RO APM Dies!

[thecarbonionangle]

Really sick. Residency expansion, Instructorships, and now proton exemption. That’s why I asked about what POS would deliver ASTROs “masterclass in leadership.”

“Land in a swamp, march through the woods, and in some inland post feel the savagery, the utter savagery, had closed round him,--all that mysterious life of the wilderness that stirs in the forest, in the jungles, in the hearts of wild men. There's no initiation either into such mysteries. He has to live in the midst of the incomprehensible, which is also detestable. And it has a fascination, too, that goes to work upon him. The fascination of the abomination--you know. Imagine the growing regrets, the longing to escape, the powerless disgust, the surrender, the hate."

The heart of darkness

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[thecarbonionangle]

Protons exempt. Essentially. Hate to say I told you so. Nah... I told you so.

Brachy was not carved out? I thought this was guaranteed?

 

[communitydoc13]

If this is a real proton exemption, the absolute worst. The lowest value intervention exempted? For innovation?

What this is is radonc leadership colluding with CMS to not provide value based care but rather to consolidate the field further (and thus provide less value based care).

Their goal will be to establish (likely through shady AF analysis of less than stellar clinical trial results) that their large capital investment over the past 10-20 years represents "new radonc", "a paradigm change" and message that essentially all non-proton therapy is essentially antiquated and less than optimal. Despite the fact that we all know that if you replaced every linac with a state of the art proton machine today, this would not move the needle of cancer mortality one bit. (Screening, public health initiatives, cheap health insurance, timely community care and new systemic agents do that).

Just today in my clinic, an affluent 80+ year old woman with newly diagnosed, high volume metastatic cancer and dwindling performance status (a hospice candidate) asked about proton therapy with hope in her voice.

There cannot possibly be a convincing moral argument for the proton exemption. I am waiting to hear one.

 

[Mandelin Rain]

What this is is radonc leadership colluding with CMS to not provide value based care but rather to consolidate the field further (and thus provide less value based care).

Bingo.

This is messed up as hell.

 

[TheWallnerus]

LOOK FOR A HUGE UPTICK IN RANDOMIZED TRIALS IN PROTON THERAPY
(See below)

As discussed in the proposed rule, we considered excluding PBT from the included modalities in instances where an RO beneficiary is participating in a federally-funded, multi-institution, randomized control clinical trial for PBT so that further clinical evidence assessing its health benefit comparable to other modalities can be gathered. We also solicited public comment on whether or not the RO Model should include RO beneficiaries participating in federally-funded, multi-institution, randomized control clinical trials for PBT. The following is a summary of the public comments received on these proposals and our responses:

....

A couple of commenters suggested that CMS decline to expand this exemption to include registry trials. A commenter emphasized that in sites such as breast, head and neck, esophagus, and prostate cancer, a registry trial adds only a single arm or retrospective data that does little to compare proton to photon therapy in these sites. Another commenter believed that an exemption for registry trials would lead every patient at every proton center to be put on a registry trial, adding only to an existing body of literature on single arm series of proton therapy. This commenter did not believe registry trials add sufficient evidence to change the standard of care.

One commenter emphasized that proton therapy for primary treatment of prostate cancer should be performed within the context of a prospective clinical trial or registry.

A few commenters recommended that CMS exempt all care—not just PBT—provided under a clinical trial protocol from the Model. A commenter specifically recommended that CMS exclude patients enrolled in clinical trials in which the focus is radiation oncology treatment or technology, emphasizing that the costs of these cases are unique and may influence adjustment factors or future Model data.

Response: We appreciate these comments and suggestions. We agree with commenters that the use of registry trials is insufficient, as the single-arm design of registry trials makes them unlikely to result in published studies evaluating the comparative effectiveness of PBT to other RT modalities. We agree that these registry trials are unlikely to generate the type of evidence needed to change the standard of care. We also note that data collected through registry trials is often not analyzed or published. We believe that the inclusion of federally-funded, multi-institution, randomized control clinical trial for PBT is important to include so that further clinical evidence assessing its health benefit comparable to other modalities can be gathered. There are established procedures that exist in the Medicare claims systems for identifying and paying for services furnished during participation in clinical trials. A recent study concluded that prospective trials are warranted to validate studies related to the use of proton and photon beam therapies.

