Rad Onc Twitter

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Meanwhile, it is advocacy day. Just a fun story - as a "new" member and one that is interested in policy and advocating for our specialty, I applied for Advocacy Day. I've done this in the past, it's definitely interesting.

After filling out the application, I got an email from headquarters and they wanted to speak to me. It was an interesting conversation. They said that based on past comments, my participation may not be in their best interest. I said that as an ASTRO member going on Advocacy Day, my own personal beliefs were irrelevant and I'd stick to the script. They are worried I'd say negative things about ROCR. Which I have done, but would not do. Despite "firebrand" online persona, those that have met me know I'm a "company man" and not disruptive at work. If I don't like something, I move on. They also said that because I work for a benefits management company (part time), that it would be a conflict of interest. I said, "have you read my writings on prior auth?" I work for a prior auth company part time and have explained my rationale for this. I'd way rather it be me then Evicore. Do you see people complaining about OncoHealth? No, because we are doctor and patient friendly. Anyway, at the end they never got back to me. I finally reached out and asked to confirm my disinvitation a few days ago. They apologized for not letting me know sooner. Don't worry, I didn't buy airline tickets.

Think about the value there is for someone that understands the inner dealings of prior auth. Someone that has given talks to multiple centers on "how to beat prior auth" while working for a PA company. Who has educated multiple people on how to navigate this. Conflicted? Give me a break.

It's literally 2-3 meetings with members' aides. Everyone knows DC is run by 24 year olds. You sit there and you tell them about how important your particular problem is. They will nod and agree with you and jot down some notes. There are so many things to advocate about - not just prior auth. Research funding, non-competes, these coding changes, medical training, cancer care in general.

Anyway, I bet its a lovely day in DC to sit an conference room and chit chat with buddies and "groupthink" on how ROCR will solve all our problems.
 
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- Well-known physician who cares deeply about his specialty reaches out to the specialty's organization to try to help
- This physician has advocated for the specialty before
- Two non-physicians interview the physician, expressing their concerns that his personal beliefs might go against the specialty's
- The specialty organization not only does not allow him to help with advocacy, but never even responds to him to let them know their decision after it is made.

10/10 ASTRO. No notes. Stellar all around.
 
WildRivers said:
Meanwhile, it is advocacy day. Just a fun story - as a "new" member and one that is interested in policy and advocating for our specialty, I applied for Advocacy Day. I've done this in the past, it's definitely interesting.

After filling out the application, I got an email from headquarters and they wanted to speak to me. Dave Adler and Laura Gogal. It was an interesting conversation. They said that based on past comments, my participation may not be in their best interest. I said that as an ASTRO member going on Advocacy Day, my own personal beliefs were irrelevant and I'd stick to the script. They are worried I'd say negative things about ROCR. Which I have done, but would not do. Despite "firebrand" online persona, those that have met me know I'm a "company man" and not disruptive at work. If I don't like something, I move on. They also said that because I work for a benefits management company (part time), that it would be a conflict of interest. I said, "have you read my writings on prior auth?" I work for a prior auth company part time and have explained my rationale for this. I'd way rather it be me then Evicore. Do you see people complaining about OncoHealth? No, because we are doctor and patient friendly. Anyway, at the end they never got back to me. I finally reached out and asked to confirm my disinvitation a few days ago. They apologized for not letting me know sooner. Don't worry, Dave, I didn't buy airline tickets.

Think about the value there is for someone that understands the inner dealings of prior auth. Someone that has given talks to multiple centers on "how to beat prior auth" while working for a PA company. Who has educated multiple people on how to navigate this. Conflicted? Give me a break.

It's literally 2-3 meetings with members' aides. Everyone knows DC is run by 24 year olds. You sit there and you tell them about how important your particular problem is. They will nod and agree with you and jot down some notes. There are so many things to advocate about - not just prior auth. Research funding, non-competes, these coding changes, medical training, cancer care in general.

Anyway, I bet its a lovely day in DC to sit a conference room and chit chat with buddies and "groupthink" on how ROCR will solve all our problems.
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There is a Seinfeld episode where George realizes he’s failed at everything in life so he decides that whenever he is about to decide to do something he will do exactly the opposite what he would normally do. Because what else did he have to lose?

