Rad Onc Twitter

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FindMeOnTheLinks said:
Not really though anymore. Our attendings didn’t put up with being chained to the machine for very long. Pretty easy to train the therapists to contour stomach, bowel and duo. Page attending after it’s done. Check gtv. Reoptimization takes 15-20 seconds. Approve plan. Literally at the machine for 3mins these days
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How rad onc as a specialty becomes obsolete. Save us from your center. Or as per @TheWallnerus, from the NHS.
 
temujim said:
How rad onc as a specialty becomes obsolete. Save us from your center. Or as per @TheWallnerus, from the NHS.
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I know a place like UTSW assigns an IGRT and bGRT and MRI replanning “physician of the day” every day from their deep bench of docs. How does a single MD center do that. Just because a new tech comes along and there’s some arbitrary feeling that a physician must now stand at the machine doesn’t mean if physicians no longer stand at the machine physicians are obsolete. We went through this with kV X-ray IGRT about 16 years ago where suddenly everyone said physicians have to stand at the machine all day. And then one day *poof* everyone said “Nah, no more standing at machine.” If constant machine presence is required we might as well just go ahead and run the linac and room and setup the patients. Thank goodness no one ever got the bright idea we need to constantly stand at the TPS while dosimetry is contouring OARs and inversely optimizing targets and making clinically/dosimetrically consequential decisions.
 
TheWallnerus said:
I know a place like UTSW assigns an IGRT and bGRT and MRI replanning “physician of the day” every day from their deep bench of docs. How does a single MD center do that. Just because a new tech comes along and there’s some arbitrary feeling that a physician must now stand at the machine doesn’t mean if physicians no longer stand at the machine physicians are obsolete. We went through this with kV X-ray IGRT about 16 years ago where suddenly everyone said physicians have to stand at the machine all day. And then one day *poof* everyone said “Nah, no more standing at machine.” If constant machine presence is required we might as well just go ahead and run the linac and room and setup the patients. Thank goodness no one ever got the bright idea we need to constantly stand at the TPS while dosimetry is contouring OARs and inversely optimizing targets and making clinically/dosimetrically consequential decisions.
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You don’t stand behind your dosimetrist and stare at them awkwardly while they plan?
 


Baby Boomers Boomer GIF by MOODMAN
 
TheWallnerus said:
People have to recall that in the not long ago past CPT 77014 was CT simulation billed with 77290 at sim. Then vendors *cough* *Varian* *cough* said we are going to glom a CT scanner onto the linac. And then everyone said “you know what, I am gonna bill a CT simulation code EVERY day.” Because there were no rules one way or the other. And as of now there are no guardrails at the payor level, either insurance or Medicare, to keep more than 2 or 3 CPT 77301’s being billed per course of treatment. (Just like there were no 77014 guardrails back then… some were quite “freaked” to bill daily CT scan charges.) Try it… 77301 multiples. On any patient. One will see I am correct. A similar current tale can be told of the the derms and daily 77280 with superficial RT. We think derms would be satisfied with $25 a day for the superficial RT treatment code alone?
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We need to learn to have a healthy conversation about these issues. It is so disappointing that technology is running ahead of policy. I realize this is common around the world and a wide ranging problem in the US, but you'd think highly technical physicians, physicists, and "leaders" could work this out in our little niche.

Daily on-table adaptive SBRT is a lot more work for therapists, physicists, and physicians so it is not unreasonable to pay more for it. There is nascent data that implies patients benefit from the technique... implies of course, but it does take time to generate data. This is the perfect situation to craft a fair policy while the data matures. I have hope that we don't screw this up, but have very low expectations because of our history with selfish leadership.

Even if you take UTSW giant building of adaptive machines, when you compare this to the idea of a giant an infusion center, this is a good investment for our healthcare system IMO.
 
It's a strange cycle.

People and systems respond to incentives. Some CPT codes pay more than others. More CPT codes pays more than fewer CPT codes.

Government/politicians/payors respond with their only weapon: make the CPT codes pay less and cap/bundle when CPT codes can be used.

Then, individual physicians are considered greedy/immoral for pushing back. The concept of "value" - meaning it takes a decade or two of dedicated study and training to produce a single physician - is nowhere to be seen.

It shouldn't be about whether or not you can bill 77014 at CTSIM.

It should be about the experience and knowledge to have the authority to put another human being through a CTSIM - and the liability assumed for doing so.

But I suppose it's easier to keep bundling codes.
 