 

[BobbyHeenan]

I think that is fair if enrolled in randomized trials. I was one of the I’m sure many that sounded alarm bells on registry “trials” in the CMS comment submission period.

Perfectly appropriate IMO for a randomized carve out.

 

[SubserviantToABR]

I think that is fair if enrolled in randomized trials. I was one of the I’m sure many that sounded alarm bells on registry “trials” in the CMS comment submission period.

Perfectly appropriate IMO for a randomized carve out.

The proton people had decades to study it with literally no high quality studies came off of it. They were driven by their greed and bilked the system out of a crapton of money with nothing scientific to come out of it. These proton people are building or expanding their centers left and right, and patients and everyone else without a proton center will suffer for their sins.

And remember, Nancy Lee said that even if the trials prove that there is no benefits to protons, they will continue to use it. Let the proton facilities die.

 

[communitydoc13]

Maybe I'm wrong, but if protons were compensated at the same rate as photons under APM even for clinical trials, wouldn't this function to facilitate meaningful clinical trials without some of the weird randomize after insurance approval schemes? These schemes themselves introduce a certain level of bias and are a function of insurances feeling that protons are cost prohibitive. (I guarantee that cash patients will on average do better when age adjusted).

I mean if CMS wanted to get real gangster, they could APM all proton therapy independent of zip code with a direct financial incentive for any patient under clinical trial. Just pay everyone for clinical trial enrollment, including community places. Make it substantial. This is a way to drive value based care.

 

[elementaryschooleconomics]

LOOK FOR A HUGE UPTICK IN RANDOMIZED TRIALS IN PROTON THERAPY
(See below)

As discussed in the proposed rule, we considered excluding PBT from the included modalities in instances where an RO beneficiary is participating in a federally-funded, multi-institution, randomized control clinical trial for PBT so that further clinical evidence assessing its health benefit comparable to other modalities can be gathered. We also solicited public comment on whether or not the RO Model should include RO beneficiaries participating in federally-funded, multi-institution, randomized control clinical trials for PBT. The following is a summary of the public comments received on these proposals and our responses:

....

A couple of commenters suggested that CMS decline to expand this exemption to include registry trials. A commenter emphasized that in sites such as breast, head and neck, esophagus, and prostate cancer, a registry trial adds only a single arm or retrospective data that does little to compare proton to photon therapy in these sites. Another commenter believed that an exemption for registry trials would lead every patient at every proton center to be put on a registry trial, adding only to an existing body of literature on single arm series of proton therapy. This commenter did not believe registry trials add sufficient evidence to change the standard of care.

One commenter emphasized that proton therapy for primary treatment of prostate cancer should be performed within the context of a prospective clinical trial or registry.

A few commenters recommended that CMS exempt all care—not just PBT—provided under a clinical trial protocol from the Model. A commenter specifically recommended that CMS exclude patients enrolled in clinical trials in which the focus is radiation oncology treatment or technology, emphasizing that the costs of these cases are unique and may influence adjustment factors or future Model data.

Response: We appreciate these comments and suggestions. We agree with commenters that the use of registry trials is insufficient, as the single-arm design of registry trials makes them unlikely to result in published studies evaluating the comparative effectiveness of PBT to other RT modalities. We agree that these registry trials are unlikely to generate the type of evidence needed to change the standard of care. We also note that data collected through registry trials is often not analyzed or published. We believe that the inclusion of federally-funded, multi-institution, randomized control clinical trial for PBT is important to include so that further clinical evidence assessing its health benefit comparable to other modalities can be gathered. There are established procedures that exist in the Medicare claims systems for identifying and paying for services furnished during participation in clinical trials. A recent study concluded that prospective trials are warranted to validate studies related to the use of proton and photon beam therapies.

I haven't read the primary document in depth, but to me, CMS is not outright saying that registry trials WILL NOT be allowed, only that registry trials ALONE are not sufficient.

Unless there's language that explicitly excludes registry trials...?

 

[Lamount]

If protons were compensated at the same rate as photons, many of these proton centers wouldn't have been built...

As it stands right now, I would imagine that there are a few large-volume centers who would be in significant financial trouble if protons were APM'ed completely. While many may think these centers deserve this, I am sure CMS understands the ramifications that this could have on large health systems.

Personally, I think an RCT exemption is reasonable. At least we will get data that can help carve out the true indications for PBT

 

[communitydoc13]

I am sure CMS understands the ramifications that this could have on large health systems

The large health systems are the problem. I suspect they are the biggest barriers to value based care.

