Lol. When winning so hard by sheer luck becomes confused with Skill and merit..
Welcome to radiation oncology.
Paul Wallner was coordinating the MD waiting room prior to my oral boards. A physicist examinee was lost and had to be redirected - as he was walking away, Wallner said "I hope he fails."
Definitely the moment that started changing my views on ABR/ASTRO (along with the rest of what is documented in this thread). Imagine what Wallner said behind closed doors with other supposed leaders and still remained in leadership all these years?
Septermber [sic] 1997
Economic Observations
By Paul E. Wallner, D.O., FACR
Several months ago, when Chris Rose decided to "retire" as the economics columnist for this web-site, he raised the issue of continuity with me. Later, he and Peter Blitzer pervailed
[sic] upon me to actually accept. So be it! This represents my first "toe in the water," for this type of venture, so criticism will be much appreciated (constructive, please!). First, I must offer Chris my thanks, for his confidence and mentoring, for doing a fantastic job with the column, and for "telling it like it is" even when his position was unpopular. Chris will make a great president of ASTRO, and will serve his ENTIRE constituency with distinction.
Since I have been hanging around for quite a while, but not be known by many of our colleagues, some introduction may be appropriate. This is all the more important, since any "observer" of the economic landscape brings certain biases and positions to the table. I began radiation oncology practice in 1972, when we were radiation therapists, jobs were plentiful, and we were seeing an explosive growth in training programs. My first practice experience was running a department in the Army (in retrospect, those days look very good now!). Later, I went into full-time academic practice. In 1979, I ventured to New Jersey to join a group at Cooper Hospital/University Medical Center. We are something of hybrid organization, in that Cooper is the core clinical hospital for Robert Wood Johnson Medical School at Camden (the former Rutgers Medical School), with almost 200 full-time salaried faculty, but WE receive NO support from the medical school, and are entirely fee-for-service. We do have a residency program at Cooper. The group manages another community hospital program, and has three free-standing facilities. From a radiation oncology perspective, I suppose that qualifies me as "everyman." My issues and problems are your issues and problems! For several years, I have served on the ASTRO Economics Committee, and have been privileged to serve as the ASTRO representative to the RUC and CPT Committees. This year, I served as President of CARROS. To make a long story shorter, although you may not like what I have to say, or agree with my conclusions, I have seen it all, and "really do feel your pain!"
Once we get past the preliminaries above, I will try to keep the column relatively brief, pointed, and free from an unacceptable amount of sermonizing. I will not be as pithy, lucid, or erudite as Chris, and there will be few, if any, Talmudic/Biblical references.
The most pressing economic issue over the past summer was the effort to redefine the three weekly treatment management codes (77420, 425, 430),as REQUIRED by the RUC. In the absence of our willingness to do this voluntarily, there were rumblings of 20-30% cuts in the work values. A task force representing ACR, ACRO, ASTRO, AFROC, CARROS, and the physicists met/communicated regularly, and came up with a formula by which we could reduce reliance on technical factors to define our work, increase use of E/M terms (that the RUC members wanted), but retained the "uniqueness" of our specialty. This work product was presented to the CPT Editorial Panel on August 8. The Panel generally liked our solutions, but requested that we try to simplify and shorten the material. Also, they raised the issue of consideration of a SINGLE code for weekly management created by weighting our current work. The theory was that since approximately 80% of our charges for weekly management are now complex, why did we need three codes. This is a very seductive concept, since it would significantly reduce some of the burdensome documentation the original plan would have required. The task force is reviewing the proposal carefully before we respond.
A second summer issue was work with the Medicare Carrier Medical Directors to develop new guidelines for charges. To put the issue gracefully, the CMDs are fed up with what they are getting from us. They want it to stop, and were prepared to unilaterally write new payment policy that would have been severely restrictive. After what the diplomats term "frank discussions'" the CMDs agreed to let us try to rewrite the "User's Guide" so that our ability to game the system will be limited. We are working on that document now. BE AWARE that some past billing practices will no longer be acceptable! This may have a dramatic effect on some practices, but the alternative seems to be having non-radiation oncologists do the deed, or perhaps, a few of our colleagues playing golf/tennis, etc in a federal correctional facility!
The last, very complicated and divisive issue I will discuss at this time, is the practice expense initiative. You should all be aware that the relative value system totals are derived from work, practice expense, and professional liability. Work is calculated by the RUC, based on generally known methodology. Liability expense is a "pass-through". Practice expense had been based on historical charges, but Congress mandated that this be changed to "resource-based" methodology, similar to the work units. Various panels have been working for almost two years, but every attempt to reach a solution to the problem of acceptable calculations has been flawed. In typical fashion, HCFA was REQUIRED to begin the new policy 1/1/98 (now delayed to 1/1/99). The calculations them made were based on flawed assumptions and a flawed methodology, producing additive error. The formula would have increased the professional fees of radiation oncologists in the free-standing setting, and significantly reduced the payment to hospital based practitioners. An alternate method of calculation which would retain the relative value parity has been proposed to HCFA by ACR/ASTRO/ACRO/CARROS/ABS. This proposal would essentially protect the majority of our colleagues. Although AFROC has refrained from lending its organizational support to the proposal, and indeed, seems to be building a war chest to fight the compromise, I STRONGLY URGE all involved to think of the long-term consequences of careful investigation of our practices and practice policies. None of us want an IRS-like audit of the entire specialty, or our individual practices. The charge that we are caving in to the diagnostic radiologists is spurious. For the last eight years, they have been sliding, while our revenues as a specialty have been increasing, and they have still been steadfast in their support.
Well, enough for issue #1. I can be reached at FAX 609-365-8504, or e-mail at the address shown below. I have not given my phone number (in a sophmoric
[sic] attempt to discourage angry phone calls), but obviously, I am in the ASTRO Directory (and the phone book!). Feel free to complain, comment, question, or suggest topics for future columns.
email:
[email protected]
everywhere are offended by this comparison!
