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It would be too tedious for me to dig back into this thread to find our conversation with him, but I would just like to say:

I was wrong, at the time. I told him I thought his actions would seriously harm his residency Match prospects.

What I should have said was "you won't make it to the Match".

We all make mistakes!
 
elementaryschooleconomics said:
View attachment 380500

It would be too tedious for me to dig back into this thread to find our conversation with him, but I would just like to say:

I was wrong, at the time. I told him I thought his actions would seriously harm his residency Match prospects.

What I should have said was "you won't make it to the Match".

We all make mistakes!
Click to expand...

This is because of that piece he wrote about Covid?
 
Doctorer said:
It seems like there may have been a coworker/nurse...
Click to expand...
Anyone losing their position in American professional school .. well, let me say that it takes A LOT. You’ve all been there. People who fail many exams, suffer substance abuse issues, have mental health issues, even those that may have committed a crime - the school does all it can to help you get through.

Knowing nothing about what happened … I garner that

1) this is not something normal or minor

2) that there have been repeated events

3) that there is no remorse

4) that there is no desire for change

Let’s see what happens when details come out. I could be 100% wrong.

Not at all surprised at this. His tone and inability to play in the sandbox was clear from the start. It was “come at me, bro” x infinity.

(I had read the original article he wrote and found myself mostly in agreement with everything he said; my feelings towards him is his style and pugnaciousness. Med school is not the place for conflicts. Just ****ing pass)
 
Pretty clear his primary career interest was social media, not treating patients. Even still, all he had to do was keep his mouth shut and show up for a few years and get an MD and then start collecting his followers on X and launching a subscription substack.

I knew a guy like this in med school. Could not help himself and was constantly trying to find just exactly where the line was in basically everything: inappropriate comments to classmates, missing rotations to work part time jobs, arguing with admins and preceptors, shooting for the bare minimum passing grades, etc. He clearly did not want to be there and eventually well yeah he wasn't there anymore.

There are some hills worth dying on, but at this point going to med school and residency is basically like joining the army. If you sign up for it, they will inject you with whatever they want, wake you out of bed at 4AM, and throw you out of airplanes. You're their property until you're done, you've got no say in the matter, and you do what you're told. That's basically the deal now, and I'm not sure I would do it again in this age.

Stupid. Probably was just trying to manufacturer a case for a lawsuit and publicity at this point.
 
MidwestRadOnc said:
Pretty clear his primary career interest was social media, not treating patients. Even still, all he had to do was keep his mouth shut and show up for a few years and get an MD and then start collecting his followers on X and launching a subscription substack.

I knew a guy like this in med school. Could not help himself and was constantly trying to find just exactly where the line was in basically everything: inappropriate comments to classmates, missing rotations to work part time jobs, arguing with admins and preceptors, shooting for the bare minimum passing grades, etc. He clearly did not want to be there and eventually well yeah he wasn't there anymore.

There are some hills worth dying on, but at this point going to med school and residency is basically like joining the army. If you sign up for it, they will inject you with whatever they want, wake you out of bed at 4AM, and throw you out of airplanes. You're their property until you're done, you've got no say in the matter, and you do what you're told. That's basically the deal now, and I'm not sure I would do it again in this age.

Stupid. Probably was just trying to manufacturer a case for a lawsuit and publicity at this point.
Click to expand...
This guy must’ve been pretty far along in med school too. Middle of fourth year?
 
MidwestRadOnc said:
Pretty clear his primary career interest was social media, not treating patients. Even still, all he had to do was keep his mouth shut and show up for a few years and get an MD and then start collecting his followers on X and launching a subscription substack.

I knew a guy like this in med school. Could not help himself and was constantly trying to find just exactly where the line was in basically everything: inappropriate comments to classmates, missing rotations to work part time jobs, arguing with admins and preceptors, shooting for the bare minimum passing grades, etc. He clearly did not want to be there and eventually well yeah he wasn't there anymore.

