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Tolerance isn't a virtue for most people here.... It's only tolerance until you disagree with them. Confirm or endlessly hear the virtue signaling.
Tolerance: the ability or willingness to tolerate something, in particular the existence of opinions or behavior that one does not necessarily agree with. Hence, tolerance can only exist WHEN someone disagrees with you. Otherwise, it's agreement. When you make a joke that we think reflects poorly on all of us, some of us might not tolerate it. You're a martyr in your own mind.
 
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Tolerance isn't a virtue for most people here.... It's only tolerance until you disagree with them. Confirm or endlessly hear the virtue signaling.
Spare me the theatrics. #wwc and jagsi are popular punching bags here. You and turaco overplayed your cards in a quest to pander to the sdn crowd and it backfired. Turaco even claimed his views are mainstream, implying he didn’t think he would get blowback for views.

You are not champions of the underdog, you are not persecuted, and you are not silenced. You just got owned. There’s a difference.
 
That’s the problem with these “free speech” people. They aren’t being silenced. The views espoused by them aren’t being deleted. No censoring. Just people giving their opinions back (and in my case - describing their style). Yet, the snowflakes get soooo upset. It’s just fascinating. Don’t want to express any sort of misgiving about a distasteful comment that implicated someone that has no relation to the situation? Fine, that’s on you. You want us to agree with you? No one asked you to leave board. In fact, still regard y’all as some of the best posters. So odd. If that’s not tolerance, I don’t know what is.
 
Anyone think this would impact us meaningfully?


The other component of this effort is to push more hospitals to post negotiated prices. I doubt this will make more report. The only way to make more report is to increase the fine significantly which requires legislation and the pols are all in the pockets of the hospitals and insurance companies.
 
What is the status of the APM?
From CMS Website
The Consolidated Appropriations Act, 2021 (H.R. 133) enacted on December 27, 2020 includes a provision that prohibits implementation of the RO Model prior to January 1, 2022, effectively delaying the start date by 6 months. CMS intends to address the delay through notice and comment rulemaking.
Jan 1 2022 at the earliest

The RO Model is a mandatory model that tests whether changing the way RT services are currently paid – via fee-for-service payments – to prospective, site neutral, modality agnostic, episode-based payments incentivizes physicians to deliver higher-value RT care.
 
No, these changes were fought tooth and nail by the big PE-backed ED groups, as they make a lot of money from OON billing. Oncology societies didn’t fight it, to my knowledge
Didn't need to. ER is much more acute care. We usually know who is in network before we even schedule the consult
 
From CMS Website
The Consolidated Appropriations Act, 2021 (H.R. 133) enacted on December 27, 2020 includes a provision that prohibits implementation of the RO Model prior to January 1, 2022, effectively delaying the start date by 6 months. CMS intends to address the delay through notice and comment rulemaking.
Jan 1 2022 at the earliest

The RO Model is a mandatory model that tests whether changing the way RT services are currently paid – via fee-for-service payments – to prospective, site neutral, modality agnostic, episode-based payments incentivizes physicians to deliver higher-value RT care.
And just to be clear this 1-1-22 date is for all sites in the nation, meaning the trial period for just those bunch of zip codes is applied to everyone now?
 
And just to be clear this 1-1-22 date is for all sites in the nation, meaning the trial period for just those bunch of zip codes is applied to everyone now?
I would be surprised if this was the case.
 
From CMS Website
The Consolidated Appropriations Act, 2021 (H.R. 133) enacted on December 27, 2020 includes a provision that prohibits implementation of the RO Model prior to January 1, 2022, effectively delaying the start date by 6 months. CMS intends to address the delay through notice and comment rulemaking.
Jan 1 2022 at the earliest

The RO Model is a mandatory model that tests whether changing the way RT services are currently paid – via fee-for-service payments – to prospective, site neutral, modality agnostic, episode-based payments incentivizes physicians to deliver higher-value RT care.

I am seriously worried about how this is going to play out. Is it my understanding that this means we will have to turn into sales people to our patients? Nightmare situation possible where one could pursue a lawsuit for not referring patients to be considered for XRT (prostate, early stage lung, etc.)? Is stage IV disease just one site bundled payment for all recurrences (ie changes in systemic therapy) and oligomets?

Sorry for freaking out, but I am!
 
Isn't this meant to be an experiment? As in, we try it this way in some places, evaluate the results, then make a decision on how to proceed. Seems like moving beyond the first 40% isn't guaranteed and is years in the making.