In my small community clinic where almost everyone is Medicare, we were able to make money through covid (not due to federal largesse) just keeping the doors open. Our model is basic and stripped down (not perfect and there is plenty of administrative waste). We are not dependent on making money from favorable negotiated rates with large insurance companies or treating high wealth individuals from out of town.

 

[Mandelin Rain]

The large health systems are the problem. I suspect they are the biggest barriers to value based care.

In my small community clinic where almost everyone is Medicare, we were able to make money through covid (not due to federal largesse) just keeping the doors open. Our model is basic and stripped down (not perfect and there is plenty of administrative waste). We are not dependent on making money from favorable negotiated rates with large insurance companies or treating high wealth individuals from out of town.

Exactly. The large players ARE the problem with health care in America. Return the power to the docs and see what happens.

 

[RickyScott]

If protons were compensated at the same rate as photons, many of these proton centers wouldn't have been built...

As it stands right now, I would imagine that there are a few large-volume centers who would be in significant financial trouble if protons were APM'ed completely. While many may think these centers deserve this, I am sure CMS understands the ramifications that this could have on large health systems.

Personally, I think an RCT exemption is reasonable. At least we will get data that can help carve out the true indications for PBT

As it stands now, a lot of residents will be in significant financial trouble due to lack of employment because of apm, and same large health systems doubling residency spots. Neither cms or the health care systems care.

 

[fiji128]

How many proton centers are in a APM zip code? Off the top of my mind, the only one that comes to mind is UPenn.

 

[medgator]

How many proton centers are in a APM zip code? Off the top of my mind, the only one that comes to mind is UPenn.

Jax i think

 

[Radonc90]

Well,

The surgeons are in the same boat with APM.
At least they have been used to "1 fraction" (i.e. do the surgery correctly and do it only once) for > 100 yrs.
At this stage, any number of fraction(s) that is > 1 is good for us.
Glad Dr Rabinovitch argues v. 5 fractions at ASTRO21.

According to the man from Northwell, radonc jobs are everywhere, Chirstmas is coming everyday in radonc...

---

 

[GI_RadOnc]

Jax i think

Beaumont.

 

[TheWallnerus]

CMS just emailed me. Still wants to let everyone know The APM Can Suck It Party is still cancelled.

 

[elementaryschooleconomics]

CMS just emailed me. Still wants to let everyone know The APM Can Suck It Party is still cancelled.

Man, I had a meeting with our admins today about preparing for APM and I have rarely seen such histrionics outside of life and death situations.

I think the final ruling releases tomorrow? Or maybe ASTRO's summary?

 

[Radonc90]

Some old timer (about 85 yo in his retirement) told me something I cannot confirm...

- Many many many yrs ago, maybe in the 1960s, 1970s or something like that, radonc payment was lump sump.

- Then the radoncs "got greedy" and itemized everything. Bogardus (Oklahoma man) might have something to do with it.
Which was good for us financially speaking.

- Now, it looks like it is full circle back to lump sump.

Can anyone confirm this?

 

[elementaryschooleconomics]

Some old timer (about 85 yo in his retirement) told me something I cannot confirm...

- Many many many yrs ago, maybe in the 1960s, 1970s or something like that, radonc payment was lump sump.

- Then the radoncs "got greedy" and itemized everything. Bogardus (Oklahoma man) might have something to do with it.
Which was good for us financially speaking.

- Now, it looks like it is full circle back to lump sump.

Can anyone confirm this?

I'll have to do further research, but this absolutely sounds true because that's the pattern of American medicine. It wasn't just RadOnc - my understanding was the lump sum was the way most medical services were charged, because we're talking about the days before a lot of commercial Healthcare insurance products and obviously long before CMS.

Since America is a business, not a country, everyone is continually trying to find ways to make money off everything. My "counter argument" to that guy would be that all of Healthcare started to do that around that time. As far as I know, the late 70s (after the dollar got removed from the gold standard) and especially the 80s was really the most lucrative era of Medicine (for doctors at least), before Wall Street et al realized they could dip their hands in this and created our current system, where everyone wants a slice of the pie.

 

[Sheldor]

Man, I had a meeting with our admins today about preparing for APM and I have rarely seen such histrionics outside of life and death situations.

I think the final ruling releases tomorrow? Or maybe ASTRO's summary?