There are some hills worth dying on, but at this point going to med school and residency is basically like joining the army. If you sign up for it, they will inject you with whatever they want, wake you out of bed at 4AM, and throw you out of airplanes. You're their property until you're done, you've got no say in the matter, and you do what you're told. That's basically the deal now, and I'm not sure I would do it again in this age.

Stupid. Probably was just trying to manufacturer a case for a lawsuit and publicity at this point.
Click to expand...
Anyone who writes 20,000 words about anything *without being paid for doing so* is sus. Mentally imbalanced
 
smq123 said:
Probably this one:

forums.studentdoctor.net

I wonder whether this medical student will be cancelled

Say, and I know this hard to believe, but what if someone that had cachet had written this. Maybe a senior faculty member that had otherwise been known to have a reality-based slant on the world. Would they be treated the same way? I don’t believe they would. Weischalbaum posts with RaDiCaL...
forums.studentdoctor.net forums.studentdoctor.net
Click to expand...

Man I love the internet, hahaha.

Specifically, I love this feature of the internet, which is an aspect that people (politicians, ASTRO, etc) forget about.

If you can't find something, someone else can. Even if you think you deleted it...once it's "out there", you should assume it will exist as long as the internet exists.

Re-reading that thread, here's my initial post to him:

1704555216734.png


I just want to scream this at medical students and residents once a week, forever:

Medicine is not a meritocracy.

Obviously, I have a very, very, very long track record on both SDN and real life of being...obstinate. Yeah. Obstinate is a cool word for it. I'm basically a Professional Obstinatrician.

But I'm not a contrarian for the sake of being a contrarian. I agree with most "mainstream" viewpoints on most mainstream things. Honestly I wish I agreed with even more mainstream things than I do, because it would be a lot easier on my life.

The most important tactic of being a Professional Obstinatrician is resisting the urge to shotgun blast all of your opinions, all of the time. Many (most...all?) of my opinions are related to actions that I would like to see happen in the world, and often, I could be the one to take those actions.

To do so, I have to get myself into a position where "taking action" is even a remotely viable option.

That's actually the saddest part of this whole story. As I recall, Bass should be at the very end of his MD-PhD program - either an M3 or M4. He was in his 7th year back in February 2023 when that thread was made.

I'm all for standing up for what you believe in...but the cost/benefit ratio needs to make sense. He permanently altered the trajectory of his career, of his life, to...what? Did he move the needle at all on public health issues?

RealSimulD said:
Anyone losing their position in American professional school .. well, let me say that it takes A LOT. You’ve all been there. People who fail many exams, suffer substance abuse issues, have mental health issues, even those that may have committed a crime - the school does all it can to help you get through.

Knowing nothing about what happened … I garner that

1) this is not something normal or minor

2) that there have been repeated events

3) that there is no remorse

4) that there is no desire for change

Let’s see what happens when details come out. I could be 100% wrong.

Not at all surprised at this. His tone and inability to play in the sandbox was clear from the start. It was “come at me, bro” x infinity.

(I had read the original article he wrote and found myself mostly in agreement with everything he said; my feelings towards him is his style and pugnaciousness. Med school is not the place for conflicts. Just ****ing pass)
Click to expand...

I completely agree with @RealSimulD. I have zero insider info either, but the bottleneck of American med school is getting in. Once you're in, the school will go to great lengths to help you stay in.

While I suspect that whatever caused his dismissal was a particular pattern of behavior unrelated to his pandemic opinions, his social media presence only hurt him in the situation. He's a liability for the school. If we ever learn the details, I suspect that 1) dismissal was a reasonable course of action, and 2) dismissal might have been avoided, though, if he was just "another student".

The nail that sticks out gets hammered down.
 
