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Fpg1245 said:
Yeah I don’t get the fascination with radiopharm. It’s garbage. It’s keeps you in the game but at the end of the day it’s about dollars and cents and it just doesn’t add up

I mean if there a radio pharma agent out there that may increase survival substantially that it changes practice? Maybe but nobody is gonna bother looking for it.
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The idea that radoncs at large academic centers could just walk into most radiology departments and take the procedures from nuc med is absurd.
 
maxxor said:
How bout you guys lobby for better than 1.96 wrvu?

I also just ran our department’s finances for lutathera. CMS is now not even paying at cost despite us being 340b. While I would not be surprised if the coders are billing this wrong, it now seems to be a money loser on the technical side after Lutathera lost pass through status 7/1/21.

Edit: corrected date on loss of pass through.
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Fix the RVU's for physician professional fees and that helps.

But it's a lot of person hours and regulations for something that reimburses terribly. I want to offer it to patients but we're having to look at our bathroom layouts, staffing, etc for Lutathera and the PSMA drug and when we run the numbers it's just not making us enthusiastic.

Certainly as someone who bills pro fees only it looks abysmal. There needs to be a new cpt code for the radiopharm drugs, because you know you're going to be managing side effects and counts but getting that pitiful 77263 and 79101 is tough because I don't feel like they encompass the work.
 
BobbyHeenan said:
Fix the RVU's for physician professional fees and that helps.

But it's a lot of person hours and regulations for something that reimburses terribly. I want to offer it to patients but we're having to look at our bathroom layouts, staffing, etc for Lutathera and the PSMA drug and when we run the numbers it's just not making us enthusiastic.

Certainly as someone who bills pro fees only it looks abysmal.
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Everything you mention is true for any nuclear medicine department. Gotta manage your hot lab. Need techs. Need bathrooms.

It just gets turned up to 11 with therapy agents because you gotta deal with urine and stuff for longer, plus you gotta give infusions etc.

I’ve looked into it as a side gig. The numbers aren’t there. And now what I see on the technical side, I’m not sure it’s even there on that side either.

I have some emails out to Advanced Accelerator / Novartis to ask what is going on with CMS.
 
maxxor said:
Everything you mention is true for any nuclear medicine department. Gotta manage your hot lab. Need techs. Need bathrooms.

It just gets turned up to 11 with therapy agents because you gotta deal with urine and stuff for longer, plus you gotta give infusions etc.

I’ve looked into it as a side gig. The numbers aren’t there. And now what I see on the technical side, I’m not sure it’s even there on that side either.

I have some emails out to Advanced Accelerator / Novartis to ask what is going on with CMS.
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Getting another CPT code would be good but not holding out for it really.
 
Fpg1245 said:
Yeah I don’t get the fascination with radiopharm. It’s garbage. It’s keeps you in the game but at the end of the day it’s about dollars and cents and it just doesn’t add up

I mean if there a radio pharma agent out there that may increase survival substantially that it changes practice? Maybe but nobody is gonna bother looking for it.
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Main benefit I can see is that for a department like mine, we want to provide comprehensive radiation services, whether or not each individual one bills well. Helps significantly with overall department/practice reputation. It's why I do a fair amount of TBI despite it reimbursing basically nothing, we set up a TSET program, etc.
 
OTN said:
Main benefit I can see is that for a department like mine, we want to provide comprehensive radiation services, whether or not each individual one bills well. Helps significantly with overall department/practice reputation. It's why I do a fair amount of TBI despite it reimbursing basically nothing, we set up a TSET program, etc.
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That's my sentiment too.

However, admin runs it so incredibly tightly/under staffed. It's incredibly hard to expand services unless admin is willing to expand staff...which is a tough sell when it's a money losing endeavor.
 
OTN said:
Main benefit I can see is that for a department like mine, we want to provide comprehensive radiation services, whether or not each individual one bills well. Helps significantly with overall department/practice reputation. It's why I do a fair amount of TBI despite it reimbursing basically nothing, we set up a TSET program, etc.
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I know several practices with that view, and it works well for independent centers. For the typical academic or large community center, this will remain with nuc med.
cards was able to take away some procedures because they were the source of referral for cardiac studies.
 
OTN said:
Main benefit I can see is that for a department like mine, we want to provide comprehensive radiation services, whether or not each individual one bills well. Helps significantly with overall department/practice reputation. It's why I do a fair amount of TBI despite it reimbursing basically nothing, we set up a TSET program, etc.
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We offered tsebt as long as we could... Unfortunately poorly reimbursed like brachy, which is sad considering how effective it is. I don't feel bad sending brachy, tse etc out to the high cost centers, they more than make up for it with downstream revenue etc and charging more than we can
 
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medgator said:
sad considering how effective it is
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pubmed.ncbi.nlm.nih.gov

Low-dose total skin electron beam therapy as an effective modality to reduce disease burden in patients with mycosis fungoides: results of a pooled analysis from 3 phase-II clinical trials - PubMed

Low-dose TSEBT provides reliable and rapid reduction of disease burden in patients with mycosis fungoides, which could be administered safely multiple times during the course of a patient's disease with acceptable toxicity profile.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

I couldn't get a regional academic place to consider this for a patient where I was going to treat like 20 times.

