RO-APM Podcast Episode (from The Accelerators)

[elementaryschooleconomics]

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.

Maybe they can FINALLY work on the fact that the 90 day episode design means zero reimbursement for any palliative patients who present with new lesions after an initial course.

---

Members don't see this ad.

 

[mheat3]

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.

Agree with this. I think it is a chance for protons to be carved out with the non-proton practices shouldering all of the burden of APM.

 

[Burt Radnolds]

Hearing this bill will almost assuredly pass.

 

[thecarbonionangle]

Agree with this. I think it is a chance for protons to be carved out with the non-proton practices shouldering all of the burden of APM.

Proton carve out is not a matter of if it happens but when it happens. Been hearing it for a while now that it is happening but this only might confirm it further. Avoiding self flagelation, this is a big win for all of us. Thank you democrats! I think all of your folks should send more money to NAPT and ASTRO and PACs and the two democratic sponsors. They are working for you!

 

[madchemist89]

I agree 90 day episode and documentation burden need to be addressed.

 

[elementaryschooleconomics]

Proton carve out is not a matter of if it happens but when it happens. Been hearing it for a while now that it is happening but this only might confirm it further. Avoiding self flagelation, this is a big win for all of us. Thank you democrats! I think all of your folks should send more money to NAPT and ASTRO and PACs and the two democratic sponsors. They are working for you!

I would like to see a study on the average blood pressure spike your posts cause in certain individuals (please never stop).

I agree that this is a big win, and any delay in APM is good for everyone (except for the C-suite crew at Merck who were counting on this money being funneled to their fourth vacation home remodel).

However, the government will never understand how much their indecisiveness costs in terms of manpower and hours lost. Just speaking personally, in my department, over the last several months, countless meetings have been had with various groups preparing to implement this. I'm sure someone could do some fancy economic analysis and give us an estimate about the "dollar cost" of this preparation nationally, but all I can think is: those hundreds of hours of meetings could have instead been spent on patient care. An hour of me sitting on a conference call is an hour I'm not helping a family come to terms with a loved one's terminal diagnosis, or making sure my CTV expansion on a head and neck level is the optimal mix between coverage and toxicity, or authoring the perfect appeal letter for a Medicare Advantage plan denial of a 5 fraction palliative course, etc.

Perhaps CMS has a colorful PPT slide from one of their webinars on the human cost of all this, and I missed it?

 

[deleted1111261]

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.

This is just not going to happen. It’s destructive. Look how many times kicked down the road. No one wants their fingerprints on this. It will ruin community oncology.

 

[TheWallnerus]

Federal govt to America’s rad oncs

 

[thecarbonionangle]

Federal govt to America’s rad oncs

Choom gang is a friend of RO

 

[deleted941485]

I mean we’re just gonna have to do this dance all over again next year. CMS, uros, pharma, and Med Oncs will continue to run a train on RO. While I wish I could break out the champagne and celebrate, I don’t see much of a reason. Buys me 1 more year of employment I guess.

 

[Gfunk6]

I mean we’re just gonna have to do this dance all over again next year. CMS, uros, pharma, and Med Oncs will continue to run a train on RO. While I wish I could break out the champagne and celebrate, I don’t see much of a reason. Buys me 1 more year of employment I guess.

All aboard the RO money train!

We are gonna ride that baby till the wheels fall off!

 

[TheWallnerus]

I mean we’re just gonna have to do this dance all over again next year. CMS, uros, pharma, and Med Oncs will continue to run a train on RO. While I wish I could break out the champagne and celebrate, I don’t see much of a reason. Buys me 1 more year of employment I guess.

Here's my evolving thought process. At least until 2023.

(And I was right, sort of...)

You heard it here first. Protons will be exempted. After that exemption is firmly in hand, find Steve Hahn as the newly appointed proton center medical director somewhere.

CMS has a boner for rad onc and protons in particular. But there is something there w/ the Proton Lobby (big academics? Chinese?) that lets them keep escaping the guillotine. However CMS seems not to have the mindset to strike rad onc if it can't also strike protons. So as long as protons keep escaping, maybe we all escape. Which means... we become what we hate? My enemy who's an enemy to my bigger enemy is my friend??