These are the people that hold your future in your hands. This toxicity, megalomania, and authoritarianism in academia is no longer limited to the humanities departments. I don't know what happened to the guy and if there were objectively valid academic or conduct reasons to dismiss him at the very end of his training (which is definitely possible but suspicious off the bat), but I'm going to take a wild guess that a nonzero number of administrators involved in the expulsion decision were happy to see him suffer personally for speaking out on covid, regardless if he ended up being right or not. In other words, if you don't think some woke administrator has the power to totally discredit you and ruin your life for saying the wrong things.... hahaha. That's what it's all about.

jennifer1.jpg
 
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elementaryschooleconomics said:
View attachment 380500

It would be too tedious for me to dig back into this thread to find our conversation with him, but I would just like to say:

I was wrong, at the time. I told him I thought his actions would seriously harm his residency Match prospects.

What I should have said was "you won't make it to the Match".

We all make mistakes!
Click to expand...


Play stupid games, win stupid prizes.
 
evilbooyaa said:


Play stupid games, win stupid prizes.
Click to expand...

Though I dont have X access, it looks like a serious dump he's got going on. No hint at remorse. I suspect he'll be on Fox News before long touting his MD and his PhD, though I'm still not certain he's gotten the latter.
 
So in case people still weren't sure what the definition of "spin" is:

1704820932686.png


This is what I like to call...er, "Elementary School Marketing".

If you read the press release:

1704821073536.png


Hmmm...that's odd...it's like they...want you to think there's support for ROCR but...it's only mentioned one time, in the second to last paragraph...

And none of the statements from the society representatives actually use the word "ROCR"...

And while they're including the hashtag on Twitter....it's at the end of their sentences...just sort of...almost like an illusion....

Maybe someone at ASCO can teach Dave Adler "Middle School Marketing"?
 
elementaryschooleconomics said:
So in case people still weren't sure what the definition of "spin" is:

View attachment 380737

This is what I like to call...er, "Elementary School Marketing".

If you read the press release:

View attachment 380739

Hmmm...that's odd...it's like they...want you to think there's support for ROCR but...it's only mentioned one time, in the second to last paragraph...

And none of the statements from the society representatives actually use the word "ROCR"...

And while they're including the hashtag on Twitter....it's at the end of their sentences...just sort of...almost like an illusion....

Maybe someone at ASCO can teach Dave Adler "Middle School Marketing"?
Click to expand...

I love ASCO haha, wouldn't be surprised if that statement is loaded on a hotkey on some persons computer. It is delightfully generic.

The coordinated influencer tweets are kind of sad actually, I almost feel bad. Cooperation is a huge win for all of us, lets see where this goes.

If you click around AMA twitter and those associated folks, it seems there is a high chance of 2024 medicare payment reform with some kind of physician raise linked to inflation. My updated question for the ROCR folks this year is: could it be a bad idea to remove ourselves from MPFS when our reps are open to reform?

Hopefully someone will answer.
 
NotMattSpraker said:
I love ASCO haha, wouldn't be surprised if that statement is loaded on a hotkey on some persons computer. It is delightfully generic.

The coordinated influencer tweets are kind of sad actually, I almost feel bad. Cooperation is a huge win for all of us, lets see where this goes.

If you click around AMA twitter and those associated folks, it seems there is a high chance of 2024 medicare payment reform with some kind of physician raise linked to inflation. My updated question for the ROCR folks this year is: could it be a bad idea to remove ourselves from MPFS when our reps are open to reform?

Hopefully someone will answer.
Click to expand...

It's a movement at this point and for a ROCR fanboy/girl to admit that there may be a better alternative is going to be like someone in the DEI movement asking the question "has this all gone a little bit too far"
 
RealSimulD said:
If ACRO is all in for ROCR without changes then they are worse than useless
Click to expand...
Genuine question: what changes would we want to see? I haven't bothered to look into the details too closely, because I believe my ability to effect any kind of change with respect to it is zero.
 
OTN said:
Genuine question: what changes would we want to see? I haven't bothered to look into the details too closely, because I believe my ability to effect any kind of change with respect to it is zero.
Click to expand...

I floated some proposed changes and you will hear more from me. My biggest thing is Id like to see SOME discussion of including breast and prostate proton therapy for patients >40 years old. Their reason for excluding is not strong and I dont think they should be let off the hook on this very solvable issue.