That being said, it still just comes back.
 
communitydoc13 said:
pubmed.ncbi.nlm.nih.gov

Low-dose total skin electron beam therapy as an effective modality to reduce disease burden in patients with mycosis fungoides: results of a pooled analysis from 3 phase-II clinical trials - PubMed

Low-dose TSEBT provides reliable and rapid reduction of disease burden in patients with mycosis fungoides, which could be administered safely multiple times during the course of a patient's disease with acceptable toxicity profile.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

I couldn't get a regional academic place to consider this for a patient where I was going to treat like 20 times.

That being said, it still just comes back.
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It works for widespread disease for quite a while in my experience and provides effective palliation with widespread sx
 
medgator said:
We offered tsebt as long as we could... Unfortunately poorly reimbursed like brachy, which is sad considering how effective it is. I don't feel bad sending brachy, tse etc out to the high cost centers, they more than make up for it with downstream revenue etc
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I once locumed at a place that offered TSET, and got a consult there for a patient, and so spent a lot of time asking questions to their physicists about their procedures, etc.

Reimbursement aside, they were quick to tell me that if you’re smart, you refer it out. It was a giant PITA for them. Super neat treatment and effective for patients, but I got the sense they didn’t like to do it lol. Which is too bad, but I totally get it.
 
medgator said:
It works for widespread disease for quite a while in my experience and provides effective palliation with widespread sx
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I agree, and was hoping that this place with dedicated skin onc docs (and massive resources) would be on board, but it was not their priority. They encouraged me to keep giving this person local palliative XRT to the most symptomatic areas. I treated probably 12 courses and 20 sites over a 3 year period.
 
communitydoc13 said:
I agree, and was hoping that this place with dedicated skin onc docs (and massive resources) would be on board, but it was not their priority. They encouraged me to keep giving this person local palliative XRT to the most symptomatic areas. I treated probably 12 courses and 20 sites over a 3 year period.
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Ugh.... I recently had to treat 7 sites with electrons. The lesions were grouped in two general clusters on her body. I wanted to treat using two IMRT plans. Guess what United said?

So yeah.... she was on the table for a full hour each day. Therapists were thrilled about that one. I guess I could have made her come in for 10 weeks straight instead.
 
dieABRdie said:
Ugh.... I recently had to treat 7 sites with electrons. The lesions were grouped in two general clusters on her body. I wanted to treat using two IMRT plans. Guess what United said?

So yeah.... she was on the table for a full hour each day. Therapists were thrilled about that one. I guess I could have made her come in for 10 weeks straight instead.
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With how poorly reimbursed electrons are vs photons/imrt/igrt, it's a wonder you didn't lose money doing that
 
taserlaser said:
I once locumed at a place that offered TSET, and got a consult there for a patient, and so spent a lot of time asking questions to their physicists about their procedures, etc.

Reimbursement aside, they were quick to tell me that if you’re smart, you refer it out. It was a giant PITA for them. Super neat treatment and effective for patients, but I got the sense they didn’t like to do it lol. Which is too bad, but I totally get it.
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Smart would also be realizing that once dermatologists realize you're the center with TSET, then you become the "skin cancer" center, and that small bit of sacrifice w/r/t TSET can function as a "loss leader" to get many other patients in the door.

I always find it super shameful when large, tertiary care, NCCN academic centers don't offer TSET:

1659122911394.png
 
@OTN and @medgator should do a masterclass on practice building. I don't think all their techniques and strategies will work everywhere. In fact, many will work nowhere. But, they both have really aggressively built practices and developed relationships in relatively competitive markets. There is work that goes into it that people don't want to do or consider. This insight about TSET leading your center to become the skin center center. He could have said No to all those patients, and then lost great opportunity. At some point, would be a good idea to have them on the podcast with disguised voices and toupees/mustaches, fat suits, etc.
 
CurbYourExpectations said:
Gator and OTN are Goats, would be a great podcast

Would be interesting to hear where they think practices can be built still, where academics/large groups have too strong of a grasp for it to be a viable idea, how upcoming and new grads can work towards becoming a valuable member of the team etc.
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Add KHE for some color commentary.
 
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Wasn’t there a UC job a couple years back requiring fluency in Korean to be considered?

