RO-APM Podcast Episode (from The Accelerators)

[fiji128]

Playing this game is poor long term strategy. What do you do when the group your “signaling” to is out of power? What if they are out of power for like 10 years? What if this group doesn’t care about or is even antagonist to your objectives? I feel organizations like Astro have mission statements to help avoid such unnecessary entanglements.

There are thousands of other groups out there that one can join and support to play the partisan political game. Astro has one purpose and weighing in on electoral politics isn't one of them.

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[communitydoc13]

weighing in on electoral politics isn't one of them

In general I agree. But how close were we to having a national election overturned? In the long, long game (10+ years) either 1/6 viewed as a calamity or we're living in a quasi-fascist state.

I'm fine with ASTRO PACs gamble on this. I doubt that history books are going to say "ASTRO overstepped their bounds by condemning 1/6 and using what little clout they had to repudiate those that promoted the conspiracy of a rigged election".

History books won't even mention ASTRO other than to note that "It was the dominant organization for the bygone medical specialty of radiation oncology".

 

[TheWallnerus]

History books won't even mention ASTRO other than to note that "It was the dominant organization for the bygone medical specialty of radiation oncology".

 

[communitydoc13]

But those departmental holiday dinners circa 2010....damn.

I'm guessing that rare red hedge in 2014 had something to do with MACRA? I can understand.

 

[elementaryschooleconomics]

The Y axis dollar amounts are...very sad.

If Paul Wallner took a reverse mortgage out on just one of his homes, he could, by himself, beat ASTRO's all time high in 2012 of what appears to be about $360,000...and have enough money left over to buy a new Maserati...or five.

This explains a lot about our current situation.

 

[medgator]

My guess is Joe would take a call from MDACC and that call could mean something regarding upcoming radiation cuts and APM. My guess is that call is not coming.

Why should it? They aren't taking the cuts. Heck some of them are profiting off of the collective misery being doled out to (some of) the rest of us.

No different than when ASTRO paid lip service about to all the freestanding cuts that occurred for several years.. the Elie Wiesel quote really is quite fitting.

PS. We almost didn't have peaceful transfer of power in this democracy for the first time in generations, and the first attack on the capital since the 1800s. 1/6 transcended politics and those who feel otherwise are missing the point and ignoring obvious domestic terrorism

 

[Mandelin Rain]

So appropriately condemn 1/6 and the handful of truly evil people who prompted it. I guarantee the vast majority of those 140+ house Republicans didn't expect an insurrection attempt when they voted against certification any more than the dozen or so Democrats expected an insurrection attempt when they voted against certification in 2016.

Nonsensical political people doing nonsensical political things are very people a SMALL PAC like ASTRO needs to be pandering to on both sides of the aisle. Those people are easily influenced.

Avoid the actual bastards.

 

[TheWallnerus]

So appropriately condemn 1/6 and the handful of truly evil people who prompted it. I guarantee the vast majority of those 140+ house Republicans didn't expect an insurrection attempt when they voted against certification any more than the dozen or so Democrats expected an insurrection attempt when they voted against certification in 2016.

I think this is the key point, one I didn't want to make to add conflagration to the conflation of the insurrection and that vote. They were separate things. The ASTRO PAC announcement made it seem like they were the same thing. And if you're a Republican congressman making that vote (which at least on its face is unyoked from the insurrection), now you have ASTRO PAC calling you an insurrection supporter. Yay. On top of ASTRO PAC already being a PAC that tilts donations 3:2 Democrat:Republican. Again, not the greatest way to win friends and influence people. Maybe it all didn't matter and I am just in an APM funk and we are signaling past the graveyard with our very weak donations and then superweak donation withholding kabuki. If every rad onc in America gave $5K today we'd have $20+ million for the PAC which would be thousands of times more than what ASTRO PAC ordinarily donates. Perhaps that would have accomplished something. But probably it would have just gotten awesome proton therapy Medicare reimbursement.

 

[Chartreuse Wombat]

Why should it? They aren't taking the cuts. Heck some of them are profiting off of the collective misery being doled out to (some of) the rest of us.

No different than when ASTRO paid lip service about to all the freestanding cuts that occurred for several years.. the Elie Wiesel quote really is quite fitting.

PS. We almost didn't have peaceful transfer of power in this democracy for the first time in generations, and the first attack on the capital since the 1800s. 1/6 transcended politics and those who feel otherwise are missing the point and ignoring obvious domestic terrorism

We almost didn't have peaceful transfer of power in this democracy for the first time in generations, and the first attack on the capital since the 1800s.