ASTRO should consider that approach.

Also, just on principle imho, you should drop ASTRO. “I refuse to join any club that would have me as a member” said Groucho Marx. ASTRO’s behavior here also kind of reminds me of the old lady in Blazing Saddles who makes a pie for the Black sheriff and tells him “Of course you will have the good decency not to let anyone know I’ve spoken to you.” ASTRO is glad to collect your dues but they just don’t wanna be associated with you in public!
 
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WildRivers said:
Meanwhile, it is advocacy day. Just a fun story - as a "new" member and one that is interested in policy and advocating for our specialty, I applied for Advocacy Day. I've done this in the past, it's definitely interesting.

After filling out the application, I got an email from headquarters and they wanted to speak to me. Dave Adler and Laura Gogal. It was an interesting conversation. They said that based on past comments, my participation may not be in their best interest. I said that as an ASTRO member going on Advocacy Day, my own personal beliefs were irrelevant and I'd stick to the script. They are worried I'd say negative things about ROCR. Which I have done, but would not do. Despite "firebrand" online persona, those that have met me know I'm a "company man" and not disruptive at work. If I don't like something, I move on. They also said that because I work for a benefits management company (part time), that it would be a conflict of interest. I said, "have you read my writings on prior auth?" I work for a prior auth company part time and have explained my rationale for this. I'd way rather it be me then Evicore. Do you see people complaining about OncoHealth? No, because we are doctor and patient friendly. Anyway, at the end they never got back to me. I finally reached out and asked to confirm my disinvitation a few days ago. They apologized for not letting me know sooner. Don't worry, Dave, I didn't buy airline tickets.

Think about the value there is for someone that understands the inner dealings of prior auth. Someone that has given talks to multiple centers on "how to beat prior auth" while working for a PA company. Who has educated multiple people on how to navigate this. Conflicted? Give me a break.

It's literally 2-3 meetings with members' aides. Everyone knows DC is run by 24 year olds. You sit there and you tell them about how important your particular problem is. They will nod and agree with you and jot down some notes. There are so many things to advocate about - not just prior auth. Research funding, non-competes, these coding changes, medical training, cancer care in general.

Anyway, I bet its a lovely day in DC to sit an conference room and chit chat with buddies and "groupthink" on how ROCR will solve all our problems.
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Did they gave any insight in to:
-Are they willing to consider some changes to ROCR that have been suggested by radiation oncologists? For example, removing the part about how industry affiliates get to design and comment on the accreditation program.
-What is the plan if ROCR doesnt pass? Currently projected to have a 0% chance of passing by websites that track bills.
-Are there any ongoing conversations with CMS?

It is true I wish ASTRO would stop being ASTRO, but I have a genuine interest in these questions.
 
OTN said:
Have some backbone ASTRO ffs. The head of state of the US's major ally in the Middle East was treated with radiation with curative intent. Turn off the comments and let the post ride.

I'm not going to comment on the politics of this because there's no need for this thread to devolve into a reddit post.
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Standard PR playbook. Famous person has cancer or a specific treatment. Hospital sends social media post highlighting to drive screening/eval/treatment (famous person got this --> you should too!). I think it's dumb as a genre, but see it often enough. Eg Ben Sasse drove a lot of posts recently that hit my inbox and/or feed.
 
WildRivers said:
Meanwhile, it is advocacy day. Just a fun story - as a "new" member and one that is interested in policy and advocating for our specialty, I applied for Advocacy Day. I've done this in the past, it's definitely interesting.

After filling out the application, I got an email from headquarters and they wanted to speak to me. It was an interesting conversation. They said that based on past comments, my participation may not be in their best interest. I said that as an ASTRO member going on Advocacy Day, my own personal beliefs were irrelevant and I'd stick to the script. They are worried I'd say negative things about ROCR. Which I have done, but would not do. Despite "firebrand" online persona, those that have met me know I'm a "company man" and not disruptive at work. If I don't like something, I move on. They also said that because I work for a benefits management company (part time), that it would be a conflict of interest. I said, "have you read my writings on prior auth?" I work for a prior auth company part time and have explained my rationale for this. I'd way rather it be me then Evicore. Do you see people complaining about OncoHealth? No, because we are doctor and patient friendly. Anyway, at the end they never got back to me. I finally reached out and asked to confirm my disinvitation a few days ago. They apologized for not letting me know sooner. Don't worry, I didn't buy airline tickets.