You heard that final CMS ruling was today? On the 2022 or APM?

 

[elementaryschooleconomics]

You heard that final CMS ruling was today? On the 2022 or APM?

The rumor I heard was APM final ruling today, but that wasn't a guarantee (and maybe they misunderstood my question).

It was in the context of me asking if we knew for sure the elements of the CDE or the Quality Measures crap (as in, can I just tell CMS to look at the entire chart or do we need to create a singular document to address this, which of course, means more work for me and other people).

 

[Sheldor]

The rumor I heard was APM final ruling today, but that wasn't a guarantee (and maybe they misunderstood my question).

It was in the context of me asking if we knew for sure the elements of the CDE or the Quality Measures crap (as in, can I just tell CMS to look at the entire chart or do we need to create a singular document to address this, which of course, means more work for me and other people).

CMS Proposes to Extend Telehealth Flexibilities Through 2023

The Centers for Medicare & Medicaid Services (CMS) proposed in the 2022 Physician Fee Schedule to extend telehealth flexibilities through 2023 instead of through the end of the COVID-19 public health emergency, which is expected to run through th

www.policymed.com

Found this that said it was expected by 11/1, so I guess could be Monday. Though, even that isn't a done deal since congress could step in between now and then.

 

[medgator]

CMS Proposes to Extend Telehealth Flexibilities Through 2023

The Centers for Medicare & Medicaid Services (CMS) proposed in the 2022 Physician Fee Schedule to extend telehealth flexibilities through 2023 instead of through the end of the COVID-19 public health emergency, which is expected to run through th

www.policymed.com

Found this that said it was expected by 11/1, so I guess could be Monday. Though, even that isn't a done deal since congress could step in between now and then.

Well look at that, all that Astro hand wringing really changed a lot of minds at CMS (again). Should be good for at least a few more residency slots /s

 

[elementaryschooleconomics]

I was looking at the slides from the CMS webinar from a few weeks ago, and had forgotten about the "Clinical Consultant" they had from MD Anderson, Aileen Chen.

Here are the slides.

In searching through Dr Chen's publications, she has published several papers in the financial space, most recently this:

Variation in Use of High-Cost Technologies for Palliative Radiation Therapy by Radiation Oncologists

From the Discussion:

"Physician variation may also be a consequence of variability in local healthcare markets and physician compensation models. For example, prior studies have shown differences in the use of IMRT among patients treated in freestanding versus hospital-based radiation facilities, those treated at self-referring versus non–self-referring practices, and those treated in regions with favorable versus unfavorable IMRT reimbursement policies, suggesting that financial factors may play a role. In our analysis, we likewise observed a greater use of IMRT and extended fractionation at freestanding versus hospital-based facilities. On the other hand, the use of stereotactic RT was more common at hospital-based facilities, likely because of a greater need for specialized personnel and physician involvement."

While it's never explicitly said, the paper (in my interpretation, at least) clearly implies the traditional academic mantra that those outside the Ivory Tower practice questionable medicine for financial gain. Let's look at the other authors on this paper:

MD Anderson and DFCI...two PPS-exempt centers. How about, instead of making these comparisons between freestanding and hospital-outpatient, they compare PPS-exempt vs everyone else? And not just fractionation and technology, but cost to the patient. Why don't we see how much an episode of care for a palliative 5 fraction case (consult, sim, planning, delivery, etc) costs at Anderson vs a freestanding center? Maybe I'm wrong, and Anderson is the cheaper option - that's something I'd really like to know.

And why do we have a faculty member who has only ever worked at PPS-exempt centers advising the government on a model which she will not participate in? Shouldn't it be someone with skin in the game, or, at least someone not at a PPS-exempt institution? Maybe CMS should have at least two consultants (one PPS-exempt, one who is in an APM zip code)?

All a dream, I guess.

 

[medgator]

I was looking at the slides from the CMS webinar from a few weeks ago, and had forgotten about the "Clinical Consultant" they had from MD Anderson, Aileen Chen.

Here are the slides.