For those old enough to remember-

U.S. Senate: 404 Error Page

404 Error Page

www.senate.gov

For those that read history-

U.S. Senate: 404 Error Page

404 Error Page

www.senate.gov

 

[medgator]

We almost didn't have peaceful transfer of power in this democracy for the first time in generations, and the first attack on the capital since the 1800s.

For those old enough to remember-

U.S. Senate: 404 Error Page

404 Error Page

www.senate.gov

For those that read history-

U.S. Senate: 404 Error Page

404 Error Page

www.senate.gov

So over a century... Obviously some significance

 

[Chartreuse Wombat]

So over a century... Obviously some significance

You didn't read the link. The Senate was bombed in 1983 to protest US intervention in Lebanon and Granada.

I am posting to rebut that the capital hasn't been attacked since the 1800s.

I am not downplaying the significance of 1/6 only correcting the previous statement.

P.S. We still have lots to learn about 1/6.

 

[communitydoc13]

ASTRO PAC already being a PAC that tilts donations 3:2 Democrat:Republican.

Yeah, I tilt pretty far left but dems have gotten so damn corporatist and elitist that community clinics are probably not high on their priorities (unless they are branded properly). The "small radonc" sell might actually go over better with republicans.

Thing is, I could deal with an across the board, hard-ass paycut. Just CMS saying, "this is what radonc gets per patient, whether protons or photons or Harvard or community". This pandering to elite organizations while regulating nominal savings on the backs of small facilities is just bad.

 

[medgator]

You didn't read the link. The Senate was bombed in 1983 to protest US intervention in Lebanon and Granada.

I am posting to rebut that the capital hasn't been attacked since the 1800s.

I am not downplaying the significance of 1/6 only correcting the previous statement.

P.S. We still have lots to learn about 1/6.

Didn't know that, but no injuries or fatalities that were mentioned? I don't see it at being at quite the same level, but interesting to note. The number of individuals involved and collusion from the inside also appear to be novel to this

My point stands that it was an incident of domestic terrorism with associated fatalities and injuries, including on the Capitol police side and should be outside of the political realm.

It absolutely should be investigated and that's not what is happening unfortunately, just like certain individuals did not want to play ball certifying a free and fair election.

All of the above transcends politics imo

 

[Chartreuse Wombat]

Didn't know that, but no injuries or fatalities that were mentioned? I don't see it at being at quite the same level, but interesting to note. The number of individuals involved and collusion from the inside also appear to be novel to this

My point stands that it was an incident of domestic terrorism with associated fatalities and injuries, including on the Capitol police side and should be outside of the political realm.

It absolutely should be investigated and that's not what is happening unfortunately, just like certain individuals did not want to play ball certifying a free and fair election.

All of the above transcends politics imo

I don't disagree. I am hopeful that a transparent investigation will occur but I am not hopeful given how the relevant institutions have failed the public.

 

[Mandelin Rain]

All of the above transcends politics imo

Ain't that the truth.

 

[thecarbonionangle]

I guess you could call APM a funk but this ain’t the good G-Funk my boys Dre and SNOOP sing about. This is the complete opposite like a swarm of giant crickets covering the sun and killing all crops and animals bringing a famine and breadlines. T’is a great holiday season before the APM funk!

 

[elementaryschooleconomics]

I guess you could call APM a funk but this ain’t the good G-Funk my boys Dre and SNOOP sing about. This is the complete opposite like a swarm of giant crickets covering the sun and killing all crops and animals bringing a famine and breadlines. T’is a great holiday season before the APM funk!

Me, March 2022, trying to get a slice of reimbursement for a palliative bone met:

 

[Mandelin Rain]

I guess you could call APM a funk but this ain’t the good G-Funk my boys Dre and SNOOP sing about. This is the complete opposite like a swarm of giant crickets covering the sun and killing all crops and animals bringing a famine and breadlines. T’is a great holiday season before the APM funk!

If the Next Episode a patient needs care is less than 90 days out, CMS will Regulate and use No Vaseline. You won't be saying It Was A Good Day because these are some Real Muthaphuckkin G's we're dealing with.

 

[Gfunk6]

I guess you could call APM a funk but this ain’t the good G-Funk my boys Dre and SNOOP sing about. This is the complete opposite like a swarm of giant crickets covering the sun and killing all crops and animals bringing a famine and breadlines. T’is a great holiday season before the APM funk!

