Can't speak to Johnson but transparency key across the board. Big radonc may spit back "what about salary transparency?" and they are also right. Cost transparency, salary transparency, certainly tax transparency (done in other countries) are critical to mitigate greed and level various playing fields.
Salary transparency is helpful, but needs to be differentiated from cost transparency. Since the landmark paper, “it’s the prices, stupid” published 20 years ago, it is pretty much dogma at this point that hospital prices are single biggest factor responsible for out of control medical costs. A lot of research has shown that it is prices not utilization that separate us from the rest of the world.
Salary transparency means nothing at a societal level- cost transparency is what is key. Until Big RadOnc gives up their prices, they are hypocrites of the tallest order and should not be listened to when it comes to any policy matter in our field.
The classic graph; the graph from whence much of my umbrage flows.
Agree with all of the above except the societal thing. Truth is, I don't know what an associate professor, 9 years into employment at a PPS exempt cancer center makes. But it may be substantially less than me and they certainly may believe that small radonc is filled with docs that are making much more than they are and more than they deserve. This does matter substantially in terms of sense of ethics and policy changes going forward. It matters culturally to ASTRO where academics dominates.
A very productive and modestly paid assistant prof rad onc can (and does!) easily support 10 or more intrahospital extradepartmental FTEs.
Re extra dough going to innovation: do I practice differently because of any radonc research from mdacc over the past 30 years? Can’t think of a single pub.
I agree that looking only at salary data is misleading...
Got to disagree. If you think federal policy wonks aren't considering salary, you are naïve.
When I see this I think, "pretty fair, less than I make but they hopefully get time to do some research and they probably have more help".
My med onc and I almost gave cisplatin for anal cancer that one time. But, then we didn’t.
Don’t forget stability, prestige,better equipment, and really good benefits like college tuition for kids
...and likely better/more cosmopolitan location. Nobody building a major academic center in the boonies.
Cms doesn’t if pp docs are making 700k. They could be treating 25 pts. Again utilization is not the problem. Cms care about the prices of radonc. Docs at mdacc make 700k
I know some big rad onc practices have published their prices because of price transparency act. Have the surrounding small rad onc practices benefited?
I'm guessing they care. The APM from what I can tell disproportionately impacts professional not technical costs despite technical services being the bulk of payment. The whole structure of it seems to be predicated on the idea that docs are excessively treating (either by cases, fractions or technique) to drive up personal revenue. They are expecting savings based on decreased pro fees are they not?
Haven't seen the breakdown but i thought technical was taking a big hit under the model as well?
IMHO it's a good whack on both the prof and tech sides of the equations.
I spoke too soon. Not sure how it will totally shake out. Discount factor slightly more for technical, but I'm not sure how new payment schedule vs historical behavior will change total technical compensation for typical practice. (I may use more expensive tech on some pts under APM, where I was pretty cheap before). I don't actually know how my average technical charge will change relative to the new schedule for things like a bone met (and I'm leaving that to the hospital at present). I do have a sense of where pro fees are going to go for me. I don't know if CMS ever broke down projected savings by PC vs TC.
I understand this idea, although it's a tragic solution to the most unfair part of this IMO. Wouldn't want this to enter the public's consciousness.
Again, you focus on person - and that’s fine, I would focus on the argument, it’s more my style.
No- I responded to JJ - I think the cost is appropriate, and disagree with the masking tape idea. Prices are worth discussing.
Meanwhile over in Med-Onc Land...
All valid
hard to feel sorry given she has over 40 publications, a big national spotlight, speaking engagements, etc
So one grant is out of reach
Join the slums with rest of us plebs
Just keep your clothes on, ok?
Exactly. I was in meetings 10 years ago hearing med oncs whine about how much a proton facility cost. About 5-6 years ago they shut up about protons when come to fine out the list price of nivo/ipi was a million dollars a year or some such. But this forum still goes back and forth about how much protons cost or PPS centers or academic vs pvt practice. A PPS center running protons still provides more value (ie actually curing cancer) than chemo or IO on their own.
That's why evilcore will approve IO and deny sabr-comet in oligometastatic disease until the cows come home
I don't know. A course of therapy at UPenn e.g. for Gleason 6 prostate cancer can cost more than it cost to make Michael Jackson's "Thriller" music video ($500,000). I think MJ's video has done more for society than protons, and Herceptin has done more for society than "Thriller."
And MJ did a lot for kids. Ain't the world grand. Time for another drink.