I really, really do not like the accreditation requirement. Im doing a podcast on this aspect, out soon.

Jason Beckta has floated a number of changes in his podcast, or maybe more like questions that remain unanswered. He has talked a lot about their $500 transportation benefit and supporting rural practices, or large academic practices... not actually sure what this supports haha.

Mark Storey has a nice write up of ROCR and has some super interesting ideas in there on all the controversial aspects. ROCR: ASTRO's New Payment Direction

Finally, Id recommend watching the ACRO town hall. It was an actual town hall with audience questions, there are a lot of comments there from their policy folks. I got the sense that they do not agree with ROCR as defined today and I think yesterdays letter may imply that ASTRO is finally open to feedback at least from ACRO (I am not sure how much the ACR or ASCO is weighing in?).

ACRO also are running a survey on how the field feels about many of these controversial aspects of ROCR. They said they plan to report it out publicly. I strongly suggest you fill it out, especially if you don't agree with ROCR!

Everyone seems to agree that change will only work with universal support, and ACRO are the only ones who are working to understand the opinions of the field.

OTN said:
Genuine question: what changes would we want to see? I haven't bothered to look into the details too closely, because I believe my ability to effect any kind of change with respect to it is zero.
Click to expand...

The danger here is that just a few people are driving this, and we dont know who or why! The language is very unclear and confusing and there are clear potential significant COIs.

I would guess I have zero influence and its hard to tell how this will directly impact me even in the short term. I think we still have to care. This is a massive change in policy for our field.
 
OTN said:
Genuine question: what changes would we want to see? I haven't bothered to look into the details too closely, because I believe my ability to effect any kind of change with respect to it is zero.
Click to expand...
Well, weirdly, the authors of ROCR had previously authored (and published) things when APM was looming.

I would start with those authors...reading their own work from a couple years ago and incorporating their own recommendations.

Mark Storey's Substack article on this is also brilliant, with some rather unique ideas that weren't even brought up in the APM era. Worth a read.
 
NotMattSpraker said:
I floated some proposed changes and you will hear more from me. My biggest thing is Id like to see SOME discussion of including breast and prostate proton therapy for patients >40 years old. Their reason for excluding is not strong and I dont think they should be let off the hook on this very solvable issue.

I really, really do not like the accreditation requirement. Im doing a podcast on this aspect, out soon.
Click to expand...

COmpletely agree.

Our large community cancer network has literally had to hire additional staff just to keep up with many of the accreditations (ACS/CoC, ABR, APEX,MIPS/MACRA, etc). I have seen possible zero impact on actual patient care, but so many "quality metrics" to keep up with and adding additional line items in your budget just for excel spread sheet wizards to help keep up with it. This is additional staff that doesn't interact with patients, doesn't help with nursing shortages or therapy shortages/care, etc.

...and what happens to the price of this accreditation once you mandate it? It certainly doesn't drop.
 
You guys may have missed the memo. Everyone agrees with ROCR. It’s a done deal. All parties involved spoke clearly and loudly. It is a done deal. That’s what I hear on social media at least.
 
NotMattSpraker said:
The danger here is that just a few people are driving this, and we dont know who or why! The language is very unclear and confusing and there are clear potential significant COIs.

I would guess I have zero influence and its hard to tell how this will directly impact me even in the short term. I think we still have to care. This is a massive change in policy for our field.
Click to expand...

Also this.

It can be very hard (?impossible?) to account for every last variable in a big policy change like this. It's a big leap of faith that those in charge of drafting it have pure motives and are the best to do so.

The one heuristic that I would love to see is anyone with their fingerprints on this policy has to be affiliated with an institution that will atually be impacted by the policy....*must have skin in the game.* I want nothing to do with some PPS exempt doc having say over this.


1704908104286.png
 
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BobbyHeenan said:
Also this.