Ok, you asked for it:

Government Regulators, mount up

It was a clear black night, a clear white moon
Community Rad Onc was on the streets, trying to consume
Some rads for the eve, so I can get some bucks
Just rollin' in my ride, chillin' all alone

Just hit the Eastside of M-D-A-C-C
On a mission trying to find Dr. Wallner P
Seen a car full of protons ain't no need to tweak
All you Chairs know what's up with CPT 77523

So I treat my mets with 30/3 without amiss
Saw A Koong shootin' dice so I said, "Let's do this"
I jumped out the ride, and said, "What's up?"
A Kong whipped out APM so I said, "I'm stuck"

I'm gettin' jacked, I'm breakin' myself
I can't believe they taking ROs wealth
They took my rings, they took my Rolex
I looked at A Koong said, "Damn, what's next?"

 

[Mandelin Rain]

PPS Exempt thang, baby.
Eleven loc'ed out chairs screaming "pay me."
Proton center? Yeah, that's just gravy.
More residents, so we won't have to pay thee.

 

[thecarbonionangle]

Ok, you asked for it:

Government Regulators, mount up

It was a clear black night, a clear white moon
Community Rad Onc was on the streets, trying to consume
Some rads for the eve, so I can get some bucks
Just rollin' in my ride, chillin' all alone

Just hit the Eastside of M-D-A-C-C
On a mission trying to find Dr. Wallner P
Seen a car full of protons ain't no need to tweak
All you Chairs know what's up with CPT 77523

So I treat my mets with 30/3 without amiss
Saw A Koong shootin' dice so I said, "Let's do this"
I jumped out the ride, and said, "What's up?"
A Kong whipped out APM so I said, "I'm stuck"

I'm gettin' jacked, I'm breakin' myself
I can't believe they taking ROs wealth
They took my rings, they took my Rolex
I looked at A Koong said, "Damn, what's next?"

Set up your alley hoop!

Pretty soon RO will have no cheese, no kicks, no keys, no skis, no wheels, no snowmobiles, no provindin’ for my family

 

[Gfunk6]

PPS Exempt thang, baby.
Eleven loc'ed out chairs screaming "pay me."
Proton center? Yeah, that's just gravy.
More residents, so we won't have to pay thee.

A Koong:
If you got reimbursement problems I feel bad for you son
I got 99 problems but APM ain't one

 

[jondunn]

I don’t want to get banned for talking about politics again…… but there sure is a lot of minimization of 1/6 and the events leading up to it here! I don’t quite get this, other then political tribalism.


Agree that we (well not me as I don’t pay Astro dues) should donate to all who will help us. But this is pragmatic, and not in any way excusing those who promoted 1/6.

Makes me sick.

 

[Mandelin Rain]

Pragmatic is what we need.

What happened on January 6th is a travesty. The events preceding it fall primarily on Trump and the handful of characters he trotted out to froth up the crowd of loonies who stormed the Capitol.

Was every congress person who voted not to certify to blame? Nope. If you believe so, I think you may just be guilty of the political tribalism that makes you so sick.

 

[TheWallnerus]

When ASTRO PAC is not your friend...

But Florida's proton centers have no problems making a donation to an Election De-Certifier/ASTRO PAC pariah.

Politics do indeed make strange bedfellows.

Joining Rubio were U.S. Representatives Kat Cammack (R-FL), John Rutherford (R-FL), Bill Posey (R-FL), Neal Dunn (R-FL), Gregory Steube (R-FL), Byron Donalds (R-FL), Gus Bilirakis (R-FL), Scott Franklin (R-FL), Debbie Wasserman Schultz (D-FL), and Al Lawson* (D-FL).

* Jacksonville guy

Rubio, Members of the Florida Congressional Delegation, Urge CMS to Protect Patient Access to Advanced Cancer Treatment in Proposed Radiation Oncology Model​

but there sure is a lot of minimization of 1/6 and the events leading up to it here!

If come 1/1/22 PBT is out of the APM, but the APM is still happening, I think it would have been safer... for me, at least... if ASTRO PAC had jumped on the minimisation bandwagon. By minimise I mean: don't focus on politics which don't have anything to do with rad onc in a rad onc discussion.

 

[jondunn]

yeah sure, but at the end of the day, do I really think this had one iota of impact on anything to do with APM? no.

as ESE pointed out, the money we are talking about here is a rounding error. we are not that big or important. they give us one 'advocacy day' and you are lucky if you don't get an intern to show up, let alone the congressmen/women themselves

i agree that ASTRO jumped on a bandwagon, but it didn't matter either way.