I should love protons???

 

[Gfunk6]

 

[thecarbonionangle]

Here's my evolving thought process. At least until 2023.

(And I was right, sort of...)


CMS has a boner for rad onc and protons in particular. But there is something there w/ the Proton Lobby (big academics? Chinese?) that lets them keep escaping the guillotine. However CMS seems not to have the mindset to strike rad onc if it can't also strike protons. So as long as protons keep escaping, maybe we all escape. Which means... we become what we hate? My enemy who's an enemy to my bigger enemy is my friend??

I should love protons???

Absolutely you should! The NAPT and similar proton dark money groups ultimately advocate for us. What was the point of self flagellation (not to be confused with italian fellatio, a common misconception) in regards to urorads and now protons? It just put us on the “bad guys” section of the room. Protons are BIGLY your friend and they hate APM. I predict that nobody will love protons more than you guys in near future. The proton lobby saves the day. No you are not confused. It felt good and quite frankly you liked it

 

[jondunn]

Here's my evolving thought process. At least until 2023.

(And I was right, sort of...)


CMS has a boner for rad onc and protons in particular. But there is something there w/ the Proton Lobby (big academics? Chinese?) that lets them keep escaping the guillotine. However CMS seems not to have the mindset to strike rad onc if it can't also strike protons. So as long as protons keep escaping, maybe we all escape. Which means... we become what we hate? My enemy who's an enemy to my bigger enemy is my friend??

I should love protons???

The Chinese don’t miss

 

[Sheldor]

Senate Clears Last Major Hurdle to Raising Debt Ceiling (Published 2021)

Ending a monthslong impasse, lawmakers from both parties approved legislation that would let Congress raise the debt ceiling by a simple majority vote.

www.nytimes.com

It passed the senate and is on its way to Biden to be signed, the huge cuts to medicare were fixed, now small cuts, and APM delayed.

 

[jondunn]

Hopefully the GOP senators that crossed the aisle don’t get punished for it!

 

[Chartreuse Wombat]

Hopefully the GOP senators that crossed the aisle don’t get punished for it!

Several that voted for have announced they are not running in 2022

 

[Lamount]

Hopefully the GOP senators that crossed the aisle don’t get punished for it!

They will get punished, but not because of blocking Medicare cuts or delaying APM… McConnel and Schumer attached an amendment to the bill that lets the dems raise the debt ceiling with just 50 votes. The Trump wing of GOP is furious about it.

 

[medgator]

They will get punished, but not because of blocking Medicare cuts or delaying APM… McConnel and Schumer attached an amendment to the bill that lets the dems raise the debt ceiling with just 50 votes. The Trump wing of GOP is furious about it.

They were furious about the bipartisan infrastructure bill passing as well.... They seem to be fading into irrelevance and i doubt they will have any influence with how the Senate votes on the current house bill regarding APM

 

[Chartreuse Wombat]

They were furious about the bipartisan infrastructure bill passing as well.... They seem to be fading into irrelevance and i doubt they will have any influence with how the Senate votes on the current house bill regarding APM

The vote already happened and passed.

 

[deleted941485]

Absolutely you should! The NAPT and similar proton dark money groups ultimately advocate for us. What was the point of self flagellation (not to be confused with italian fellatio, a common misconception) in regards to urorads and now protons? It just put us on the “bad guys” section of the room. Protons are BIGLY your friend and they hate APM. I predict that nobody will love protons more than you guys in near future. The proton lobby saves the day. No you are not confused. It felt good and quite frankly you liked it

RO has a sales problem. IT has nothing really sexy to sell. VMAT/IMRT are getting old and honestly small Medicare cuts over a long period just mean a slow death unless you come up with something they will pay for. Protons or particle therapy and the venture capital or dark money that's funding it is probably the only thing that gives us the lobbying to fight anything anymore. we don't have a pharma level money and god knows your local academic RO doesn't think its anything is innovative if it doesn't involve less RT. We are stuck with proton. We get 4 years of training you would think they cram in some useful aka billable skills other than making meaningless changes to your contours and calling you out for not knowing the LC rate in RTOG Who gives a ****.