It can be very hard (?impossible?) to account for every last variable in a big policy change like this. It's a big leap of faith that those in charge of drafting it have pure motives and are the best to do so.

The one heuristic that I would love to see is anyone with their fingerprints on this policy has to be affiliated with an institution that will atually be impacted by the policy....*must have skin in the game.* I want nothing to do with some PPS exempt doc having say over this.


View attachment 380807
Click to expand...
or doc from proton center who would gain a competitive advantage
 
So, a friend of mine had a patient that had early stage lung CA and it was on top of PBT, so he didn't want to do 1-5 fx. He recommended 70/10 per MDACC. Evicore denies it without P2P and tells him to do ... 3D.

He blasted them on SoMe, they called him, want to do root cause analysis, etc.

But, hypothetical question -

If the doc said, "fine, I guess I'll do 3D" and the patient got a horrendous toxicity, who would actually be at fault?

You damn straight shouldn't be doing 3D to that dose for ablation, but the payor said to do it and they said it based on "medical necessity", that IMRT/SBRTlite was not approvable. And, many institutions feel that if he had treated with IMRT when approved for 3D, that would be fraud and they would not allow it.

From MD perspective (not PA perspective), this seems very dangerous. If they want to practice medicine remotely without touching the patient there should be some liability transfer away from doctor.

I would hope that when this happens, if the PA company denies something that is NCCN/ASTRO SOC, all liability should go on to the 3rd party or payor and potentially some to the hospital for not allowing physician to treat with IMRT (despite what auth said).
 
RealSimulD said:
So, a friend of mine had a patient that had early stage lung CA and it was on top of PBT, so he didn't want to do 1-5 fx. He recommended 70/10 per MDACC. Evicore denies it without P2P and tells him to do ... 3D.

He blasted them on SoMe, they called him, want to do root cause analysis, etc.

But, hypothetical question -

If the doc said, "fine, I guess I'll do 3D" and the patient got a horrendous toxicity, who would actually be at fault?

You damn straight shouldn't be doing 3D to that dose for ablation, but the payor said to do it and they said it based on "medical necessity", that IMRT/SBRTlite was not approvable. And, many institutions feel that if he had treated with IMRT when approved for 3D, that would be fraud and they would not allow it.

From MD perspective (not PA perspective), this seems very dangerous. If they want to practice medicine remotely without touching the patient there should be some liability transfer away from doctor.

I would hope that when this happens, if the PA company denies something that is NCCN/ASTRO SOC, all liability should go on to the 3rd party or payor and potentially some to the hospital for not allowing physician to treat with IMRT (despite what auth said).
Click to expand...

A root cause analysis of what?

all liability should go on to the 3rd party or payor and potentially some to the hospital for not allowing physician to treat with IMRT (despite what auth said).
Click to expand...

Im sooooo interested in this but afraid to talk online because that U-word makes people unhinged haha
 
RealSimulD said:
f the doc said, "fine, I guess I'll do 3D" and the patient got a horrendous toxicity, who would actually be at fault?
Click to expand...
Isn't dynamic conformal arc a form of 3D?

It's just a payment game at this point. I've never had Evicore deny after a P2P for something like this. Run the DCA plan and the IMRT plan. If it's at PBT there will be adjacent OARS to demonstrate superiority fairly quickly.
 
communitydoc13 said:
Isn't dynamic conformal arc a form of 3D?

It's just a payment game at this point. I've never had Evicore deny after a P2P for something like this. Run the DCA plan and the IMRT plan. If it's at PBT there will be adjacent OARS to demonstrate superiority fairly quickly.
Click to expand...
They denied without P2P!
 
10 fx imrt costs less than 5 sbrt. I've dealt with this several times. Never had it denied in the end but maybe they should have a chart on the wall that confirms they're saving money.
 
RealSimulD said:
So, a friend of mine had a patient that had early stage lung CA and it was on top of PBT, so he didn't want to do 1-5 fx. He recommended 70/10 per MDACC. Evicore denies it without P2P and tells him to do ... 3D.

