Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
1) say the quiet part out loud (Hallahan final solution)
2) provide erroneous “evidence” that a catastrophic shortage of rad oncs is coming
3) none of the “leaders” question this because they kinda like the conclusions
4) unprecedented expansion
5) unprecedented oversupply
6) “leaders” quietly collude to take advantage of grads due to oversupply and supress any efforts for transparency (“acid”)
7) field in a bottomless pit of hell, rinse and repeat!
 
Wine country and Head & Neck Cancer meetings go together like tuna fish and cigarettes



RHNEE8R.png
 
fiji128 said:
Assuming 250 consults/year at the $5k package price that $1,250,000 in cash without any interventions. Choosing wisely indeed.
Click to expand...
Based on what they have told shared patients, they should pay me for the extra effort explaining why MSK was wrong.
 
fiji128 said:
Assuming 250 consults/year at the $5k package price that $1,250,000 in cash without any interventions. Choosing wisely indeed.
Click to expand...
Explain to me how cms reimbursements at such centers (which don’t take straight Medicare) affect faculty salaries vs supply of radiation oncologists.
 
RealSimulD said:
I went to Med school with Uwe’s daughter

He was an absolute giant in health econ.
Click to expand...
He was on the board of NEJM and “it’s the prices stupid” is the most well known health Econ article ever. Only a total fraud/imposter could publish on prices/utilization and not be aware of his work or the entire field of health Economics.
 
Last edited:
I LOL'd

In July 2015 Reinhardt's 2013 syllabus and first lecture for a class titled "Introductory Korean Drama" received attention from several bloggers. By way of explanation, Reinhardt introduced the class by stating:
After the near‐collapse of the world's financial system has shown that we economists really do not know how the world works, I am much too embarrassed to teach economics anymore, which I have done for many years. I will teach Modern Korean Drama instead. Although I have never been to Korea, I have watched Korean drama on a daily basis for over six years now. Therefore I can justly consider myself an expert in that subject.
Click to expand...
 
temujim said:
I LOL'd

In July 2015 Reinhardt's 2013 syllabus and first lecture for a class titled "Introductory Korean Drama" received attention from several bloggers. By way of explanation, Reinhardt introduced the class by stating:
Click to expand...
This is a great story
 
temujim said:
After the near‐collapse of the world's financial system has shown that we economists really do not know how the world works, I am much too embarrassed to teach economics anymore, which I have done for many years. I will teach Modern Korean Drama instead. Although I have never been to Korea, I have watched Korean drama on a daily basis for over six years now. Therefore I can justly consider myself an expert in that subject.
Click to expand...
Good Lord.

Any paper published about healthcare economics, RadOnc or otherwise, should be required to cite this.

For several months, I have been asking my patients (or they volunteer it, unprompted) what the "sticker price" is for my treatments, usually during OTVs. I have heard absolutely wild numbers. They'll often tell me their out-of-pocket costs too.

On the backend, I can generally track reimbursement for my department/group. I also have the very detailed "standard charges" file, and the monthly/yearly financial statements of my hospital.

None of it MAKES ANY SENSE. None of it. I am the one prescribing and delivering the treatment. My patients are the ones receiving and paying for the treatment. There's almost no discernible pattern.

I don't think any of us truly understand healthcare economics.
 
elementaryschooleconomics said:
Good Lord.

Any paper published about healthcare economics, RadOnc or otherwise, should be required to cite this.

For several months, I have been asking my patients (or they volunteer it, unprompted) what the "sticker price" is for my treatments, usually during OTVs. I have heard absolutely wild numbers. They'll often tell me their out-of-pocket costs too.

On the backend, I can generally track reimbursement for my department/group. I also have the very detailed "standard charges" file, and the monthly/yearly financial statements of my hospital.

None of it MAKES ANY SENSE. None of it. I am the one prescribing and delivering the treatment. My patients are the ones receiving and paying for the treatment. There's almost no discernible pattern.

I don't think any of us truly understand healthcare economics.
Click to expand...
None of us understand health care economics but we can still be very confident that large departments like upenn, mskcc, and mdacc are charging outrageous prices.
 
RickyScott said:
None of us understand health care economics but we can still be very confident that large departments like upenn, mskcc, and mdacc are charging collecting outrageous prices amounts.
Click to expand...
I charge everyone, including Medicare, 300% the Medicare rate. I can't remember the last time any payor paid my center >100% Medicare allowable. A place like UPenn can, with the right patient/payor, collect a quarter million dollars for one course of prostate IMRT.
 
