Rad Onc Twitter

[Mandelin Rain]

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25 MAUDE reports in April alone, most of which are pretty bad, i.e. fistula.

Looks like 330 in past year. About 1 report per day.

I can't imagine using this on every guy through the door.

 

[OTN]

No prior authorization needed

Treating synchrous bilateral breast cancer is not challenging

 

[deleted1111261]

Treating synchrous bilateral breast cancer is not challenging

This is bananas.

They want us to do bone Mets, whole brain and maybe tangent breast (but watch it with the IMRT). The rest - high volume centers

 

[thecarbonionangle]

if you didnt treat with protons did you even treat bro?

 

[Mandelin Rain]

Treating synchrous bilateral breast cancer is not challenging

Do you even feather, brah?

Gotta cover that pre-sternal breast tissue (I learned anatomy from Total Recall).

 

[jondunn]

This is bananas.

They want us to do bone Mets, whole brain and maybe tangent breast (but watch it with the IMRT). The rest - high volume centers

You can only trewt bone Mets if you’re in the palliative care network.

 

[temujim]

25 MAUDE reports in April alone, most of which are pretty bad, i.e. fistula.

Looks like 330 in past year. About 1 report per day.

I can't imagine using this on every guy through the door.

Whatever you do, don't look at VAERS

 

[Ray D. Ayshun]

I got the impression they didn't do breath hold, which would very much bias this towards better proton dosimetry.

 

[OTN]

Do you even feather, brah?

Gotta cover that pre-sternal breast tissue (I learned anatomy from Total Recall).

What's challenging about feathering?

 

[jondunn]

will be soon that there's an MR linac on every corner

 

[Mandelin Rain]

What's challenging about feathering?

Ha. Nothing*. And I don't feather. I just don't overlap beams where there is no breast tissue.

*Never say this to your dosimetrist

 

[thecarbonionangle]

“No 4DCT, no feathering electron photon junctions, patients do “fine”. In fact, they did just “fine” when we did fields in film. We waste a lot of time!”

 

[TheWallnerus]

 

[pikachu]

Do you even feather, brah?

Gotta cover that pre-sternal breast tissue (I learned anatomy from Total Recall).

If my calculations are correct Martians should have a 33% increase in demand for breast RO services compared with earthlings…

 

[jondunn]

 

[TheWallnerus]

We are probably microseconds away from an insurance company guideline making it be the standard (for their patients at least)

 

[TheWallnerus]

How many years into the past would one have to travel to land in a time where this patient gets at least an RT recommendation in tumor board 100% of the time…

 

[jondunn]

Master clinician Jordan!

 

[RadOncDoc21]

Master clinician Jordan!

Wow… WTF!!? I hate admins. It’s never enough with them. How did we as a profession ever get to this when a guy in a suit determines the amount of work you are doing? I’ve always been the one to ask them where would they be without us?

 

[deleted1111261]

What a frustrating conversation.

 

[Ray D. Ayshun]

To me it's a we get what money we can from insurance issue. They'll stiff us on same day sim treat, so there are ways to make up for that. Having this conversation is acknowledging 77470 as a valid way of justifying underpayment in the first place.

 

[communitydoc13]

Can always reply that with concurrent therapy there is a greater need to start, monitor and modulate steroids, antiemetics, pain medications and anti diarrheal medications. More likely to require mid week assessment for treatment tolerance, more likely to be put on break, more likely to require emergent referral for hospitalization, more likely to require IVF or labs outside of those protocolized by medonc.

 

[communitydoc13]

Treating synchrous bilateral breast cancer is not challenging

Can you even do NTCP modeling when you don’t know what effective dose you are delivering?

 

[deleted1111261]

Can always reply that with concurrent therapy there is a greater need to start, monitor and modulate steroids, antiemetics, pain medications and anti diarrheal medications. More likely to require mid week assessment for treatment tolerance, more likely to be put on break, more likely to require emergent referral for hospitalization, more likely to require IVF or labs outside of those protocolized by medonc.

Gonna template this

 

[RadOncDoc21]

Gonna template this

Won’t be enough. Next year, they’ll ask for documentation that you ask these specific questions, documented their Creatinine, gave them drugs, etc, etc. it will never be enough. Their purpose is to drain your soul.

 

[Mandelin Rain]

Can you even do NTCP modeling when you don’t know what effective dose you are delivering?

Garbage in, garbage out.

Wonder what risk of rib fracture the NTCP spits out? IRL it's ~25% for unilateral, so....bilateral must be higher.

What about esophagitis? 30%?

 

[RickyScott]

Won’t be enough. Next year, they’ll ask for documentation that you ask these specific questions, documented their Creatinine, gave them drugs, etc, etc. it will never be enough. Their purpose is to drain your soul.

Please Don’t give Ron D any ideas for scaring docs into buying his services. You will need to be present when the creatinine was drawn, despite what cms states.

 

[SubserviantToABR]

Seriously? Who is this guy? I thought he was a radiation therapist, who pivoted to this new role. But then again, what do I know?

 

[thecarbonionangle]

This Jordan dude is a total clown. Many many clown emojis is the only appropriate answer. Healthcare is ****ed up because of these people. My dislike of admins grows more and more by the day. the sad thing it is all over healthcare. Only option is to leave medicine. Empty suit people all over the place.

 

[Ray D. Ayshun]

This Jordan dude is a total clown. Many many clown emojis is the only appropriate answer. Healthcare is ****ed up because of these people.

Go easy on him. Looks like he has to wake up everyday in Jackson, MS.