In searching through Dr Chen's publications, she has published several papers in the financial space, most recently this:

Variation in Use of High-Cost Technologies for Palliative Radiation Therapy by Radiation Oncologists

From the Discussion:

"Physician variation may also be a consequence of variability in local healthcare markets and physician compensation models. For example, prior studies have shown differences in the use of IMRT among patients treated in freestanding versus hospital-based radiation facilities, those treated at self-referring versus non–self-referring practices, and those treated in regions with favorable versus unfavorable IMRT reimbursement policies, suggesting that financial factors may play a role. In our analysis, we likewise observed a greater use of IMRT and extended fractionation at freestanding versus hospital-based facilities. On the other hand, the use of stereotactic RT was more common at hospital-based facilities, likely because of a greater need for specialized personnel and physician involvement."

While it's never explicitly said, the paper (in my interpretation, at least) clearly implies the traditional academic mantra that those outside the Ivory Tower practice questionable medicine for financial gain. Let's look at the other authors on this paper:

View attachment 345117

MD Anderson and DFCI...two PPS-exempt centers. How about, instead of making these comparisons between freestanding and hospital-outpatient, they compare PPS-exempt vs everyone else? And not just fractionation and technology, but cost to the patient. Why don't we see how much an episode of care for a palliative 5 fraction case (consult, sim, planning, delivery, etc) costs at Anderson vs a freestanding center? Maybe I'm wrong, and Anderson is the cheaper option - that's something I'd really like to know.

And why do we have a faculty member who has only ever worked at PPS-exempt centers advising the government on a model which she will not participate in? Shouldn't it be someone with skin in the game, or, at least someone not at a PPS-exempt institution? Maybe CMS should have at least two consultants (one PPS-exempt, one who is in an APM zip code)?

All a dream, I guess.

The fraction shamers always ignore prices. Biggest elephant in the room by far

 

[RickyScott]

I was looking at the slides from the CMS webinar from a few weeks ago, and had forgotten about the "Clinical Consultant" they had from MD Anderson, Aileen Chen.

Here are the slides.

In searching through Dr Chen's publications, she has published several papers in the financial space, most recently this:

Variation in Use of High-Cost Technologies for Palliative Radiation Therapy by Radiation Oncologists

From the Discussion:

"Physician variation may also be a consequence of variability in local healthcare markets and physician compensation models. For example, prior studies have shown differences in the use of IMRT among patients treated in freestanding versus hospital-based radiation facilities, those treated at self-referring versus non–self-referring practices, and those treated in regions with favorable versus unfavorable IMRT reimbursement policies, suggesting that financial factors may play a role. In our analysis, we likewise observed a greater use of IMRT and extended fractionation at freestanding versus hospital-based facilities. On the other hand, the use of stereotactic RT was more common at hospital-based facilities, likely because of a greater need for specialized personnel and physician involvement."

While it's never explicitly said, the paper (in my interpretation, at least) clearly implies the traditional academic mantra that those outside the Ivory Tower practice questionable medicine for financial gain. Let's look at the other authors on this paper:

View attachment 345117

MD Anderson and DFCI...two PPS-exempt centers. How about, instead of making these comparisons between freestanding and hospital-outpatient, they compare PPS-exempt vs everyone else? And not just fractionation and technology, but cost to the patient. Why don't we see how much an episode of care for a palliative 5 fraction case (consult, sim, planning, delivery, etc) costs at Anderson vs a freestanding center? Maybe I'm wrong, and Anderson is the cheaper option - that's something I'd really like to know.

And why do we have a faculty member who has only ever worked at PPS-exempt centers advising the government on a model which she will not participate in? Shouldn't it be someone with skin in the game, or, at least someone not at a PPS-exempt institution? Maybe CMS should have at least two consultants (one PPS-exempt, one who is in an APM zip code)?

All a dream, I guess.

Sickening. Aileen Chen and co dishe out the highest cost radiation services in the world, which allows her and buddy, Ben Smith to earn 500K+ while doing little clinical work.

 

[elementaryschooleconomics]

Well, since they work in Texas...

At least $600k
and almost $1 million.

I am absolutely NOT saying those two, or anyone else, don't deserve to make that much (or more) for the work that they do.

I am saying, however, that it's awfully hard to imagine how MD Anderson can afford to pay their faculty that much unless they have negotiated reimbursement rates far beyond the average rates the rest of us work for.

Again, if anyone wants to prove me wrong, I will immediately change my opinion.

 

[communitydoc13]

While it's never explicitly said, the paper (in my interpretation, at least) clearly implies the traditional academic mantra that those outside the Ivory Tower practice questionable medicine for financial gain.