We were the ugly kids at the dance...we struck it rich but the is party way over...and now we can go back to being ugly wall flowers again while the alpha dogs in surg and med subspecialists can go back to forgetting about you and probably laughing behind your back.

 

[elementaryschooleconomics]

We get 4 years of training you would think they cram in some useful aka billable skills other than making meaningless changes to your contours and calling you out for not knowing the LC rate in RTOG Who gives a ****.

I'm always reassured to learn my experience was not an isolated occurrence but rather, the "standard of care".

 

[thecarbonionangle]

RO has a sales problem. IT has nothing really sexy to sell. VMAT/IMRT are getting old and honestly small Medicare cuts over a long period just mean a slow death unless you come up with something they will pay for. Protons or particle therapy and the venture capital or dark money that's funding it is probably the only thing that gives us the lobbying to fight anything anymore. we don't have a pharma level money and god knows your local academic RO doesn't think its anything is innovative if it doesn't involve less RT. We are stuck with proton. We get 4 years of training you would think they cram in some useful aka billable skills other than making meaningless changes to your contours and calling you out for not knowing the LC rate in RTOG Who gives a ****.

We were the ugly kids at the dance...we struck it rich but the is party way over...and now we can go back to being ugly wall flowers again while the alpha dogs in surg and med subspecialists can go back to forgetting about you and probably laughing behind your back.

Yeah that’s why my boy Willard said “Protons are people my friend!”. Why alienate the only people left in our field with money to actually delay what was going to decimate us all. It comes for all after a few years for those thinking they were safe.

I for one welcome the proton NAPT dark money overlords and “the chinese”. They know how to get shet done. We need more of this: twist arms, pay people off just kill this thing. No more limp afraid of their own shadow approach.

 

[jondunn]

Yeah that’s why my boy Willard said “Protons are people my friend!”. Why alienate the only people left in our field with money to actually delay what was going to decimate us all. It comes for all after a few years for those thinking they were safe.

I for one welcome the proton NAPT dark money overlords and “the chinese”. They know how to get shet done. We need more of this: twist arms, pay people off just kill this thing. No more limp afraid of their own shadow approach.

Dark money is dark. they will always bleed you dry.

its like getting in bed with the mafia

 

[deleted1111261]

Interesting that 40 Republicans either voted No or Present on the senate side. Physicians appear to be mostly Republican (I know this varies based on specialty), but I would say in general Republicans vote against our interest more often than that. It appears that physicians voters care more about non-Healthcare issues and than healthcare issues.

 

[thecarbonionangle]

Interesting that 40 Republicans either voted No or Present on the senate side. Physicians appear to be mostly Republican (I know this varies based on specialty), but I would say in general Republicans vote against our interest more often than that. It appears that physicians voters care more about non-Healthcare issues and than healthcare issues.

I agree. I think largely even though some people on this board don’t like to admit one party is clearly more physician and rad onc friendly. This vote could not be any more clear.

The people who ignore this clearly care about other wedge isssues (cultural, religious, “taxes”), whatever. Bottomline APM was mostly a Trump crony baby, pushed by Azar, despite some obscure thing tying it to previous admin, and the dems killed it with almost zero GOP support. I’ll say it again—-thank you democrats!

 

[communitydoc13]

Interesting that 40 Republicans either voted No or Present on the senate side. Physicians appear to be mostly Republican (I know this varies based on specialty), but I would say in general Republicans vote against our interest more often than that. It appears that physicians voters care more about non-Healthcare issues and than healthcare issues.

I remember a graph from some years back. Political affiliation did trend strongly with specialty (primary care docs were mostly democrats). I'm guessing there were also quite substantial trends with type of practice (my assumption is academic docs more left leaning than private practice). I believe younger docs are more likely to lean left.

