's legacy? or has own dominant heart program or some other very well known program.

 

[radoncgrad2019]

at least Baylor Houston has an 'academic' affiliation but if it's Baylor Dallas, that place is a private practice collecting 'academic' rate money. WOW.

 

[DoctwoB]

Redirect Notice

www.google.com

The second half of this article discusses what happened when the state of Indiana allowed employees to choose healthcare plan where they had higher deductible but the amount of the deductible was placed in their hsa. Anything leftover in the hsa each year stayed in the employees name/hsa account for following years. Marked reduction in rx drug costs, er use, etc.

Interestingly enough I was just wondering about this. My employer offers a PPO option, an EPO option (narrower network and less OON coverage but lower copay and deductible) and a high deductible option in which they give you the full deductible for free in your HSA and everything over that in network (the broad PPO network, not the narrow EPO) is covered 100% and OON covered like PPO, not EPO. I was searching up and down trying to find the downside, like why wouldn’t everyone pick it? I guess that explains it, they know by the fact that I keep the difference in what they give me and what I spend, I’ll be more price sensitive.

Works for me, plus I can put away more money pre tax in HSA

 

[dieABRdie]

agreed, admin bloat is a huge portion of healthcare costs. both in hospitals AND insurance companies.

shut em down

Caveat: Correlation doesn't mean causation.......

 

[PhotonBomb]

 

[PhotonBomb]

Error post

 

[dieABRdie]

Interestingly.... this might be more valuable than an actual clinical rotation at some places. Where I was a resident the rotating students basically spend Monday through Friday standing in the corner of a clinic room all day without ever seeing a linac or touching a treatment plan. I always felt bad for them....

 

[deleted956486]

Emory doc getting turned out promoting a COVID radiation trial. I think it's going well.

 

[PhotonBomb]

Emory is known for ass backwards logic and poor treatment of colleagues

 

[thecarbonionangle]

Emory doc getting turned out promoting a COVID radiation trial. I think it's going well.

you ain’t seen nothing yet, baby!

 

[evilbooyaa]

Emory doc getting turned out promoting a COVID radiation trial. I think it's going well.

Most replies I've ever seen to a Rad Onc's tweet, so he's got that going for him. Time to parlay into a contrarian twitter personality.

Fine as an idea, it was the initial terminology of "promises to improve results" that really set a lot of people off. He has since edited the tweet to reflect that it is not a slam dunk that this will help.

Good luck to Emory therapists and patient transporters and other outpatient staff who will be put at increased risk of developing the infection. I encourage the PI of the trial to be physically present during the entirety of the patient's treatment and assist therapists with moving.

Hope Emory therapists are going to get hazard pay for dealing with academics doing human experimentation (not clinical research) in their rush to publish.

 

[PhotonBomb]

 

[RadOncDoc21]

To be fair, if it works, it will definitely be a game changer in regards to people respecting our field.

Technically challenging for most places to achieve, but if they are able to keep themselves, other patients and their staff safe... kudos!

Me on the other hand... “this is why no one will ever remember (my) name.” -Achilles from Troy

 

[Ray D. Ayshun]

Emory doc getting turned out promoting a COVID radiation trial. I think it's going well.

Will they be using concurrent inhaled Lysol as a radiosensitizer?

 

[RadOncDoc21]

Will they be using concurrent inhaled Lysol as a radiosensitizer?

No, it has to be ingested. Haven’t you been listening, How are you still licensed to practice medicine?

 

[scarbrtj]

First, on record as respecting the Khan.
Second, many of the responses are petty and goofy and for lack of better word very non-self-aware.
However, med students and aspiring rad onc'ers... here be the Life of the Rad Onc. It is a lonely life. It is a hard life. People who aren't rad oncs will attack and judge and dismiss. And people who are rad oncs will tend to do that to you twice as hard!
They have a saying in the UK, "Don't put your head above the parapet." You can try doing so in business, law, the personal fitness industry, professional soccer, orthopedic surgery, and a few other things I can think of. BUT NEVER TRY TO DO THIS IN RAD ONC.

 

[medgator]

Will they be using concurrent inhaled Lysol as a radiosensitizer?

First, on record as respecting the Khan.
Second, many of the responses are petty and goofy and for lack of better word very non-self-aware.
However, med students and aspiring rad onc'ers... here be the Life of the Rad Onc. It is a lonely life. It is a hard life. People who aren't rad oncs will attack and judge and dismiss. And people who are rad oncs will tend to do that to you twice as hard!
They have a saying in the UK, "Don't put your head above the parapet." You can try doing so in business, law, the personal fitness industry, professional soccer, orthopedic surgery, and a few other things I can think of. BUT NEVER TRY TO DO THIS IN RAD ONC.

Note to self, don't even try to loosely endorse questionable medical comments from the POTUS on Twitter