He blasted them on SoMe, they called him, want to do root cause analysis, etc.

But, hypothetical question -

If the doc said, "fine, I guess I'll do 3D" and the patient got a horrendous toxicity, who would actually be at fault?

You damn straight shouldn't be doing 3D to that dose for ablation, but the payor said to do it and they said it based on "medical necessity", that IMRT/SBRTlite was not approvable. And, many institutions feel that if he had treated with IMRT when approved for 3D, that would be fraud and they would not allow it.

From MD perspective (not PA perspective), this seems very dangerous. If they want to practice medicine remotely without touching the patient there should be some liability transfer away from doctor.

I would hope that when this happens, if the PA company denies something that is NCCN/ASTRO SOC, all liability should go on to the 3rd party or payor and potentially some to the hospital for not allowing physician to treat with IMRT (despite what auth said).
Click to expand...

There is nothing more frustrating than having to deliver a 3DCRT plan because insurance refuses IMRT and watch the patient have noticeably worse acute toxicity. Anything in the pelvis non-palliative needs IMRT IMO. 4 and 3 field plans for GYN and GI stuff? Get out of here.

It's like purposely driving around in a 30 year old Toyota with a blown head gasket, the heat stuck on HI, and mismatched tires vs. buying a new Tesla with gas at $5/gal. Sure, it gets you there. If that's all you care about I guess.
 
MidwestRadOnc said:
There is nothing more frustrating than having to deliver a 3DCRT plan because insurance refuses IMRT and watch the patient have noticeably worse acute toxicity. Anything in the pelvis non-palliative needs IMRT IMO. 4 and 3 field plans for GYN and GI stuff? Get out of here.

It's like purposely driving around in a 30 year old Toyota with a blown head gasket, the heat stuck on HI, and mismatched tires vs. buying a new Tesla with gas at $5/gal. Sure, it gets you there. If that's all you care about I guess.
Click to expand...
At least two current Evicore reviewers have been trying to work where I do. No one that has ever worked there, Evolent or HealthHelp will get my seal of approval. I don't know that it will be my decision, but if I have any say in the matter, they will will be blocked. And they can do the same to me if they want, but I'd never work at any other PA company.
 
RealSimulD said:
At least two current Evicore reviewers have been trying to work where I do. No one that has ever worked there, Evolent or HealthHelp will get my seal of approval. I don't know that it will be my decision, but if I have any say in the matter, they will will be blocked. And they can do the same to me if they want, but I'd never work at any other PA company.
Click to expand...
Why? Aren’t they just following Evercores policies?
 
MidwestRadOnc said:
There is nothing more frustrating than having to deliver a 3DCRT plan because insurance refuses IMRT and watch the patient have noticeably worse acute toxicity. Anything in the pelvis non-palliative needs IMRT IMO. 4 and 3 field plans for GYN and GI stuff? Get out of here.

It's like purposely driving around in a 30 year old Toyota with a blown head gasket, the heat stuck on HI, and mismatched tires vs. buying a new Tesla with gas at $5/gal. Sure, it gets you there. If that's all you care about I guess.
Click to expand...
I guess if there’s anything I’d like people to understand is that the insurance company cannot dictate what you do just because they have paid for a thing. That is to say, you can deliver IMRT for 3D payments. It is not fraud. It is not illegal. The insurance companies do not care. “Having to deliver 3DCRT” is what Gary Busey calls F.E.A.R.: false evidence appearing real.

I want us to get paid. But you will never get paid zero bucks per fraction for delivering IMRT. In the case of 3D, most times it’s about $100 less per fraction (Medicare rates) when doing IMRT but billing a standard fraction. And you get sims, complex device per beam, and IGRT technical, etc., with non-IMRT that you don’t with IMRT. The remunerative outrage can wind up being slightly overwrought and a waste of good energy.
 