Being able to communicate effectively with patients is fundamental to the practice of medicine. It’s the whole reason medical interpreters exists, and even that feels like you’re doing the patient no favors and at best 50% of the information is landing.
 
RadRadRad said:
Odd times
Lots of talk about patients having access to doctors of same race or gender, but it’s xenophobic to expect they can communicate in same language ?
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But for real.

Can you become board eligible in rad onc in America sans English fluency (can you graduate a med school sans English fluency)
 
Ray D. Ayshun said:
Haha. Wanting "English fluency" is xenophobic? What's wanting your doctor to be "medically competent?". That's discriminatory. I wonder if Luke Higgins has ever consented anyone.
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why are you guys playing dumb?

the clear and obvious implication is 'you're not an FMG, you'll match' with the implication that FMGs are bad.

call a spade a spade.

this is nothing to do with physicians actually not being able to speak english and you know it.

dear lord.
 
jondunn said:
why are you guys playing dumb?
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I'm not playing dumb, sure probably enough from mroga, but it's not really that much to ask that English fluency be an important part of our job. We're curing cancer after all, not running a country.
 
the question you should be asking yourself is why MROGA can't help antagozing medical students every chance he gets

hes a 40-50 year old man with millions in the bank. Have some self respect.

yes he is a very prolific SDN poster.
 
TheWallnerus said:
But for real.

Can you become board eligible in rad onc in America sans English fluency (can you graduate a med school sans English fluency)
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Apparently you can match into an advanced radiation oncology position but not secure a prelim IM/surgery position. This happened in the last cycle and was not something I've ever heard of happening before in any other specialty, let alone rad onc

Rad onc is setting new standards annually it seems
 
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jondunn said:
this is nothing to do with physicians actually not being able to speak english and you know it.
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I mean... in the South (Alabama e.g., not Mexico) many native born, very white Americans do not speak English in a way I'd call fluently, and the Brits question Americans' English fluency... my question is: if you don't know what a prepositional phrase is, a split infinitive is, or the difference between "its" and "it's," can you graduate medical school in America. And if you haven't graduated medical school in America, and you want to become BC in rad onc in America, you definitely need English fluency or 1) you won't get a residency spot, and/or 2) you'll never pass written boards.

So English fluency is actually a reasonable screening tool for admission to any US residency program, I would think?
 
RadRadRad said:
Odd times
Lots of talk about patients having access to doctors of same race or gender, but it’s xenophobic to expect they can communicate in same language ?
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The person who runs the @LukeMHiggins twitter handle needs some more adult experiences in his life. Some programs need more self-policing of behavior that reflects poorly on them.
 
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TheWallnerus said:
I mean... in the South (Alabama e.g., not Mexico) many native born, very white Americans do not speak English in a way I'd call fluently, and the Brits question Americans' English fluency... my question is: if you don't know what a prepositional phrase is, a split infinitive is, or the difference between "its" and "it's," can you graduate medical school in America. And if you haven't graduated medical school in America, and you want to become BC in rad onc in America, you definitely need English fluency or 1) you won't get a residency spot, and/or 2) you'll never pass written boards.

So English fluency is actually a reasonable screening tool for admission to any US residency program, I would think?
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literally zero people would ever argue that doctors shouldn't be fluent in English. That is not being disputed by anyone, including the person that made that tweet about MROGA.

this is not the point.
 
i don’t know what the actual point of mroga post was, but the call out by the young man is just as nonsensical. Why is it xenophobic?

Fluency matters a lot. It’s so hard to communicate complicated things to people and I know much gets lost in translation. My parents have lived here 40-50 years, yet English speaking doctors that talk fast still confuse them. So for native born Americans, i presume non-native English speaker with an accent and non-American English can be confusing.

It isn’t racist or xenophobic to expect a provider be able to communicate with you effectively.

Another day, another person using an -ism just because they disagree or don’t like what someone is saying.
 
jondunn said:
a made up argument, my friend. No one is arguing this point
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I think the outrage regarding MROGA is made up in this instance. Very little denigration of IMGs here and there shouldn't be.

The other guy misread MROGAs tweet IMO. Just a flippant Tweet by MROGA where they were commenting on minimum standards.

Beriwal is an IMG and a GOAT. Probably a disproportionate fraction of posters here with IMGs in their family.

Every IMG that I've ever worked with has been fluent in English. There have been occasional docs with accents strong enough to cause some communication issues with patients.

A healthy field would always consider exceptional IMGs and would not match every US applicant.
 
‘Every IMG that I've ever worked with has been fluent in English.’

Exactly which is why the whole ‘but shouldn’t we at least want our docs to be fluent’ argument is spurious. No one is saying that - and in fact to suggest otherwise reveals a bias by those who would argue that point.
 
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