 

[thecarbonionangle]

When ASTRO PAC is not your friend...

But Florida's proton centers have no problems making a donation to an Election De-Certifier/ASTRO PAC pariah.

Politics do indeed make strange bedfellows.

Joining Rubio were U.S. Representatives Kat Cammack (R-FL), John Rutherford (R-FL), Bill Posey (R-FL), Neal Dunn (R-FL), Gregory Steube (R-FL), Byron Donalds (R-FL), Gus Bilirakis (R-FL), Scott Franklin (R-FL), Debbie Wasserman Schultz (D-FL), and Al Lawson* (D-FL).

* Jacksonville guy

Rubio, Members of the Florida Congressional Delegation, Urge CMS to Protect Patient Access to Advanced Cancer Treatment in Proposed Radiation Oncology Model​

If come 1/1/22 PBT is out of the APM, but the APM is still happening, I think it would have been safer... for me, at least... if ASTRO PAC had jumped on the minimisation bandwagon. By minimise I mean: don't focus on politics which don't have anything to do with rad onc in a rad onc discussion.

I wonder why so many Rs are in pockets of protons!

 

[TheWallnerus]

yeah sure, but at the end of the day, do I really think this had one iota of impact on anything to do with APM? no.

as ESE pointed out, the money we are talking about here is a rounding error. we are not that big or important. they give us one 'advocacy day' and you are lucky if you don't get an intern to show up, let alone the congressmen/women themselves

i agree that ASTRO jumped on a bandwagon, but it didn't matter either way.

We will see!

 

[Mandelin Rain]

I wonder why so many Rs are in pockets of protons!

Florida man....

 

[elementaryschooleconomics]

Florida man....

There's a reason 21C was born there...

 

[Lamount]

When ASTRO PAC is not your friend...

But Florida's proton centers have no problems making a donation to an Election De-Certifier/ASTRO PAC pariah.

Politics do indeed make strange bedfellows.

Joining Rubio were U.S. Representatives Kat Cammack (R-FL), John Rutherford (R-FL), Bill Posey (R-FL), Neal Dunn (R-FL), Gregory Steube (R-FL), Byron Donalds (R-FL), Gus Bilirakis (R-FL), Scott Franklin (R-FL), Debbie Wasserman Schultz (D-FL), and Al Lawson* (D-FL).

* Jacksonville guy

Rubio, Members of the Florida Congressional Delegation, Urge CMS to Protect Patient Access to Advanced Cancer Treatment in Proposed Radiation Oncology Model​

If come 1/1/22 PBT is out of the APM, but the APM is still happening, I think it would have been safer... for me, at least... if ASTRO PAC had jumped on the minimisation bandwagon. By minimise I mean: don't focus on politics which don't have anything to do with rad onc in a rad onc discussion.

It's worth remembering that politics wasn't always so tribal and need not be in the future. I am definitely left of center... but I am quite at ease with the notion that there are issues where I will side with Republicans.

I don't think that APM is a partisan issue. The only people who want this 1) have it in for Rad Onc because they think we are overpaid or 2) are in bed with Pharma and want to divert ire away from drug prices.

The truth is... APM should offend both parties. The GOP should take issue with government overreach... and the dems should take issue with the fact that this is going worsen access to cancer care and will likely exacerbate disparities.

Let's keep our eye on the prize: APM is cutting cancer care, likely at the expense of patient access.

 

[thecarbonionangle]

Dont be surprised if protons are exempt last minute folks!

 

[medgator]

It's worth remembering that politics wasn't always so tribal and need not be in the future. I am definitely left of center... but I am quite at ease with the notion that there are issues where I will side with Republicans.

I don't think that APM is a partisan issue. The only people who want this 1) have it in for Rad Onc because they think we are overpaid or 2) are in bed with Pharma and want to divert ire away from drug prices.

The truth is... APM should offend both parties. The GOP should take issue with government overreach... and the dems should take issue with the fact that this is going worsen access to cancer care and will likely exacerbate disparities.

Let's keep our eye on the prize: APM is cutting cancer care, likely at the expense of patient access.

It's only cutting cancer care for some, actually. And the people who have the best access won't feel a thing

 

[jondunn]

There is classic crony capitalism corruption going on here with APM and just money in medicine in general. Sad.


This is why we need to get money out of politics. We can’t ever move forward or improve without that. Grifters grift and I’m sure a new one would form, but we need money out of politics.

 

[TheWallnerus]

There is classic crony capitalism corruption going on here with APM and just money in medicine in general. Sad.