Certainly some very corporate GOP docs in the past were very politically influential (see Bill Frist).

Nearly all docs are largely paid by the federal government. This should not be forgotten. Only concierge docs and elective surgeon types should believe that free markets are roughly where they work.

I'm anti corporatist (and anti-proton outside of academia at present) and anti private-equity as well as anti-consolidation of community care by large, mostly urban academic medicine that has mastered regulatory capture.

I believe in largely public medicine, with decentralized care rooted in communities and centralized research with community enrollment emphasized.

I don't believe that the present republican party is representative of most conservative docs. A majority of national republican politicians are only marginally capable of independent decisions outside of the Trump brand at this point.

 

[deleted1111261]

This is why I still don’t get Astro making a stink about the election last year. Does not mean I’m justifying their actions. Politicians are my mercenaries to make my world a better place and I have no allegiance to labels and parties. If you do good for my family, for me and for my profession- you get my support. Right now, the Ds represent physicians much more strongly than the Rs (has not always been the case). But, some Rs get it, and they should be supported, as well.

 

[Lamount]

This is why I still don’t get Astro making a stink about the election last year. Does not mean I’m justifying their actions. Politicians are my mercenaries to make my world a better place and I have no allegiance to labels and parties. If you do good for my family, for me and for my profession- you get my support. Right now, the Ds represent physicians much more strongly than the Rs (has not always been the case). But, some Rs get it, and they should be supported, as well.

Would agree with this in general. In this specific situation, I do think that many in the GOP were against for reasons that have nothing to do with medicare cuts/APM... but rather because McConnel and Schumer attached a provision that would temporarily change the senate rules to allow the senate to increase the debt ceiling with a mere majority (rather than needing 60 votes). Raising the debt ceiling is extremely unpopular among the Trump wing of the GOP... so tying it to preventing medicare cuts was a way to get more people to allow the temporary rule change. Sausage-making at its finest!

 

[communitydoc13]

Raising the debt ceiling is extremely unpopular among the Trump wing of the GOP

Debt ceiling raised 3 times under Trump with ~8T increase in Fed debt. This was tied to tax cuts among other things. I believe McConnell has voted 30+ times for debt ceiling increases.

 

[Lamount]

Debt ceiling raised 3 times under Trump with ~8T increase in Fed debt. This was tied to tax cuts among other things. I believe McConnell has voted 30+ times for debt ceiling increases.

...to say nothing of the fact that we already owe the money. Voting to raise the debt ceiling is essentially voting to pay our bills.

 

[medgator]

Interesting that 40 Republicans either voted No or Present on the senate side. Physicians appear to be mostly Republican (I know this varies based on specialty), but I would say in general Republicans vote against our interest more often than that. It appears that physicians voters care more about non-Healthcare issues and than healthcare issues.

Specialty and age dependent.... There's an article about this somewhere.... Ortho and peds aren't in the same part of the field as an example iirc

 

[iradi8r]

I generally stay out of politics...

But a couple of observations.

1) The debt ceiling has nothing to do with defaulting on the national debt interest payments because the law of the land is such that those payments must be made first after collecting taxes. Then the remainder can be spent by the federal government.

"This year, the federal government will spend $300 billion on interest payments on the national debt. This is the equivalent of nearly 9 percent of all federal revenue collection and over $2,400 per household. The federal government spends more on interest than on science, space, and technology; transportation; and education combined. The household share of federal interest is larger than average household spending on many typical expenditures, including gas, clothing, education, or personal care."

So we will not default on the debt, we just will need to cut forward spending. Thus the government shuts down.

2) These votes are always weaponized by the opposing party.

3) Although I am glad the APM was delayed, tacking it on to a larger issue is very porky. This is how are government gets bloated.

4) Per CMS "

Background​

Since 2014, CMS has explored potential ways to test an episode-based payment model for RT services. In December 2015, Congress passed the Patient Access and Medicare Protection Act, which required the Secretary of Health and Human Services to submit to Congress a report on “the development of an episodic alternative payment model” for RT services. The report was published in November 2017. The report (PDF) identified three key reasons why RT is ready for payment and service delivery reform: the lack of site neutrality for payments; incentives that encourage volume of services over the value of services; and coding and payment challenges."