TheWallnerus said:
I charge everyone, including Medicare, 300% the Medicare rate. I can't remember the last time any payor paid my center >100% Medicare allowable. A place like UPenn can, with the right patient/payor, collect a quarter million dollars for one course of prostate IMRT.
Click to expand...
And they love to spout off how they charge Protons at imrt rates!
 
elementaryschooleconomics said:
None of it MAKES ANY SENSE.
Click to expand...

I am very stupid and have not had to negotiate with insurance companies before. Can somebody explain to me why payors are willing to give certain large centers many multiples more than others? Isn't it in their financial interests to minimize payouts? Why would they agree to pay one center $20k global for a course of prostate IMRT and another $100k? What's in it for them to write checks for so much more? Is the negotiating power of refusing to accept their insurance really that strong or is there something else going on?
 
Moonbeams said:
I am very stupid and have not had to negotiate with insurance companies before. Can somebody explain to me why payors are willing to give certain large centers many multiples more than others? Isn't it in their financial interests to minimize payouts? Why would they agree to pay one center $20k global for a course of prostate IMRT and another $100k? What's in it for them to write checks for so much more? Is the negotiating power of refusing to accept their insurance really that strong or is there something else going on?
Click to expand...
The requirement of making profits cap at 20 percent incentivizes plans to pay out the most so they can keep more money?
 
Moonbeams said:
I am very stupid and have not had to negotiate with insurance companies before. Can somebody explain to me why payors are willing to give certain large centers many multiples more than others? Isn't it in their financial interests to minimize payouts? Why would they agree to pay one center $20k global for a course of prostate IMRT and another $100k? What's in it for them to write checks for so much more? Is the negotiating power of refusing to accept their insurance really that strong or is there something else going on?
Click to expand...
Payors are not “paying” in these scenarios. Employers pay the bills and the insurance company is just a middle man (taking no risk). Therefore, a high bill is in their financial inferest.
 
RickyScott said:
Payors are not “paying” in these scenarios. Employers pay the bills and the insurance company is just a middle man (taking no risk). Therefore, a high bill is in their financial inferest.
Click to expand...
If i have an independent policy, and I get a cancer treatment that is charged 200k, I have a 5k deductible with 1M out of pocket maximum. So I pay 5k, and the insurance company has a negotiated rate for the other 195k charge. Wouldn't the insurance company want to negotiate that down as much as possible as it would eat into their profit margins? I guess the confusion here is how employers set premiums for group plans. They want to keep as much of the premium as possible, but at the same time are incentivized to keep prices high so they can keep premiums high with the latter being more important that the former?
 
Moonbeams said:
I am very stupid and have not had to negotiate with insurance companies before. Can somebody explain to me why payors are willing to give certain large centers many multiples more than others? Isn't it in their financial interests to minimize payouts? Why would they agree to pay one center $20k global for a course of prostate IMRT and another $100k? What's in it for them to write checks for so much more? Is the negotiating power of refusing to accept their insurance really that strong or is there something else going on?
Click to expand...
There are three numbers I always look for: what is charged, what is reimbursed, and what the patient pays out-of-pocket. There are obviously about 10,000 other numbers...but those three are the interesting ones.

There are several advantages, but in my opinion, the primary benefit from a huge "charge" that gets an "adjustment": it can be written off as charitable care.

So $200k for the prostate treatment charge will be adjusted to $20k-$30k pretty routinely. Then the hospital can say "look, we ate the cost for the $170k we didn't get".

The PPS-exempt centers are in a whole different league. While most of the country is stuck billing Medicare for the same rate, 11 institutions can charge whatever they want and get paid for it...because of "the mission".
 
Moonbeams said:
If i have an independent policy, and I get a cancer treatment that is charged 200k, I have a 5k deductible with 1M out of pocket maximum. So I pay 5k, and the insurance company has a negotiated rate for the other 195k charge. Wouldn't the insurance company want to negotiate that down as much as possible as it would eat into their profit margins? I guess the confusion here is how employers set premiums for group plans. They want to keep as much of the premium as possible, but at the same time are incentivized to keep prices high so they can keep premiums high with the latter being more important that the former?
Click to expand...

For larger clients, the insurance company just serves as an administrator of the plan, while the giant company/teacher's union/nursing union/etc are actually responsible for paying for the treatment.
 