Think about the value there is for someone that understands the inner dealings of prior auth. Someone that has given talks to multiple centers on "how to beat prior auth" while working for a PA company. Who has educated multiple people on how to navigate this. Conflicted? Give me a break.

It's literally 2-3 meetings with members' aides. Everyone knows DC is run by 24 year olds. You sit there and you tell them about how important your particular problem is. They will nod and agree with you and jot down some notes. There are so many things to advocate about - not just prior auth. Research funding, non-competes, these coding changes, medical training, cancer care in general.

Anyway, I bet its a lovely day in DC to sit an conference room and chit chat with buddies and "groupthink" on how ROCR will solve all our problems.
Click to expand...

1777497222183.png
 
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Who is this guy? I don’t wanna judge someone whom I don’t know. But he looks like someone who’s been banking my by screwing over private practice rad oncs…
 
DrProtonX said:
Who is this guy? I don’t wanna judge someone whom I don’t know. But he looks like someone who’s been banking my by screwing over private practice rad oncs…
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In short, he is a professional grifter. The best way to think about him is as a professional tax preparation service.

Taxes in the U.S. are extremely complicated — doubly so if you are a physician with W-2 income, 1099 income, business expenses, real estate investments, equities, pre-tax retirement vehicles, etc. You could probably save a few bucks, buy TurboTax, and file yourself. The problem is that the IRS operates in a one-sided, predatory manner. They know what you owe, but they won’t tell you. And if you pay less than you owe, you are at risk for an audit and penalties. So you bite the bullet and hire a CPA who prepares your taxes, charges you a pretty penny, and at least assumes some liability if something gets screwed up.

That’s Ron D. He is the CPA.

Except if he gives you ****ty advice that ruins your department, he doesn’t take liability — you do.

From Ron D.’s perspective, keeping RO billing, documentation, and coding requirements arcane, frequently changing, and hard to understand is not merely in his interest; it is the entire basis for his existence. And big hospitals, with their empty-headed RN administrators, are more than happy to pay big bucks for the privilege of his opinion.
 
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Gfunk6 said:
In short, he is a professional grifter. The best way to think about him is as a professional tax preparation service.

Taxes in the U.S. are extremely complicated — doubly so if you are a physician with W-2 income, 1099 income, business expenses, real estate investments, equities, pre-tax retirement vehicles, etc. You could probably save a few bucks, buy TurboTax, and file yourself. The problem is that the IRS operates in a one-sided, predatory manner. They know what you owe, but they won’t tell you. And if you pay less than you owe, you are at risk for an audit and penalties. So you bite the bullet and hire a CPA who prepares your taxes, charges you a pretty penny, and at least assumes some liability if something gets screwed up.

That’s Ron G. He is the CPA.

Except if he gives you ****ty advice that ruins your department, he doesn’t take liability — you do.

From Ron G.’s perspective, keeping RO billing, documentation, and coding requirements arcane, frequently changing, and hard to understand is not merely in his interest; it is the entire basis for his existence. And big hospitals, with their empty-headed RN administrators, are more than happy to pay big bucks for the privilege of his opinion.
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Yup.

the whole consultant /non physician rad onc peripheral progras are “thank goodness you hired me, you couldn’t possibly understand these rules and you’d be in jail without me.”

Same group that was telling people years ago they couldn’t sign a treatment plan from their home PC - they had to physically be in the department to sign the plan.

The collective wisdom of SDN outshines any consult group I’ve ever worked with. There anre really smart people here in varieties of practices. Ask your questions here and even for gray areas you get reasonable opinions.
 