Thus this APM is clearly born of the democrats and carried to fruition by the CMS bureaucrats/administrators. It can only be stopped by congress. It can be modified by CMS

 

[thecarbonionangle]

Yeah! Trump loved the “democrat” APM so much he decided to double down and have his pharma crony Azar double down on it, then democrats killed their own baby or ate it or whatever they do. You be the judge,Q!

 

[iradi8r]

Yeah! Trump loved the “democrat” APM so much he decided to double down and have his pharma crony Azar double down on it, then democrats killed their own baby or ate it or whatever they do. You be the judge,Q!

If this is aimed at me clearly you mistake me for someone who gives a S..T about either party. My politics are just on the libertarian side of anarchy....

 

[thecarbonionangle]

If this is aimed at me clearly you mistake me for someone who gives a S..T about either party. My politics are just on the libertarian side of anarchy....

Na you good brotha. You in cook out, grab a beer, chug a beer.

 

[communitydoc13]

Na you good brotha. You in cook out, grab a beer, chug a beer.

iradi8r seems solid. Should get his/her libertarian ass to publish that reirradiation prostate series though to help the rest of us out!

 

[Lamount]

I generally stay out of politics...

But a couple of observations.

1) The debt ceiling has nothing to do with defaulting on the national debt interest payments because the law of the land is such that those payments must be made first after collecting taxes. Then the remainder can be spent by the federal government.

"This year, the federal government will spend $300 billion on interest payments on the national debt. This is the equivalent of nearly 9 percent of all federal revenue collection and over $2,400 per household. The federal government spends more on interest than on science, space, and technology; transportation; and education combined. The household share of federal interest is larger than average household spending on many typical expenditures, including gas, clothing, education, or personal care."

So we will not default on the debt, we just will need to cut forward spending. Thus the government shuts down.

2) These votes are always weaponized by the opposing party.

3) Although I am glad the APM was delayed, tacking it on to a larger issue is very porky. This is how are government gets bloated.

4) Per CMS "

Background​

Since 2014, CMS has explored potential ways to test an episode-based payment model for RT services. In December 2015, Congress passed the Patient Access and Medicare Protection Act, which required the Secretary of Health and Human Services to submit to Congress a report on “the development of an episodic alternative payment model” for RT services. The report was published in November 2017. The report (PDF) identified three key reasons why RT is ready for payment and service delivery reform: the lack of site neutrality for payments; incentives that encourage volume of services over the value of services; and coding and payment challenges."

Thus this APM is clearly born of the democrats and carried to fruition by the CMS bureaucrats/administrators. It can only be stopped by congress. It can be modified by CMS

Although it is, indeed, very porky... I suspect the initiative to delay the APM/CMS cuts and the initiative to raise the debt ceiling both benefited from each other. The debt ceiling made people care about the bill and created urgency, and delaying APM/CMS cuts made it hard to vote against. A master class in sausage-making.

 

[Radonc90]

Boys/girls...you all should write a thank you letter to Dr Join Luh et al (ASTRO team work etc.).
I am serious...

 

[TheWallnerus]

Boys/girls...you all should write a thank you letter to Dr Join Luh et al (ASTRO team work etc.).
I am serious...

Join is one of the most intelligent, humble, altruistic, "involved" ROs working today.

 

[elementaryschooleconomics]

You guys probably beat me to this and posted it in one of the other APM threads (perhaps even this one), but my brain can only retain only so many factoids per day.

Just saw a Tweet about the following editorial:

I think many of us have asked, regarding APM - if the goal is to save CMS money, what if, instead of imposing this poorly written model on small practices, we simply ended PPS-exemptions for the giant 11 academic centers it applies to?

