If someone is throwing golf balls off of an overpass and one hits your windshield, with whom will you be angry?... the car in front of you that made it through unscathed, or the idiot throwing the golf balls?
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RO APM Dies!
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I’m mad at the golf ball! I was never the sharpest tool in the shed.
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According to Royce's paper from June JCO Oncology Practice, ,CMS would have saved 500 million in 2012 alone had those 11 hospitals been paid like everyone else. 1 year, 11 hospitals. $500 million.
Estimated total savings of APM during the 5-year implementation period? 5-years, impacting half the zip codes in America? $230 million.
Like, umm..... does anyone see the ****ing problem here?
Anyone?
FWIW, my bet is a Freedom of Information Act query on this whole boondoggle could put some folks in real hot water.
Big pharma doesn't
What if the guy throwing the golf balls was being directed by the one who got through unscathed?
You know, medical director from a PPS-exempt academic center and all...
Satellites within 35 miles of main center is my understanding. Pps exempt centers should buy out competition and keep raising prices.
Is this speculation or a specific reference?
Specific reference. RO APM medical director can't be from an included site/zip which is just mind boggling
"The radiation oncology medical director slated to work with CMS as the RO Model is implemented comes from a PPS-exempt academic hospital, which makes me wonder whether this person is qualified to represent the challenges faced by the large number of small practices mandated to participate."
Has no one read Skin in the Game? The person advising about the policy will not be suffering any consequences from said policy?
I didn’t previously appreciate that the Rad Onc advisor on APM is at a PPS exempt place
ok, I’m fuming again.
“Bureaucracy is a construction by which a person is conveniently separated from the consequences of his or her actions.”
I didn’t previously appreciate that the Rad Onc advisor on APM is at a PPS exempt place
ok, I’m fuming again.
“Bureaucracy is a construction by which a person is conveniently separated from the consequences of his or her actions.”
It’s also called a negative externality and it’s disgusting. A true leader would insist that they be included in a negative policy that they created.
… and I thought you were just being cynical. That’s pretty sketchy
It seems like you haven’t thoroughly read the entire editorial; you should.
Willful ignorance among the Exempt'ers, of which (based solely on posting history) I believe Lamount is one.
Other than an editorial and lobbying...are there any other avenues that could be taken?
Class action suit or injunction from a judge?
Does anyone have the monetary reserve or appetite for that?
ASTRO took the - we understand APM/bundling is coming, let us "guide" you through it - approach instead of just fighting it like crazy. So I'm not sure they would tackle some opposition in a more aggressive way....largely I'd imagine due to a big chunk of ASTRO power brokers being not effected by APM anyway.
That is the issue the ASTRO Board doesn't represent the interests of majority of ROs.
The only other “solution” is invest in lube and as others have said work hard to diversify your skill set to prepare for a future where you are not a full time Radiation Oncologist.
Once the proverbial nukes start flying, the time for diplomacy is done. All you can do is hurry to a fallout shelter and start making plans post-apocalypse.
#CancelASTRO #DefundASTRO
Look at the Board and see home many are in an APM Zip. Two of 14. 12 are either Exempt, not in the US or were lucky to avoid APM.
30-40% random sample. No problem for most institutions represented by the Board
| Name | Institution | APM Zip | Protons |
| Eichler | ? Johnston Willis Hospital | Yes | No |
| Dawson | Princess Margaret | No Canada | No |
| Jacobson | West Virginia | No | No |
| DeWeese | Johns Hopkins | No | Yes |
| Smith | MD Anderson | Exempt | Yes |
| Ford | Univ Washington | No | Yes |
| Movsas | Henry Ford | Yes | No |
| Erickson | MCW | No | No |
| Sandler | Cedars | No | No |
| Bajaj | Inova Schar | No | Yes |
| Hartsell | Northwestern | No | Yes |
| Mantz | Genesis Oncology (21C) | No | No |
| Park | UCSF | No | No |
| Marples | Rochester | No | No |
Really only one associated site affected. Eichler essentially retired from clinical work from what I can tell. His job is ASTRO president.
Does it make sense that the president of our society is no longer practicing medicine?
Why do we have a physician from a Chinese-owned company on the ASTRO Board of Directors?
Why is the President of the American Society of Therapeutic Radiation Oncology from Canada? Do we really think she will push as hard against an American anti-radonc payment initiative as someone who actually practices in this country?
The Astro board does not reflect its membership and those that control the organization are obsessed with pedigree. To be involved in Astro at that level you have to have had played the "academic" game really well. Climbing the greasy poll as the say. I made a comment on these boards about a year ago suggesting a research project looking at the boards of various medical professional societies and who sits on them regarding academic vs community/private practice. I'm sure Astro is by far the leader in "academic" over representation. This is probably at the root of why so many practicing rad oncs feel that Astro does not represent their interest.
Disgusting
I believe Houston is in APM, but of course, MDACC is exempt. Will afford them an even greater opportunity to crush competition.
I'm sure all the above is purely coincidental, BTW. After all, these were "random" zip codes.