 

[thecarbonionangle]

The disrepect and presumptiousness to refer to yourself as “clinical” because you took some classes. These people literally think they know more than you and treat you like an imbecile. Nobody on this board should be seriously claiming this guy is a good guy. He is a grifter among many trying to make money off us

 

[deleted1116990]

Seriously? Who is this guy? I thought he was a radiation therapist, who pivoted to this new role. But then again, what do I know?

Wow.

Simul 100% on this.

Also, you would think somebody whose primary job is "getting things paid" would know how to spell payors.

 

[ROforbetterorworse]

Only thing Jordan is qualified for is being a grifter

 

[Ray D. Ayshun]

I had a payor deny this on a head and neck patient who needed me to coordinate feeding tube placement midtreatment and then manage the nutrition. It works itself out more or less. All this **** is complicated. 2D palliative isnt always a walk in the park.

 

[TheWallnerus]

This Jordan dude is a total clown. Many many clown emojis is the only appropriate answer. Healthcare is ****ed up because of these people.

Everyone in rad onc, MDs or non MDs should encircle one another with support, understanding, and unwavering loyalty. Like stupid unthinking loyalty. Like you can do no wrong mentality.

Instead everyone wants to “Yes but” one another at best, act like a Pharisee and point out everyone else’s sin at worst. Meanwhile there are people out there who aren’t even our own religion/faith who want to extinguish us from existence! If there had been twitter in the 1940s I guarantee some rad oncs would have been tweeting “Can I walk on the same sidewalk as the Schutzstaffel? And I’m not sure Bob’s papers are in order.”

 

[jondunn]

Not sure who is the bigger grifter - Jordan or Ron G

 

[jondunn]

The topic that won’t die

 

[RickyScott]

The topic that won’t die

I would try to bury it, not boast about it.

 

[Ray D. Ayshun]

I had a payor deny this on a head and neck patient who needed me to coordinate feeding tube placement midtreatment and then manage the nutrition. It works itself out more or less. All this **** is complicated. 2D palliative isnt always a walk in the park.

I recently got told from the VA that I couldn't bill for laryngoscopy as they deemed our specialty to be one that didn't give adequate training for that. I still do it, and the clinic loses money on the disposable scope, but someone trying to justify that we, community docs at least, ask for less, doesn't get it.

 

[RickyScott]

Everyone in rad onc, MDs or non MDs should encircle one another with support, understanding, and unwavering loyalty. Like stupid unthinking loyalty. Like you can do no wrong mentality.

Instead everyone wants to “Yes but” one another at best, act like a Pharisee and point out everyone else’s sin at worst. Meanwhile there are people out there who aren’t even our own religion/faith who want to extinguish us from existence! If there had been twitter in the 1940s I guarantee some rad oncs would have been tweeting “Can I walk on the same sidewalk as the Schutzstaffel? And I’m not sure Bob’s papers are in order.”

Never seen more backstabbing/divide between community and academic centers than in xrt.

 

[RadOncDoc21]

I recently got told from the VA that I couldn't bill for laryngoscopy as they deemed our specialty to be one that didn't give adequate training for that. I still do it, and the clinic loses money on the disposable scope, but someone trying to justify that we, community docs at least, ask for less, doesn't get it.

Wow, maybe we shouldn’t plan using imaging either.

 

[elementaryschooleconomics]

I recently got told from the VA that I couldn't bill for laryngoscopy as they deemed our specialty to be one that didn't give adequate training for that. I still do it, and the clinic loses money on the disposable scope, but someone trying to justify that we, community docs at least, ask for less, doesn't get it.

WHAT??

That's insane.

 

[RadOncDoc21]

Seriously? Who is this guy? I thought he was a radiation therapist, who pivoted to this new role. But then again, what do I know?

Ask him how many patients is he licensed to treat?

 

[CaesarRO]

I recently got told from the VA that I couldn't bill for laryngoscopy as they deemed our specialty to be one that didn't give adequate training for that. I still do it, and the clinic loses money on the disposable scope, but someone trying to justify that we, community docs at least, ask for less, doesn't get it.

Yeah this is pretty outrageous.

I like to keep a low profile but hearing stuff like this makes me want to fight

 

[TheWallnerus]

I recently got told from the VA that I couldn't bill for laryngoscopy as they deemed our specialty to be one that didn't give adequate training for that. I still do it, and the clinic loses money on the disposable scope, but someone trying to justify that we, community docs at least, ask for less, doesn't get it.

Never seen more backstabbing/divide between community and academic centers than in xrt.

Ask him how many patients is he licensed to treat?

There comes a time in every rad onc's career where he/she realizes that it's not about what's right or wrong, what you think you know or don't, and so on. The person who bills (and the admin who is the boss of the biller) is the person with final say. They have the "license to bill," and the license to tell you what's what, all of which is actually more important than the license to treat. And if the payor (ie VA) says you don't have "adequate training," it doesn't matter what you think. If Evicore changes a guideline tomorrow that says RT is no longer indicated for a certain diagnosis and the data doesn't support it, it doesn't matter if there are studies showing it works...

 

[jondunn]

License to Bill was the worst roger Moore film

 

[Mandelin Rain]

 

[medgator]

Seriously? Who is this guy? I thought he was a radiation therapist, who pivoted to this new role. But then again, what do I know?

United tried to deny 370 on a tmz pt. They are arguing that oral chemo isn't chemo. Probably had Jordan in their back pocket "advising" them

 

[Mandelin Rain]

Oral chemo isn't chemo.
-Bill Clinton, for Evicore

 

[communitydoc13]

oral chemo isn't chemo

I've seen a patient die of neutropenic complications from Temodar.