This is why we need to get money out of politics. We can’t ever move forward or improve without that. Grifters grift and I’m sure a new one would form, but we need money out of politics.

And politics out of medicine.

 

[thecarbonionangle]

APM pie in the oven. Delicious!

 

[elementaryschooleconomics]

Problem: CMS thinks too much money goes to Radiation Oncology (because AstraZeneca pays Senators to tell them what to think)

Poorly Designed Solution: The bundled payments of APM to "save" $300 million (aka redistribute it to Merck and AbbVie)

Problem: The FDA makes an insanely questionable decision to approve Aduhelm for the treatment of Alzheimer's, which is potentially very expensive to CMS

Poorly Designed Solution: CMS raises Medicare Part A & Part B premiums to pay for Aduhelm

Introducing: An Elementary Solution to an Economic Problem

1) Don't enact APM

2) Don't use Medicare dollars to pay for Aduhelm

Instead, keep RadOnc reimbursements at the current levels (and FFS) while treating Alzheimer's with the Swiss Army Knife of pharmaceuticals: Viagra!

 

[communitydoc13]

Instead, keep RadOnc reimbursements at the current levels (and FFS) while treating Alzheimer's with the Swiss Army Knife of pharmaceuticals: Viagra!

That the most sophisticated machinations of propensity scoring and "Judicious in-silico medicine discovery"-->JISM--> reveals an association between boning and cognition is....not impressive.

 

[Burt Radnolds]

House proposed a bill today that included delaying APM another year and scaling back other Medicare cuts.

 

[jondunn]

House proposed a bill today that included delaying APM another year and scaling back other Medicare cuts.

who proposed it?

 

[jondunn]

if true - never ever again doubt the power of the proton lobby!

 

[Sheldor]

who proposed it?

Rep. Schrier Introduces Bill to Prevent Medicare Cuts

WASHINGTON, DC – Today U.S. Representatives Kim Schrier, M.D. (WA-08) and Steven Horsford (NV-04) introduced the Supporting Health Care Providers During the COVID-19 Pandemic Act that will mitigate Medicare payment cuts to providers. Without this legislation, cuts would go into effect next...

schrier.house.gov

Looks like she is an MD, very cool

 

[elementaryschooleconomics]

Rep. Schrier Introduces Bill to Prevent Medicare Cuts

WASHINGTON, DC – Today U.S. Representatives Kim Schrier, M.D. (WA-08) and Steven Horsford (NV-04) introduced the Supporting Health Care Providers During the COVID-19 Pandemic Act that will mitigate Medicare payment cuts to providers. Without this legislation, cuts would go into effect next...

schrier.house.gov

Looks like she is an MD, very cool

Well this is the happiest thing I've seen in awhile, I hope it passes.

 

[thecarbonionangle]

APM delay brought to you by proton lobby. They say you are welcome sir!

 

[Chartreuse Wombat]

Rep. Schrier Introduces Bill to Prevent Medicare Cuts

WASHINGTON, DC – Today U.S. Representatives Kim Schrier, M.D. (WA-08) and Steven Horsford (NV-04) introduced the Supporting Health Care Providers During the COVID-19 Pandemic Act that will mitigate Medicare payment cuts to providers. Without this legislation, cuts would go into effect next...

schrier.house.gov

Looks like she is an MD, very cool

Rep. Kim Schrier - Washington District 08

Fundraising profile for Rep. Kim Schrier - Washington District 08

www.opensecrets.org

 

[Lamount]

Rep. Schrier Introduces Bill to Prevent Medicare Cuts

WASHINGTON, DC – Today U.S. Representatives Kim Schrier, M.D. (WA-08) and Steven Horsford (NV-04) introduced the Supporting Health Care Providers During the COVID-19 Pandemic Act that will mitigate Medicare payment cuts to providers. Without this legislation, cuts would go into effect next...

schrier.house.gov

Looks like she is an MD, very cool

You've gotta love the name of the bill...

Who doesn't want to support COVID healthcare workers?

 

[jondunn]

Who doesn't want to support COVID healthcare workers?

lol many people these days.

 

[medgator]

lol many people these days.

"don't Fauci my Florida"

 

[Gfunk6]

I’m getting news blasts that the House has introduced legislation to delay RO APM until Jan 2023. It still needs to pass the Senate but that seems likely.

 

[madchemist89]

I think delay of APM at this point will only allow for more exceptions to be introduced. Site neutrality and protons will probably be out if delayed.