Guys, it is not so complicated. Despite inflation, cost-of-living increases, and cost-of-capital increases these factors are not linked in any way to Medicare reimbursement. It is considered a victory every year if Medicare reimbursement remains STABLE but instead we usually see small cuts that accumulate. We are being paid less every year for the same work.

Commercial payors on the other hand have been raking in record profits but denying, delaying and withholding care. Also, any administrator will tell you that commerical insurance:Medicare ratios have been dropping every single year. So you can't rely on one Aetna PPO patient to defray the costs of the next six Medicare/Medicaid patients anymore.

There is a reckoning coming - it will be highly disruptive and painful.
 
Gfunk6 said:
Guys, it is not so complicated. Despite inflation, cost-of-living increases, and cost-of-capital increases these factors are not linked in any way to Medicare reimbursement. It is considered a victory every year if Medicare reimbursement remains STABLE but instead we usually see small cuts that accumulate. We are being paid less every year for the same work.

Commercial payors on the other hand have been raking in record profits but denying, delaying and withholding care. Also, any administrator will tell you that commerical insurance:Medicare ratios have been dropping every single year. So you can't rely on one Aetna PPO patient to defray the costs of the next six Medicare/Medicaid patients anymore.

There is a reckoning coming - it will be highly disruptive and painful.
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This is true for freestanding centers and small hospitals. Large monopolistic systems negotiate higher prices (which is on balance good for the insurance cos which profit from the transactional fees) yearly.
 
sirspamalot said:
Salvation Army CEO gets paid 100k. The Red Cross CEO gets a million+. Komen Foundation? Don't even get me started.

Nonprofits get milked. Time to start your own.
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100k seems totally reasonable. Many large "non" profit health system CEOs are making several million a year while they use their non profit "foundation" to buy equipment for the hospital which they can then turn around and bill CMS with. They also can cherry pick insurances and use their bargaining power with insurance companies.

If only those of us without the nonprofit moniker had the same tools:

people money GIF
 
elementaryschooleconomics said:
It's all about the game:

View attachment 365027
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If you can't beatm.. Joinm.

He is not happy at this time however.

Look at that mug.. Lol.

www.mysuncoast.com

Sarasota oncologist arrested, charged with prescription fraud

Two Sarasota pharmacies filled prescriptions for Diazepam under Dattoli’s wife’s name
www.mysuncoast.com www.mysuncoast.com

Looks like he tapped out into intervention to avoid prosecution..

unicourt.com

STATE OF FLORIDA VS DATTOLI, MICHAEL JOSEPH

On 12/17/2021 STATE OF FLORIDA filed a Civil court case against DATTOLI, MICHAEL JOSEPH in Florida Circuit Courts. Court records for this case are available from Twelfth Judicial Circuit.
unicourt.com unicourt.com
 
sirspamalot said:
Salvation Army CEO gets paid 100k. The Red Cross CEO gets a million+. Komen Foundation? Don't even get me started.

Nonprofits get milked. Time to start your own.
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It’s not so much what they pay their executives (although that is a problem) but the charitable essence of a nonprofit. Often they don’t take Medicaid, most Medicare advantage plans and deliver very little charity care. Some also pursue debts of indigent patients, garnish their wages etc.
In the 1990s, none of this crap was going on. I rotated through mdacc and they were treating a lot of illegal Mexican immigrants for cervix cancer. Would never happen today at most of these institutions.
 
Overview of predatory billing by “nonprofits”. At what point does the I was “just following orders” argument of those who work for these centers fall apart. (Ben smith)
www.npr.org

'The Price We Pay' Argues Rising Health Care Costs Undermine Public Trust In Medicine

Surgeon and researcher Marty Makary traveled the country talking to people about their experiences with health care. He learned that costs are poisoning Americans' relationships with medicine.
www.npr.org www.npr.org

www.nytimes.com

They Were Entitled to Free Care. Hospitals Hounded Them to Pay. (Published 2022)

With the help of a consulting firm, the Providence hospital system trained staff to wring money out of patients, even those eligible for free care.
www.nytimes.com www.nytimes.com

I submit that much of the lack of trust (ie vaccines etc) in medical pharmaceutical complex is spurred by price gouging and predatory billing.
 
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RickyScott said:
It’s not so much what they pay their executives (although that is a problem) but the charitable essence of a nonprofit. Often they don’t take Medicaid, most Medicare advantage plans and deliver very little charity care. Some also pursue debts of indigent patients, garnish their wages etc.
In the 1990s, none of this crap was going on. I rotated through mdacc and they were treating a lot of illegal Mexican immigrants for cervix cancer. Would never happen today at most of these institutions.
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Exactly.

What bothers me is the term "nonprofit" and how the public perceives it.