*60%er
 
Isn't this meant to be an experiment? As in, we try it this way in some places, evaluate the results, then make a decision on how to proceed. Seems like moving beyond the first 40% isn't guaranteed and is years in the making.

*60%er
I think according to the plan/law, The APM is like Thanos. It is inevitable.
 
Good thing we’re not portable x Ray supplier.. Oh wait they getting paid! Rock bottom keeps getting lower!
 
We (surg, radonc, medonc etc.) should go on hunger strike...
 
More people getting older, needing more care, while CMS pot stays far more fixed.... Not a good situation long-term
It must be exhausting to be focused on physician advocacy. Most of your efforts are focused on staving off cuts which then are reapplied the next year, rinse and repeat. I guess job security is good?
 
Biden is proposing a $3.5 trillion expansion to medicare. Does anyone know if this would address the CMS reimbursements?
 
It must be exhausting to be focused on physician advocacy. Most of your efforts are focused on staving off cuts which then are reapplied the next year, rinse and repeat. I guess job security is good?
I don’t get the effort put into staving off cuts? The mdaccs of the world just increase their prices 10+ % yearly anyway. That is why health care expenditure outpaces inflation.
 


Thanks @medgator for sharing our work and appreciate the feedback @Mandelin Rain and by David Chang!

Tried to highlight big difference b/w West Coast vs Midwest, and subregions in between

I agree, I tried my best to be as granular as possible, but the sample sizes became so small when I tried to filter multiple combos that hard to make any statistical conclusion

ie, Mid Atlantic + >500,000 preference + received offer, etc vs Mid Atlantic <50,000 preference + received offer

Based on my experience + discussions with colleagues + job postings over the past few years + survey data, I do agree there is a clearly a big difference in opportunity and chances for a job offer based on location + city/metro size

Least Opportunities --> Most Opportunities

NYC, SF, LA, DC, Philly, Boston, ATL, Austin, Denver ---> Cleveland, Columbus, etc ------------> Rhinelander, Selena, Alexandria, etc

These are semi-broad examples, but trend likely holds for now

I'm not disparaging any of these locations esp considering it's such a personal decision for everyone!

-Mudit

 
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This whole idea of getting a "job offer" in your region of interest as a measure of success is a joke.

A region is a whole large several state area encompassing both large metros and small metros.

There are plenty of rural and urban areas in both the west coast and mountain west. Those had the worst percentages. There is just no need for more radiation oncologists there, and that is about 1/3 of the entire United States.

Further, there is no control for whether the one job offer received is total garbage.

Most specialties are looking at multiple job offers within a single metro or part of a state. They look at it as a disaster if they can't find a job in one specific city (see recent article from emergency forum where someone couldn't get a job in Houston). We can't even call it a disaster if we can't find a job in an area the size of Western Europe.

All of these papers should conclude with "the job market is an absolute disaster" not the softball crap that is written in those red journal articles.
 
This whole idea of getting a "job offer" in your region of interest as a measure of success is a joke.

A region is a whole large several state area encompassing both large metros and small metros.

There are plenty of rural and urban areas in both the west coast and mountain west. Those had the worst percentages. There is just no need for more radiation oncologists there, and that is about 1/3 of the entire United States.

Further, there is no control for whether the one job offer received is total garbage.

Most specialties are looking at multiple job offers within a single metro or part of a state. They look at it as a disaster if they can't find a job in one specific city (see recent article from emergency forum where someone couldn't get a job in Houston). We can't even call it a disaster if we can't find a job in an area the size of Western Europe.

All of these papers should conclude with "the job market is an absolute disaster" not the softball crap that is written in those red journal articles.
It's not THAT much of a joke when you're sitting there as a young 18 year old and thinking, "All my life I have dreamed one dream: to become a radiation oncologist. I don't care if I have to work on an Indian Reservation and if every friend I have gets a job in his or her preferred region. As God as my witness I will become a radiation doctor."

This was me. Dreams do come true. Just ask my wife, or our cows!
 
I think every radiation oncologist in training needs a midwest 101 course to best prepare for available job opportunities. Learn about rooting for moribund football teams; appreciate amazing cost of living advantages and a patient population with retired union benefits! Not to mention how climate change has reduced winter by a month (and counting...)

Seriously though... there are midwest places with good biryani. I'm in one of them, obviously. 🤓
 
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