Doctorer said:
For larger clients, the insurance company just serves as an administrator of the plan, while the giant company/teacher's union/nursing union/etc are actually responsible for paying for the treatment.
Click to expand...
So if you work for Walmart or something, and you pay $200/month for your portion of the insurance plan, Walmart isn't paying an extra $800/month (assuming the total premium costs $1k)? Instead you pay your $200/month, the employer pays no premium at all, and are instead sent the actual charges of the medical services utilized by the employees?

I had heard a pretty nasty manager for a big company in the past make a comment about deciding whether or not to retain employees based on their health expenses, which didn't completely make sense at the time, but seems understandable in this context. That is also pretty disturbing as it motivates employers to discourage employees from having children and families. What a toxic system.
 
Moonbeams said:
So if you work for Walmart or something, and you pay $200/month for your portion of the insurance plan, Walmart isn't paying an extra $800/month (assuming the total premium costs $1k)? Instead you pay your $200/month, the employer pays no premium at all, and are instead sent the actual charges of the medical services utilized by the employees?

I had heard a pretty nasty manager for a big company in the past make a comment about deciding whether or not to retain employees based on their health expenses, which didn't completely make sense at the time, but seems understandable in this context. That is also pretty disturbing as it motivates employers to discourage employees from having children and families. What a toxic system.
Click to expand...
Vast majority of employers are self insured. They pay your medical expenses. So when mskcc or upenn charge 200k to treat a policeman or teacher, the city has less money for the homeless or to feed hungry poor children school lunches!
 
RickyScott said:
Vast majority of employers are self insured. They pay your medical expenses. So when mskcc or upenn charge 200k to treat a policeman or teacher, the city has less money for the homeless or to feed hungry poor children school lunches!
Click to expand...
I’d love to learn more about this
Have not heard this from my small business owner friends, ever
 
RealSimulD said:
I’d love to learn more about this
Have not heard this from my small business owner friends, ever
Click to expand...
Not true for small business- different type of plans.

“According to a 2021 Kaiser Family Foundation analysis, 64% of U.S. employees with employer-sponsored health insurance are in self-insured plans.1 Most businesses”

www.verywellhealth.com

What Is Self-Insured Health Insurance?

Most very large employers self-insure their workers' health coverage, so the plans are governed by federal—instead of state—regulations.
www.verywellhealth.com www.verywellhealth.com
 
Last edited:
RickyScott said:
Vast majority of employers are self insured. They pay your medical expenses. So when mskcc or upenn charge 200k to treat a policeman or teacher, the city has less money for the homeless or to feed hungry poor children school lunches!
Click to expand...
I know that was one of the things the automakers struggled with - medical expenses for pensioners who lived way longer than they anticipated.
But what's the point at which employers do this and why?
Obviously a 5 employee small business cannot afford to shoulder the actual medical expenses and presumably are just splitting premiums. Do insurance companies just refuse to function as actual "insurance" by selling a policy at a premium beyond a certain number of employees?
 
Moonbeams said:
I know that was one of the things the automakers struggled with - medical expenses for pensioners who lived way longer than they anticipated.
But what's the point at which employers do this and why?
Obviously a 5 employee small business cannot afford to shoulder the actual medical expenses and presumably are just splitting premiums. Do insurance companies just refuse to function as actual "insurance" by selling a policy at a premium beyond a certain number of employees?
Click to expand...
Insurance companies would rather be out of the insurance business and take on 0 risk! The plans for small business tend to be shtty and incredibly expensive if they include premium hospitals in network. It is cheaper for large employers to insure themselves than with an insurance company. I think They do have secondary disaster policies covering rare extreme events like a bunch of employees needing transplants all at once.

Most of us work for hospitals which are self insured.
Just ask the cfo, which is how I learned about all of this. They know the rates of all the neighboring hospitals because some employees end up being treated around town.
 
Last edited:
Presumably, wouldn't an employer very sensitive to cost, maybe a local 200 person manufacturing business with a self-insured plan, prohibit their employees from receiving care at MSKCC as a $300k payment for a single employee's prostate cancer would dangerously eat into their revenue?

The employee thinks their health insurance is United, not aware their employer is actually insuring them, as that is what their card says. But United determines who is in-network and covered? Forces the employer?
 
RickyScott said:
Not true for small business- different type of plans.

“According to a 2021 Kaiser Family Foundation analysis, 64% of U.S. employees with employer-sponsored health insurance are in self-insured plans.1 Most businesses”

www.verywellhealth.com

What Is Self-Insured Health Insurance?