It's all so gross.
If you're still giving money to ASTRO, you may be your own worst problem.
Slides from Coding & Billing Seminar.
Hope you've not eaten lunch. It almost feels like doing the billing for a single patient will equal the work and effort of preparing your entire year's personal taxes. Will have to hire an extra FTE if you treat a lot of Medicare? Which we all do. IT'S ALL ABOUT COMPLIANCE.
Also looks like brachy exclusion is in the "proposal" but not quite as much as a done deal as liver exclusion. I'm sure it will be, but with these guys and gals I wouldn't rule out any shenanigans.
Hope you've not eaten lunch. It almost feels like doing the billing for a single patient will equal the work and effort of preparing your entire year's personal taxes. Will have to hire an extra FTE if you treat a lot of Medicare? Which we all do. IT'S ALL ABOUT COMPLIANCE.
Also looks like brachy exclusion is in the "proposal" but not quite as much as a done deal as liver exclusion. I'm sure it will be, but with these guys and gals I wouldn't rule out any shenanigans.
The big question is whether protons are OUT. Right now they are but wouldn't be surprised if they become exempt
It would surprise me. A fair, and seemingly telling, portion of the original CMS RO-APM rule bemoaned protons' effect on CMS's rad onc expenditures.
As a side note, I don't know how we get another IMRT, IGRT, proton machine, MRgRT, BgRT, etc., under APM. It "socializes" all treatments to such an extent there should be a race to efficiency and what's cheapest. High tech companies like Reflexion and Siemens and Mevion can't be thrilled with APM.
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My suspicion is that leadership is much more pragmatic than this. APM will help further consolidate the field. While there will be significant savings per patient regarding protons if included, absolute savings numbers will be parsed and total savings likely greater for photon modalities.
This will be used for a "protons in the wrong hands" argument. PPS system remains. Most of these centers with protons fortuitously out of pilot model, and the battle 5-10 years down the road will be, "But INOVA and Hopkins need protons and are standard bearers. What we really needed is to get them out of the hands of private practice."
I doubt any of the people on the board (well maybe one) would really mind if catchment areas for academic systems (or INOVA) started to resemble the catchment areas in Canada.
I can say from personal experience that Dr. Benjamin Smith, who is currently on the ASTRO board, has had zero problem lying to my patients about my ability to safely and effectively treat them. Given this, I am not enthusiastic about his ability to remain partial when it comes to policies affecting academic vs private practices, and I do strongly believe he will use his position on the ASTRO board to further the interests of academia at the expense of private practice.
Accuray will be happy. Rumored that they put the initial language in the federal legislation that mandated RO-APM
Seriously, I’ve experienced this also. I even had an academic doc recommend the exact same treatment but wanted it done at their center because their rapid arc was somehow more accurate then mine!
I’ve lost all respect for that institution and sadly it’s starting to become more common with similar false statements.
In my market I have two large academic medical centers. Both compete with my practice, but I trained at one of them. The other one does routinely poach patients and lies to them, "radiation is better here than there."
But I do have to give kudos to my home residency institution as they frequently send me patients for their convenience. I once had a patient referred to me by my home institution. When I asked the patient why, the patient said that the academic attending said, "Well I trained Gfunk6 so he basically does everything the same as me. No reason for you to come here everyday for treatment, stay local."
I have zero experience with him personally and have found his input on mednet helpful.
But from a far I have some concerns...
His paper about how we are ever so UNDER supplied for rad oncs (which didn't account for any hypofractionation in breast and prostate at at time when that was picking up steam, usage of mid levels, or changes in supervision) was THE lynch pin for "evidence" of how we needed residency expansion. Big shocker, the follow up showed he was completely wrong.
In addition, he has been a voice against breast IMRT. I don't personally use much (if any) whole breast IMRT, but Dr. Smith is also a co auther on some proton APBI trials....so spare us the "cost" arguments for your PPS exempt center while you deliver proton APBI.
Sea Change: A Decade of Intensity-Modulated Radiation Therapy for Treatment of Breast Cancer
“Nothing of him that doth fadeBut doth suffer a sea-changeInto something rich and strange”
academic.oup.com
God he's obtuse.I have zero experience with him personally and have found his input on mednet helpful.
But from a far I have some concerns...
His paper about how we are ever so UNDER supplied for rad oncs (which didn't account for any hypofractionation in breast and prostate at at time when that was picking up steam, usage of mid levels, or changes in supervision) was THE lynch pin for "evidence" of how we needed residency expansion. Big shocker, the follow up showed he was completely wrong.
In addition, he has been a voice against breast IMRT. I don't personally use much (if any) whole breast IMRT, but Dr. Smith is also a co auther on some proton APBI trials....so spare us the "cost" arguments for your PPS exempt center while you deliver proton APBI.
