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I think those of us who frequent RadOnc Social Media are aware that Simul/Spraker/Laucis started a podcast recently called "The Accelerators".
They just released a beast of an episode, available on Spotify here.
I know for me, trying to learn about the APM has been very difficult and time consuming, even when I consider reading about RadOnc policy and economics to be basically my main hobby. They do an incredible job having a discussion about what the APM is, what it affects, and why it's important, and they do so by bringing in several guests who actually know what they're talking about (including Anne Hubbard and Dave Adler, the policy/advocacy leadership from ASTRO).
I would strongly encourage folks who aren't really sure about why some of us are very concerned about APM re: the future of the specialty to listen to this episode. I know I've spent a lot of time advocating for cutting residency spots because I think oversupply is a threat to the health of RadOnc, but the implications of APM, as it is currently written, threatens existing practices independent of any of the canonical SDN issues of oversupply, ABR board exams, etc.
I also really appreciate Spraker bringing up the PPS-exempt centers (which are exempt from APM as well), and the fact that CMS has chosen to bring on a Clinical Consultant from MD Anderson into what appears to be high-level decision making circles about APM. Hubbard side steps the issue by explaining the mechanics of why PPS-exempt centers are also APM-exempt, but not commenting further. I don't think any of us were confused about why they aren't included (they've exempted several types of geographies/designations because they're already not operating in the standard FFS fashion that most of the country uses).
I think we're more concerned that someone with zero skin in the game is being given a chance to advise on policy that will affect almost 1,000 practices/institutions, but not their own. Faculty and staff from the 11 PPS-exempt shouldn't be anywhere near having input on APM (at least in the "forced enrollment experimental stage"), or at least their presence should be balanced out by adding someone who, you know, will actually have to practice under this model. Again, this is definitely not a comment about that particular person or anyone from that institution, I just don't want anyone from those places creating the rules to a game they don't have to play.
Very relevant to me, as someone who will be forced to participate in APM, was the comment towards the end of the episode about the wish for CMS to collect their own data. A large part of the "experiment" of APM is that CMS wants to analyze practice patterns and assess the efficacy of their model in regards to cutting reimbursement to Radiation Oncology (because all that Keytruda and Herceptin ain't gonna reimburse itself).
The analogy was made that, if a patient enrolls on a clinical trial, do we ask the patient to record and report all of their own data and submit it to the PI? No, because that's obviously ridiculous - the team running the clinical trial will collect and analyze the data. Why, on God's green Earth, is CMS forcing non-consenting practices to participate in an experimental reimbursement model AND collect and submit their own data on it? Documentation requirements are already astronomical, and CMS is demanding more? Never mind that currently, about two months away from APM implementation, the only way to submit this data is through manually entering it into an Excel spreadsheet on the CMS website and submitting it through the portal. There are no vendor solutions for this. Well, I guess that's not entirely true - though not discussed in the podcast, one of my admins heard that Varian has created an $85,000 product to generate the APM data, and that product is evidently...not great. Also, CMS expects us to submit data on all of our patients, even the ones not covered by APM. That's right, they want data on your Anthem and Aetna patients, too. I'm not sure how that doesn't violate some sort of patient privacy rights, but perhaps smarter people than me already have that figured out.
But I digress - listen to the episode!
(@RealSimulD, I'll send you a link to my Venmo account for the advertising fee)
They just released a beast of an episode, available on Spotify here.
I know for me, trying to learn about the APM has been very difficult and time consuming, even when I consider reading about RadOnc policy and economics to be basically my main hobby. They do an incredible job having a discussion about what the APM is, what it affects, and why it's important, and they do so by bringing in several guests who actually know what they're talking about (including Anne Hubbard and Dave Adler, the policy/advocacy leadership from ASTRO).
I would strongly encourage folks who aren't really sure about why some of us are very concerned about APM re: the future of the specialty to listen to this episode. I know I've spent a lot of time advocating for cutting residency spots because I think oversupply is a threat to the health of RadOnc, but the implications of APM, as it is currently written, threatens existing practices independent of any of the canonical SDN issues of oversupply, ABR board exams, etc.
I also really appreciate Spraker bringing up the PPS-exempt centers (which are exempt from APM as well), and the fact that CMS has chosen to bring on a Clinical Consultant from MD Anderson into what appears to be high-level decision making circles about APM. Hubbard side steps the issue by explaining the mechanics of why PPS-exempt centers are also APM-exempt, but not commenting further. I don't think any of us were confused about why they aren't included (they've exempted several types of geographies/designations because they're already not operating in the standard FFS fashion that most of the country uses).
I think we're more concerned that someone with zero skin in the game is being given a chance to advise on policy that will affect almost 1,000 practices/institutions, but not their own. Faculty and staff from the 11 PPS-exempt shouldn't be anywhere near having input on APM (at least in the "forced enrollment experimental stage"), or at least their presence should be balanced out by adding someone who, you know, will actually have to practice under this model. Again, this is definitely not a comment about that particular person or anyone from that institution, I just don't want anyone from those places creating the rules to a game they don't have to play.
Very relevant to me, as someone who will be forced to participate in APM, was the comment towards the end of the episode about the wish for CMS to collect their own data. A large part of the "experiment" of APM is that CMS wants to analyze practice patterns and assess the efficacy of their model in regards to cutting reimbursement to Radiation Oncology (because all that Keytruda and Herceptin ain't gonna reimburse itself).
The analogy was made that, if a patient enrolls on a clinical trial, do we ask the patient to record and report all of their own data and submit it to the PI? No, because that's obviously ridiculous - the team running the clinical trial will collect and analyze the data. Why, on God's green Earth, is CMS forcing non-consenting practices to participate in an experimental reimbursement model AND collect and submit their own data on it? Documentation requirements are already astronomical, and CMS is demanding more? Never mind that currently, about two months away from APM implementation, the only way to submit this data is through manually entering it into an Excel spreadsheet on the CMS website and submitting it through the portal. There are no vendor solutions for this. Well, I guess that's not entirely true - though not discussed in the podcast, one of my admins heard that Varian has created an $85,000 product to generate the APM data, and that product is evidently...not great. Also, CMS expects us to submit data on all of our patients, even the ones not covered by APM. That's right, they want data on your Anthem and Aetna patients, too. I'm not sure how that doesn't violate some sort of patient privacy rights, but perhaps smarter people than me already have that figured out.
But I digress - listen to the episode!
(@RealSimulD, I'll send you a link to my Venmo account for the advertising fee)