What are the questions that we trust our academic elites to solve?

Developing new therapeutics? Sure. Damn straight actually. Takes decades of training and collective expertise to make things happen in this space.

Developing scientific consensus about the physical universe? Like global warming or vaccine efficacy or the standard model? Sure, who else is going to do this. This is the purview of the elites.

Developing solutions to disparities in health care and health economic policy? Hell no. Especially when they can't seem to address their own role as beneficiaries of the present system.

The solution to healthcare disparities is to give away health care. This is simple and is what other countries do. This is why we we rank poorly on global health indices. There is still probably no better place to have cancer if you have money than the US. It is a bad place for health (compared to other rich countries) if you are poor. We don't really need more studies on this IMO.

At present, the solution to radiation deserts is me. It is the person who did not qualify for academia or prestigious urban practices but was willing to move away because there were some benefits. I provide relative cost effectiveness because my time is not spent doing research or participating in collaborative group leadership. The benefits are good pay, local prominence without being elite and autonomy. These are the same reasons why there are any specialists at all spread out through Red America. These are the some of the reasons that people are fairly conservative when you get away from large urban centers.

I had a health care consultant (and former CEO) ask me if I thought a community hospital had any place in the emerging health care environment? My reply was "why not"? We are a non-profit. We have community support. We still have bloated administrative costs that we can cut. I don't see why we couldn't exist under a single payor model. As a matter of fact, a single payor model might be better, because the major threat to our existence is larger health care systems. These systems cost everybody more. They charge more and expand and steal local market share from local places. When they purchase community hospitals, they think in terms of large system finances and strip services from the smaller facilities. They make it harder to get radiation locally (or more importantly, an appendectomy). In the community where I am, we are unlikely to make up the loss of uninsured care on high negotiated rates with private insurance. If everyone can pay, we do better. (ACA actually helped).

So IMO, academic radonc should stay small, elite, focused on therapeutics and be in facilities where the charge is the same as everywhere else. Instead, it has become the most corporate aspect of our field and the biggest beneficiary of regulatory capture. The Feds should have left the academic elite off the boat when they were making policy.

APM should have been universally applied if at all.

 

[Radonc90]

So,

I contacted my old-timer in his 80s, he directed me to this article written by C. Bogardus Jr. (from Oklahoma and is now RIP).

https://www.arrs.org/publications/HRS/oncology/RCI_O_c08.pdf

Back in the days 1950s and 1960s, radonc was basically "therapeutic radiologist", and was basically hospital employee.
The most important paragraph is on page 208 by Bogardus. See the screenshot...

PS: Diff topic, but some young graduates just want to be an employee of hosp bc they don't want to do billing, paying for malpractice insurance etc. etc. But there is some beauty in indepedent practice bc you are not at the mercy of the dumb MBA hosp admins (bunch of crooks)...

----

 

[Gfunk6]

Latest and greatest regarding RO APM from a news blast of an RO advocacy group:

. . . the Protecting Medicare and American Farmers from Sequester Cuts Act delayed the start date of the ROAPM by one year. ASTRO has indicated that CMS is contemplating scrapping the model given the number of delays it has encountered. ASTRO is attempting to achieve changes to the model via legislation that hope will be added to the budget package (Continuing Resolution, Omnibus, or Cromnibus) that will need to be passed in February. ASTRO is currently circulating legislative text that contains the following requests:

1. Reduction in Discount Factor - 3% for both TC (4.5%) and PC (3.5%)

2. Freeze number of model participants

3. Advanced APM bonus eligibility

4. Freeze MPFS FFS payments

If ASTRO can achieve these changes via legislation, it has signaled a willingness to start the model in July of this year. Please note that it is entirely possible that ASTRO will be successful in obtaining these changes legislatively only to have CMS cancel the model due to an inability to show cost savings. We continue to monitor this situation closely and will immediately provide updates as they become available.[/quote[

 

[deleted941485]

Latest and greatest regarding RO APM from a news blast of an RO advocacy group:

Will they just can it at this point?

The discount factor is a joke and basically allows them to claim savings by simply paying unfortunate practices less

Will protons be exempted. Im a proton shill now so kinda need that exemption.

 

[Burt Radnolds]

Maybe I'm reading this wrong but I really don't like it. What jumps out to me is that CMS is considering scrapping it but ASTRO wants to make some light handed changes to salvage it? Is that really in the best interest of the field?