So I guess that's the answer. Impose APM on "little RadOnc", save $46 million a year, jeopardize care in the community. End PPS-exempt status on 11 of the "big RadOnc" hospitals (literally just reimburse them the same as the rest of us), save $500 million a year, nothing is jeopardized. This...seems like the obvious solution, if CMS feels strongly about moving money away from RadOnc to pay for sketchy Alzheimer's drugs or some pill which extends PFS by a statistically significant 3 weeks.

Again, someone else probably brought this up already, but I missed this stat in the Anderson-approved CMS webinars.

 

[RickyScott]

You guys probably beat me to this and posted it in one of the other APM threads (perhaps even this one), but my brain can only retain only so many factoids per day.

Just saw a Tweet about the following editorial:

View attachment 346735

I think many of us have asked, regarding APM - if the goal is to save CMS money, what if, instead of imposing this poorly written model on small practices, we simply ended PPS-exemptions for the giant 11 academic centers it applies to?

View attachment 346736

So I guess that's the answer. Impose APM on "little RadOnc", save $46 million a year, jeopardize care in the community. End PPS-exempt status on 11 of the "big RadOnc" hospitals (literally just reimburse them the same as the rest of us), save $500 million a year, nothing is jeopardized. This...seems like the obvious solution, if CMS feels strongly about moving money away from RadOnc to pay for sketchy Alzheimer's drugs or some pill which extends PFS by a statistically significant 3 weeks.

Again, someone else probably brought this up already, but I missed this stat in the Anderson-approved CMS webinars.

Delay of apm must be a deep disappointment to those would benefit through competitive pricing advantage (MDACC) and those who were positioning to sell compliance software (Ben smith)?

 

[Ray D. Ayshun]

You guys probably beat me to this and posted it in one of the other APM threads (perhaps even this one), but my brain can only retain only so many factoids per day.

Just saw a Tweet about the following editorial:

View attachment 346735

I think many of us have asked, regarding APM - if the goal is to save CMS money, what if, instead of imposing this poorly written model on small practices, we simply ended PPS-exemptions for the giant 11 academic centers it applies to?

View attachment 346736

So I guess that's the answer. Impose APM on "little RadOnc", save $46 million a year, jeopardize care in the community. End PPS-exempt status on 11 of the "big RadOnc" hospitals (literally just reimburse them the same as the rest of us), save $500 million a year, nothing is jeopardized. This...seems like the obvious solution, if CMS feels strongly about moving money away from RadOnc to pay for sketchy Alzheimer's drugs or some pill which extends PFS by a statistically significant 3 weeks.

Again, someone else probably brought this up already, but I missed this stat in the Anderson-approved CMS webinars.

How about we just save $250,000,000, and reimburse everyone the same, but somewhere in the middle?

 

[elementaryschooleconomics]

Delay of apm must be a deep disappointment to those would benefit through competitive pricing advantage (MDACC) and those who were positing to sell compliance software (Ben smith)?

Even with the delay, an incalculable amount of money has been made (or spent) from the APM. Various enterprising individuals/LLCs were offering consulting services, and in addition to Ben Smith's EMR plugin, Varian was offering their $100k plugin as well (though it's unclear to me if transactions with Varian have occurred or were just proposed). I assume there are other pieces of software out there that could have been purchased?

My hospital had discussed hiring consultants, but ultimately decided to do as much as we could in-house while watching Congress. So while we didn't pay anyone directly with money, we definitely paid an opportunity cost in terms of time and effort getting ready.

It's honestly bewildering to think about, really. CMS poured an unknown amount of effort (personnel, salary, etc) into writing this model; institutions and practices paid an unknown cost in preparing for this model. In aggregate, likely thousands of hours across individual departments from existing employees, software developed and sold, independent agencies developing and selling consulting strategies, a special edition of a JCO journal dedicated to it, the machine of ASTRO/ACRO/AMA/ACR engaged to varying degrees, Tweet/letters/phone calls to Congress, legislation written and passed, and...for what?

All of this was meant, in some convoluted way, to "help patients", I think. So my question to the kind folks over at the CMS: are you accomplishing your mission? Are you contributing to the greater good? Is this going the way you hoped it would?