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Grifter or not, he's correct in this case. Medi-cal is currently paying 38 dollars per fraction for IMRT and not reimbursing IGRT. California radoncs are essentially treating Medi-cal patients for free.
 
Reaganite said:
Grifter or not, he's correct in this case. Medi-cal is currently paying 38 dollars per fraction for IMRT and not reimbursing IGRT. California radoncs are essentially treating Medi-cal patients for free.
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And many people in California think the rich don’t pay their fair share! It is to laugh. This is essentially a tax by a different name on the heads of those rich California radiation oncologists.
 
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Well, as a private practice in CA we don’t have this issue. At least in my part of the Bay Area we see vanishingly few pure Medi-Cal patients. Patients in that bucket are instead administered through their local county insurance. Such entities, unlike Medi-Cal, can be negotiated with to give favorable rates if you prove value.
 
True straight Medi-cal is rare in California. Patients are effectively forced to pick an HMO, and I believe 90-95% of the state's Medi-cal is in managed care. However, the fee schedules for most of these HMOs have historically been tied to the Medi-cal fee schedule. Not sure how COHS works, but heard it pays a % of Medi-cal vs case rate.
 
Palex80 said:
View attachment 418505
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I’ve talked about this for years. Cervical has officially become NCI classifiable as rare. We need like just one or two centers per state doing this work. Some states don’t even need one. I just hope vendors never give up on making HDR units and tandem and ovioids because they’re money losing businesses.
 
TheWallnerus said:
I’ve talked about this for years. Cervical has officially become NCI classifiable as rare. We need like just one or two centers per state doing this work. Some states don’t even need one. I just hope vendors never give up on making HDR units and tandem and ovioids because they’re money losing businesses.
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Just like they are money losing businesses in many freestanding departments
 
medgator said:
Just like they are money losing businesses in many freestanding departments
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Which is kind of crazy. Like I would be cautious as a medical student entering a specialty where one of its main treatments guarantees you lose money. ABS and ARS? American Money Losing Society, American Real Poor Society? Kind of wild to think there were dedicated HDR clinics that were super profitable in the 1990s.
 
TheWallnerus said:
Which is kind of crazy. Like I would be cautious as a medical student entering a specialty where one of its main treatments guarantees you lose money. ABS and ARS? American Money Losing Society, American Real Poor Society? Kind of wild to think there were dedicated HDR clinics that were super profitable in the 1990s.
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How much therapy is brachy now? Let's be honest. I'm gonna guess less than 10%
 
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reminds me of the current state in rad onc

So now Sameer is saying there was nothing ASTRO could do. Freestanding was just effed no matter what? Or the missiles striking their ship is fake news? Very Pontius Pilate type stuff.

President's Corner - American Society for Radiation Oncology (ASTRO)

Welcome to ASTRO President’s Corner, a video series where ASTRO President, Neha Vapiwala, MD, FASTRO, and other ASTRO leadership, will present different topics and interviews to give more insights into the Society’s operations.
www.astro.org www.astro.org

IMG_4370.jpeg
 
One of the biggest concerns I have is that ASTRO leadership seems fixated on "technology". She said it herself in the interview.

We need to take a step back and remember that our best outcome improvements are with IMRT, and that is (or should be) ubiquitous. We can in theory do a lot with existing technology to raise the average quality of radiation in the US.

Given what they wrote in to ROCR and how they talk, I remain concerned about their priorities.
 
physicians who *** say *** that they leave clinical practice. how many people you know who actually quit altogether? people do on-off locums instead
 
A_DeMichele said:
physicians who *** say *** that they leave clinical practice. how many people you know who actually quit altogether?
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a) have heard of many
b) this is somewhat of a tricky question as many people leave right after medical school so there's confirmation bias as you never meet these people later on, unless you interface with industry a lot.
 
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Palex80 said:
View attachment 421808

A bridge to what?
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Bryan Johnson will eventually die. Probably not from gastritis.

Hopefully he takes comfort in both of these realities.

Are we collectively, culturally looking for opportunities to administer LDRT now? Is anyone doing it on themselves?

Should have had a polymarket bet on Bryan Johnson's health and Evan Thomas' care intersecting publicly.
 
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