Most very large employers self-insure their workers' health coverage, so the plans are governed by federal—instead of state—regulations.
www.verywellhealth.com www.verywellhealth.com
Click to expand...
Wow!
 
Moonbeams said:
Presumably, wouldn't an employer very sensitive to cost, maybe a local 200 person manufacturing business with a self-insured plan, prohibit their employees from receiving care at MSKCC as a $300k payment for a single employee's prostate cancer would dangerously eat into their revenue?

The employee thinks their health insurance is United, not aware their employer is actually insuring them, as that is what their card says. But United determines who is in-network and covered? Forces the employer?
Click to expand...
I think United has many different insurance products not all of which have expensive hospitals in network.
 
My understanding is the big centers command higher prices because insurance companies want the big centers to be "in network" in order to promote their plan to more customers.

If you are deciding which insurance to pick and have a choice, aren't you going to go with one that lets you go to the big hospital system you want to have access to?
 
CaesarRO said:
My understanding is the big centers command higher prices because insurance companies want the big centers to be "in network" in order to promote their plan to more customers.

If you are deciding which insurance to pick and have a choice, aren't you going to go with one that lets you go to the big hospital system you want to have access to?
Click to expand...
Insurance companies want the big centers to charge more because then they get a bigger commission. Vinay prassad said it best- if you only get one slice of the pizza, you want the pizza to be as big as possible.
 
CaesarRO said:
My understanding is the big centers command higher prices because insurance companies want the big centers to be "in network" in order to promote their plan to more customers.

If you are deciding which insurance to pick and have a choice, aren't you going to go with one that lets you go to the big hospital system you want to have access to?
Click to expand...
Bingo. Different tiers of insurance with different in network panels of providers and hospitals.

That's why many of the Medicare/Medicaid HMO plans aren't in network the local NCI designated PPS-exempt financially toxic site of service. Ditto for the cheaper Humana/Cigna/blue cross etc options out there
 
CaesarRO said:
My understanding is the big centers command higher prices because insurance companies want the big centers to be "in network" in order to promote their plan to more customers.

If you are deciding which insurance to pick and have a choice, aren't you going to go with one that lets you go to the big hospital system you want to have access to?
Click to expand...
Which is also why hospitals continue to consolidate. More pricing power with a monopoly.
 
RickyScott said:
Insurance companies want the big centers to charge more because then they get a bigger commission. Vinay prassad said it best- if you only get one slice of the pizza, you want the pizza to be as big as possible.
Click to expand...
Maybe true but consumers want cheaper options hence there are silver/bronze plans that don't let you go to Anderson/Sloane/Dana/moffitt for that second opinion
 
medgator said:
Maybe true but consumers want cheaper options hence there are silver/bronze plans that don't let you go to Anderson/Sloane/Dana/moffitt for that second opinion
Click to expand...
Maybe consumers shopping for plans. Goldman Sachs, t police and teachers are not excluding mskcc from what they offer employees. There are many different products, like games at a casino.
 
But if 64% of patients are “self insured” at these companies … I think this isn’t “bingo”. It’s more complex
 
RealSimulD said:
But if 64% of patients are “self insured” at these companies … I think this isn’t “bingo”. It’s more complex
Click to expand...
Lots of regulations about how much money has to be set aside to cover the employees. Also Large unions and gov workers almost always have top health benefits.
 
RickyScott said:
The patients aren’t self insured. The companies are.
Click to expand...
I understand that

But how does negotiation work then? If you’re saying the company is paying the bills and the insurer is admin, the company has incentive to lower prices.
 
RealSimulD said:
I understand that

But how does negotiation work then? If you’re saying the company is paying the bills and the insurer is admin, the company has incentive to lower prices.
Click to expand...
They absolutely do have an in incentive to lower costs, but supposedly they are not very good at because of the all the hidden prices and Byzantine structure. Evercore etc are services that insurers contract with to help companies lower costs, but utilization is not nearly as much a problem as prices.
 
You must log in or register to reply here.

Similar threads

uchihastan
Rad Onc vs. Heme/Onc
Replies
16
Views
2K
medgator
M
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
7K
RickyScott
R
TheWallnerus
Rad Onc is in a dark place
Replies
13
Views
3K
RickyScott
R
M
Rad Onc Oral Boards: To quote or not quote studies?
Replies
5
Views
731
RSAOaky
R
Top