 

[TheWallnerus]

Even with the delay, an incalculable amount of money has been made (or spent) from the APM. Various enterprising individuals/LLCs were offering consulting services, and in addition to Ben Smith's EMR plugin, Varian was offering their $100k plugin as well (though it's unclear to me if transactions with Varian have occurred or were just proposed). I assume there are other pieces of software out there that could have been purchased?

My hospital had discussed hiring consultants, but ultimately decided to do as much as we could in-house while watching Congress. So while we didn't pay anyone directly with money, we definitely paid an opportunity cost in terms of time and effort getting ready.

It's honestly bewildering to think about, really. CMS poured an unknown amount of effort (personnel, salary, etc) into writing this model; institutions and practices paid an unknown cost in preparing for this model. In aggregate, likely thousands of hours across individual departments from existing employees, software developed and sold, independent agencies developing and selling consulting strategies, a special edition of a JCO journal dedicated to it, the machine of ASTRO/ACRO/AMA/ACR engaged to varying degrees, Tweet/letters/phone calls to Congress, legislation written and passed, and...for what?

All of this was meant, in some convoluted way, to "help patients", I think. So my question to the kind folks over at the CMS: are you accomplishing your mission? Are you contributing to the greater good? Is this going the way you hoped it would?

 

[deleted941485]

Even with the delay, an incalculable amount of money has been made (or spent) from the APM. Various enterprising individuals/LLCs were offering consulting services, and in addition to Ben Smith's EMR plugin, Varian was offering their $100k plugin as well (though it's unclear to me if transactions with Varian have occurred or were just proposed). I assume there are other pieces of software out there that could have been purchased?

My hospital had discussed hiring consultants, but ultimately decided to do as much as we could in-house while watching Congress. So while we didn't pay anyone directly with money, we definitely paid an opportunity cost in terms of time and effort getting ready.

It's honestly bewildering to think about, really. CMS poured an unknown amount of effort (personnel, salary, etc) into writing this model; institutions and practices paid an unknown cost in preparing for this model. In aggregate, likely thousands of hours across individual departments from existing employees, software developed and sold, independent agencies developing and selling consulting strategies, a special edition of a JCO journal dedicated to it, the machine of ASTRO/ACRO/AMA/ACR engaged to varying degrees, Tweet/letters/phone calls to Congress, legislation written and passed, and...for what?

All of this was meant, in some convoluted way, to "help patients", I think. So my question to the kind folks over at the CMS: are you accomplishing your mission? Are you contributing to the greater good? Is this going the way you hoped it would?

The vultures were definitely circling. I can remember getting a freaking DM on linked in from a rep from cyberknife. He opens with...now that APM is in effect your gonna need to use CK to accomplish faster treatments with SBRT and SRS. It was almost like he was gloating like"HA! got you now use my product".

I was in a saucy kind of mood and I responded and told him my linac gets the job done just as well and provides more value than a CK. I sincerely hope he goes home and slits his wrists

 

[Chartreuse Wombat]

The vultures were definitely circling. I can remember getting a freaking DM on linked in from a rep from cyberknife. He opens with...now that APM is in effect your gonna need to use CK to accomplish faster treatments with SBRT and SRS. It was almost like he was gloating like"HA! got you now use my product".

I was in a saucy kind of mood and I responded and told him my linac gets the job done just as well and provides more value than a CK. I sincerely hope he goes home and slits his wrists

Accuray is behind the initial legislative language...Hear it from a friend

 

[deleted941485]

Accuray is behind the initial legislative language...Hear it from a friend

In 2021, there isn't really anything appealing about that device from a practical clinical POV. The CK machines I have seen are either barely used or have been decommissioned and are accumulating dust. The work load was shifted to the linac a long time ago.

 

[RickyScott]

In 2021, there isn't really anything appealing about that device from a practical clinical POV. The CK machines I have seen are either barely used or have been decommissioned and are accumulating dust. The work load was shifted to the linac a long time ago.

I don’t see how the cyberknife benefits from the apm. True beam much more versatile and quicker at delivering sbrt.