Sea Change: A Decade of Intensity-Modulated Radiation Therapy for Treatment of Breast Cancer
“Nothing of him that doth fadeBut doth suffer a sea-changeInto something rich and strange”
“Nothing of him that doth fade
But doth suffer a sea-change
Into something rich and strange”
—William Shakespeare, The Tempest
The Centers for Medicare and Medicaid’s recently proposed Radiation Oncology Alternative Payment Model, slated to launch in 2020, is expecting to markedly disrupt radiation oncology practice patterns in the 40% of facilities selected for participation. By implementing a policy of equivalent reimbursement regardless of chosen radiation technique, the financial incentive to recommend IMRT will be removed. We anticipate that a focus on treatment strategies that mitigate internal costs through higher patient throughput—such as ultrahypofractionation or volumetric arc therapy—could lead to new patterns of treatment adoption as facilities seek to improve their per-patient margin.
First, when APM starts, I'm IMRTing everything. And I do mean everything (almost). Second, VMAT = IMRT. False flag.
But third, every time I mention how APM is going to "markedly disrupt practice patterns," I'm told, "If you change your practice patterns that's bad." Ben loves quoting Shakespeare. Makes him look smart. But prick us do we not bleed? Economically incentivize/disincentivize us do we not respond?
Some of these centers have huge faculties who need the RVUs.
I use plenty of imrt when treating nodes and have for years. To be anti-imrt but pro protons is about about as asinine as predicting a massive shortage of radoncs, or wearing a bow tie for that matter.I have zero experience with him personally and have found his input on mednet helpful.
But from a far I have some concerns...
His paper about how we are ever so UNDER supplied for rad oncs (which didn't account for any hypofractionation in breast and prostate at at time when that was picking up steam, usage of mid levels, or changes in supervision) was THE lynch pin for "evidence" of how we needed residency expansion. Big shocker, the follow up showed he was completely wrong.
In addition, he has been a voice against breast IMRT. I don't personally use much (if any) whole breast IMRT, but Dr. Smith is also a co auther on some proton APBI trials....so spare us the "cost" arguments for your PPS exempt center while you deliver proton APBI.
Sea Change: A Decade of Intensity-Modulated Radiation Therapy for Treatment of Breast Cancer
“Nothing of him that doth fadeBut doth suffer a sea-changeInto something rich and strange”
I'm gonna call you out for that sartorial hate speech. Bow ties are cheaper (less material). transmit infection less than a long tie and it is very difficult (although not impossible) to ruin a bow tie by spilling food or drink on said mark of sartorial splendor.
Unfortunately the bow tie look has been adopted by some rather nefarious creatures.
Sorry for being late to the party, why are these centers exempt if they’re in the zip code? Could someone please break down the rules that allow these places to remain exempt? Seems incredibly unfair for their local competitors.
D
deleted1111261
Unnecessary to go after accessories. One thing to call out an off the rack suit, but this is a new low.
D
deleted941485
In Canada, not only can you have have a PP the vast majority of ROs work at Academic centers. If you have cancer in Canada there's a 70% chance you're getting treatment esp RT at an academic center.
Just politics. Started nearly 40 years ago in a Social Security Bill. Our elites really are horrible creatures.
Posted many times but here they are again
How the Bobos Broke America
The creative class was supposed to foster progressive values and economic growth. Instead we got resentment, alienation, and endless political dysfunction.
We're all bobos but we've been out bobo'd by this crew. Makes me want to participate in an anti-APM flotilla.
I echo this sentiment and have to say that the large academic center that I trained at which is also in the metro area where I now work has been an excellent source of referrals and rarely poaches patients. I return the favor in circumstances where it is appropriate. I do think this is very dependent upon having a positive relationship with the department where one trained. My experience with other large academic centers has sadly been more like OTN's.
I think this can be very faculty-dependent. At my residency institution, when I was a PGY3, I got an inpatient consult on a patient who had already been seen and had recommendations made by a local PP doc, who was an alumni of our program. When I told my attending this, and asked if we still needed to see the patient, he scoffed and said "of course, our job as the academic center is to render an informed opinion that a local 'doc-in-a-box' isn't able to do". Spoiler alert: his opinion was the exact same as the PP doc.
Another time, a few years later with a different attending, I was seeing a consult who wanted to go to a PP doc closer to their home. That patient had a family member with them that day, who had been treated for an oropharynx cancer by that PP doc 6 years prior. She was still cancer-free, and the only long term side effect she appeared to have was some neck fibrosis. When I told my attending this, he goes "can you IMAGINE being treated for head and neck cancer at that place?!? I can't, what a great way to die". I wasn't quite sure how to respond, given the evidence to the contrary sitting literally in front of us.
These negative opinions of PP physicians were, of course, passed along to patients, either subtly or, usually, blatantly.
I find it ironic that I’ve trained at a better institution then the one that is talking down to my practice even though they don’t know anything about me or care to learn.
I guess some of these guys have such low self-esteem, getting that “academic position” has to mean something important even though most docs who are in private practice or work for other systems decided to do it. I turned down a couple of academic positions based on either the pay, location or job details. It’s not some righteous position in life where only a few are selected! Hell, in ten years, most positions will be “academic” due to satellite expansion. Again, these are the same ones who tell patients all brain mets need gamma knife.
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