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TheWallnerus said:
I guess if there’s anything I’d like people to understand is that the insurance company cannot dictate what you do just because they have paid for a thing. That is to say, you can deliver IMRT for 3D payments. It is not fraud. It is not illegal. The insurance companies do not care. “Having to deliver 3DCRT” is what Gary Busey calls F.E.A.R.: false evidence appearing real.

I want us to get paid. But you will never get paid zero bucks per fraction for delivering IMRT. In the case of 3D, most times it’s about $100 less per fraction (Medicare rates) when doing IMRT but billing a standard fraction. And you get sims, complex device per beam, and IGRT technical, etc., with non-IMRT that you don’t with IMRT. The remunerative outrage can wind up being slightly overwrought and a waste of good energy.
Click to expand...
I have been repeatedly told that it is medicare fraud to bill for 3DCRT planning but deliver IMRT or SBRT. I am not a lawyer, but it would be helpful to be convinced otherwise.
 
One lawyer’s take:

racmonitor.medlearn.com

Are all billing errors created equal? – MedLearn Publishing

Does underbilling equate to overbilling? Not exactly. A Monitor Monday listener recently asked, “is it true that underbilling is just as bad as overbilling? Can you be accused of fraud when you make a mistake that saves the government money?” This question comes up somewhat frequently, in part...
racmonitor.medlearn.com racmonitor.medlearn.com
 
RealSimulD said:
One lawyer’s take:

racmonitor.medlearn.com

Are all billing errors created equal? – MedLearn Publishing

Does underbilling equate to overbilling? Not exactly. A Monitor Monday listener recently asked, “is it true that underbilling is just as bad as overbilling? Can you be accused of fraud when you make a mistake that saves the government money?” This question comes up somewhat frequently, in part...
racmonitor.medlearn.com racmonitor.medlearn.com
Click to expand...

Great article

"This question comes up somewhat frequently, in part because people love to promote panic. I don’t know if such fear-mongering is an attempt to sell services by saying “you need to hire us so that you code perfectly,” or perhaps whether it’s driven by a desire to generate an exciting topic of conversation – but either way, it is wrong."

Bruh this feels so personal lol
 
drowsy12 said:
it’s just the reality we live in. The proton lobby killed RO APM the first time. They own ASTRO
Click to expand...
If you have the money to buy a 50-250 million dollar proton center, you have the money to bully or capture a $24 million dollar a year professional society. Probably told ASTRO to focus on DEI and forget about protons.
 
drowsy12 said:
it’s just the reality we live in. The proton lobby killed RO APM the first time. They own ASTRO
Click to expand...
I would say it's "worse", in that the proton lobby doesn't care about ASTRO. They don't need to, unless ASTRO does something stupid.

It's why protons aren't in ROCR. It's not because ASTRO tried and protons fought it.

ASTRO didn't even try. They just knew.
 
TheWallnerus said:
I guess if there’s anything I’d like people to understand is that the insurance company cannot dictate what you do just because they have paid for a thing. That is to say, you can deliver IMRT for 3D payments. It is not fraud. It is not illegal. The insurance companies do not care. “Having to deliver 3DCRT” is what Gary Busey calls F.E.A.R.: false evidence appearing real.

I want us to get paid. But you will never get paid zero bucks per fraction for delivering IMRT. In the case of 3D, most times it’s about $100 less per fraction (Medicare rates) when doing IMRT but billing a standard fraction. And you get sims, complex device per beam, and IGRT technical, etc., with non-IMRT that you don’t with IMRT. The remunerative outrage can wind up being slightly overwrought and a waste of good energy.
Click to expand...
I get it and you’re not wrong.

But at some point that’s just rewarding their strategy of refusing to pay you for the work you’re doing and preying off your altruism. It’s a slippery slope.

If it’s really not that much different $ then just pay it.

The other issue is that often the docs don’t have a say here. Billers won’t let you bill it as 3D in spite of what you’re saying. We’ve seen time and time on here how middle managers and billers have more sway than the actual docs.
 
The proton lobby wrote the Astro proton guidelines. They are very well acquainted.

The mafia analogy earlier was germane.
 
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