Culturally, there's a sense that medicine is supposed to be a "calling", that doctors and nurses are doing the job out of a desire to help their fellow man.

We're hardwired to say that generating financial wealth from such a "calling" is bad, immoral, wrong.

Mix this with "money is the root of all evil" in any industry and well, "profit" equals "evil".

You get an absolutely amazing two-for-one deal by getting nonprofit status. Not only can you access a ridiculous number of tax loopholes for you and your friends (don't forget that donating to a nonprofit is a tax write-off), you get instant positive optics/PR.

Take two hospitals that are the exact same by every metric. Give one nonprofit status but not the other. It will have the better reputation every time.
 
elementaryschooleconomics said:
Exactly.

What bothers me is the term "nonprofit" and how the public perceives it.

Culturally, there's a sense that medicine is supposed to be a "calling", that doctors and nurses are doing the job out of a desire to help their fellow man.

We're hardwired to say that generating financial wealth from such a "calling" is bad, immoral, wrong.

Mix this with "money is the root of all evil" in any industry and well, "profit" equals "evil".

You get an absolutely amazing two-for-one deal by getting nonprofit status. Not only can you access a ridiculous number of tax loopholes for you and your friends (don't forget that donating to a nonprofit is a tax write-off), you get instant positive optics/PR.

Take two hospitals that are the exact same by every metric. Give one nonprofit status but not the other. It will have the better reputation every time.
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“More than half the nation’s roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.
But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.”
 
Its time to eliminate "big corporate" nonprofits.

Small (under 10m/year) charities can retain the status.

Churches, Hospitals, and Tax Loophole Inc need to go. Buh bye.
 
Health economics has known since the late 90s that both for-profit and not-for-profit health systems behave in the exact same manner. Only difference is that in for-profit systems the money is diverted back to shareholders, while in not-for-profit systems it gets returned back to the institution.

All that art isn't going to pay for itself.
 
OTN said:
Health economics has known since the late 90s that both for-profit and not-for-profit health systems behave in the exact same manner. Only difference is that in for-profit systems the money is diverted back to shareholders, while in not-for-profit systems it gets returned back to the institution.

All that art isn't going to pay for itself.
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it goes back into the institution by hiring more administrating, building more, and purchasing very expensive equipment.
 
RickyScott said:
For the grace of god, it could have been me.
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Yea, definitely not a good thing and yes he could have been more careful but I’ve definitely had some “close calls” regarding wrong site documented or labeled from other providers/staff, etc. to wrong energy or been given a plan that I approved that had a structure mislabeled by a resident/dosimetry.

Again, not making any excuses because he was obviously at fault but these kinds of stories always make it seem like the docs are the devil.
 
RadOncDoc21 said:
Yea, definitely not a good thing and yes he could have been more careful but I’ve definitely had some “close calls” regarding wrong site documented or labeled from other providers/staff, etc. to wrong energy or been given a plan that I approved that had a structure mislabeled by a resident/dosimetry.

Again, not making any excuses because he was obviously at fault but these kinds of stories always make it seem like the docs are the devil.
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Daily imaging and pretreatment pet fusion should eliminate these kind of mistakes. I try to pull up the consult notes right before contouring as well.
 
RickyScott said:
Daily imaging and pretreatment pet fusion should eliminate these kind of mistakes.
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I believe the pet/fusion would but after it’s been approved and treatments have started, much harder to kinda catch the systemic mistakes. I’m not defending him but just feel like this isn’t something I can be too critical with as there have been certain things I didn’t catch initially when I thought I did my due dillegence. I guess that’s the role for chart review and Q&A but definitely a humbling experience.
 
RadOncDoc21 said:
I believe the pet/fusion would but after it’s been approved and treatments have started, much harder to kinda catch the systemic mistakes. I’m not defending him but just feel like this isn’t something I can be too critical with as there have been certain things I didn’t catch initially when I thought I did my due dillegence. I guess that’s the role for chart review and Q&A but definitely a humbling experience.
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No doubt. I have seen some of the best docs I know make these kind of mistakes.
 
Fpg1245 said:
But are they really the best? Especially if they make such an elementary mistake
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In the movies, immediately after a person something like, they usually cut to him/her talking to a malpractice attorney in the following scene.

Just sayin'... 😉
 
I can't stand the holier-than-thou attitude of these urologists and "experts." I have seen much more egregious cases with men inappropriately taken for surgery, many at high-volume centers like the one this "professor" works at.

There are folks calling this malpractice. This is just a case of some self-promoting finger-wagging at community rad oncs.

Twitter is such a garbage dump.
 
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