 

[thecarbonionangle]

Will they just can it at this point?

The discount factor is a joke and basically allows them to claim savings by simply paying unfortunate practices less

Will protons be exempted. Im a proton shill now so kinda need that exemption.

People in know will assure you it will be but i can’t tell where their confidence comes from. Proton arrogance or they know something?

 

[OTN]

Maybe I'm reading this wrong but I really don't like it. What jumps out to me is that CMS is considering scrapping it but ASTRO wants to make some light handed changes to salvage it? Is that really in the best interest of the field?

If this is what ASTRO is doing, then it really should be a "storm the gates with pitchforks" kind of moment for us all.

 

[TheWallnerus]

Maybe I'm reading this wrong but I really don't like it. What jumps out to me is that CMS is considering scrapping it but ASTRO wants to make some light handed changes to salvage it? Is that really in the best interest of the field?

NO. Which tells me everything I need to know about ASTRO.

 

[Lamount]

NO. Which tells me everything I need to know about ASTRO.

Full discloser... I have no inside info on this (but hope to get some soon).

I have a feeling that these "small changes" are not quite so small...

I am guessing the cost savings of APM had some pretty tight margins and these changes may tip the scales, making the whole program unprofitable. It may be ASTRO making a seemingly reasonable counteroffer, so that they can appear to be negotiating in good faith... knowing full well that the APM would not save money if it were "reasonable".

...but maybe that is just wishful thinking on my part.

 

[RickyScott]

NO. Which tells me everything I need to know about ASTRO.

 

[Mandelin Rain]

Can ASTRO just pitch.... end PPS exemption, freeze reimbursement at 2022 levels for 5 years, then annual 2% COL increases in reimbursement?

Would be fine with them eliminating low (read: no) value codes like.... protons, as well.

 

[Lamount]

Can ASTRO just pitch.... end PPS exemption, freeze reimbursement at 2022 levels for 5 years, then annual 2% COL increases in reimbursement?

Would be fine with them eliminating low (read: no) value codes like.... protons, as well.

Isn’t PPS-exemption ALL care at NCI cancer hospitals, not just RT?

 

[RickyScott]

Isn’t PPS-exemption ALL care at NCI cancer hospitals, not just RT?

Yes, and not all nci centers. Only 11 are pps exempt.

 

[Mandelin Rain]

Isn’t PPS-exemption ALL care at NCI cancer hospitals, not just RT?

Yes. I'm also okay with these chosen 11 institutions not upcharging infusion and surgical services.

 

[RickyScott]

Yes. I'm also okay with these chosen 11 institutions not upcharging infusion and surgical services.

the worst is that the regulations allow them to charge said rates at satellites within something like 25-50 miles of the main campus! (ie when mskcc brings these rates to brookln)

 

[Mandelin Rain]

the worst is that the regulations allow them to charge these at satellites within something like 25-50 miles of the main campus! (ie when mskcc brings these rates to brookln)

 

[medgator]

Yes. I'm also okay with these chosen 11 institutions not upcharging infusion and surgical services.

Maybe start requiring them to take Medicaid and HMO plans as well?

 

[TheWallnerus]

the worst is that the regulations allow them to charge said rates at satellites within something like 25-50 miles of the main campus! (ie when mskcc brings these rates to brookln)

 

[Lamount]

Yes. I'm also okay with these chosen 11 institutions not upcharging infusion and surgical services.

I am just not so sure that is a fight ASTRO should be starting (or would win)... because the counter-argument from the med oncs and surg oncs at the biggest name cancer hospitals would be something like "Alternatively, why don't we just slash rad onc reimbursement more?"

I think it is safe to assume that they have better lobbyists than we do

 

[TheWallnerus]

I am just not so sure that is a fight ASTRO should be starting (or would win)... because the counter-argument from the med oncs and surg oncs at the biggest name cancer hospitals would be something like "Alternatively, why don't we just slash rad onc reimbursement more?"

I think it is safe to assume that they have better lobbyists than we do

Let’s face it. Someone is going to have to have kompromat on a Senator to get PPS exempt places off the teat, and if they have kompromat they won’t use it for something as boring as that.

 

[thecarbonionangle]

It has been said that the RO APM is suspected dead. A new proposed rule which appeared in office of budget and management might suggest it is a cancellation before it is made public. Need to follow this folks but yuge if true.