Rumor: major NCI/academic rad onc (large) satellite program in deep South says it's treating nearly as many OA/benign patients as cancer. Could that be true.
-
CycleTrack and SDN are teaming up to make medical school admissions more transparent and accessible! Read the announcement to learn how we’re supporting the future of CycleTrack’s free application-tracking tools .
Rumor time
Started by TheWallnerus
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
another one....I have second hand info of a community hospital based clinic running two linacs....each treating around 20 patients. One is only arthritis and same throughput as the cancer linac.
as Dana Carvey/Johnny Carson used to say "that is wild stuff." (I was working with a community clinic recently and the previous older rad onc there said he was "not comfortable" treating arthritis. Not comfortable for what reasons I do not know.)
A physicist asked me about opening a derm/Ortho rads center and wondering about the feasibility. Rad onc really does lend itself to a multi specialist setup just never thought it would direct Ortho/rheum/PCP referrals as a major source
I am very comfortable with it....the logistics/work flow, getting that Goldilocks level of volume on it is the challenge. You can't inundate staff with hunting down arthritis records while your head/neck cancer patient referral needs a work up in a more timely manner.
I think once you get in-house work flows built it's a nice volume booster from what I can tell. but going "all in" on advertising and pushing LDRT can overwhelm staff and clinic time if you are already running on a skeleton crew.
I know this is not new info to you (or probably most here)...but I have seen some frustrations with colleagues dabbling more in the arthritis game.
I can't imagine that many level 1 or level 2 arthritis treatments could keep the lights on ....
Now adding it to your pre-existing volume without increasing major staff time is a nice feather in cap...but I can't imagine a derm/Ortho rads place could stay open with the new 2026 delivery codes.
Where are they getting all the volume? Docs here don’t want to refer. They think it is bogus. It works but it’s not magic.
I'll just leave this here: Non-Invasive Joint Pain Relief & Treatment | JointGlow
This is why we can’t have nice things.
I think it’s feasible if you bought one of those orthovoltage machines being sold at ASTRO for 300k. They advertised ability to treat arthritis and skin.
The math can definitely math as the kids say.
Back of envelope calcs (YMMV) suggest there are about as many chronic plantar fasciitis cases per year in US as breast and prostate cancer combined. (WAAYYY more PF cases, overall.)
Supposedly rad oncs follow published evidence and established guidelines... and orthovoltage would probably be a great machine for ~100% of all PF cases.
The "volume" reality is that cancer is relatively very uncommon versus many other conditions that are likewise irradiateable. Radiation has a pretty low utilization rate in (de novo) cancer overall; about 1 in 4 and ever falling. IMHO about 1 in 4 is the right utilization rate in PF (and OA)... but 25% of those diagnoses getting RT is theoretically a big volume.
Last edited:
FletchersGarb
Full Member
Juts visited a large community hospital department and looked through OTV list; 25% patients under the beam are arthritis, just large joints
I'm going to push as I always have whenever I disagree with eviCore. If they end up denying after appeal then cash pay it would have to be. Cash pay is very, very common in the pain treatment world, and I don't think it's as world-crumbling as it would be in oncology care.
What's a good price? $2000? $1500? Do you throw in 2nd course for half price?
I agree - it isn't the end of the world to do this + it is not cancer - it still feels cringe
I agree - it isn't the end of the world to do this + it is not cancer - it still feels cringe
Each clinic/department has a way to convert insurance pay to cash pay, so that process can simply be followed. I disagree that it's cringe. To quote the great Jeremy Irons: "We are selling to willing buyers at the current fair market price". Only difference here is that the data shows there may be a benefit, unlike with subprime
The universe of patients willing to pay that is probably fairly limited, especially if they have presumably already paid for an insurance product that is supposed to cover it in the first place.
We use Medicare rates for self pay. Cheaper than what commercial would typically be
In my experience patients are very used to insurance not paying for pain procedures and are very willing to pay cash out of pocket.
This is the cringe part to me at least.
My cash pay price is benchmarked to the prices hospitals bill out to insurance, often medicare.
So... not a rate set by a cash pay market. My cash pay price is substantially more expensive than a corticosteroid injection, even if I forgo the sim and use a diagnostic CT instead (usually covered by insurance).
Evicore could not have made it more obvious that they’re doing this for money and no other reason. They literally erased all their paragraphs in support of benign just months before this complete 180 that happens to coincide with more clinics starting to offer it.
Just appeal every single one to their denials to the highest level. Insurers will get sick of appeals to the state, reverse the decisions and cancel their contracts with Evicore. We have randomized evidence with Bobby’s study.
We are more in the driver’s seat than we think, but we gotta do the work. I personally love getting on the phone with Evicore and telling them off. Some part of me is excited about this.
Just appeal every single one to their denials to the highest level. Insurers will get sick of appeals to the state, reverse the decisions and cancel their contracts with Evicore. We have randomized evidence with Bobby’s study.
We are more in the driver’s seat than we think, but we gotta do the work. I personally love getting on the phone with Evicore and telling them off. Some part of me is excited about this.
Honestly, who has the time/resources for this for arthritis treatments?
I'll make time. Can't let them get away with it.
Back office staff resources are in short supply but rad onc’s in general are not that busy. Unless you are treating 700+ new patients a year without a midlevel and you’re motivated to keep your time at work under 45 hours. Then yeah, the back and forth with evicore is probably not worth it.
I've decided that I don't. I treat a very sick difficult rural population and I've held off on going full on arthritis because I value my sanity and free time more than the slight bump in pay. Now I'm very glad I held off - if things change with the auths I'll open it up.
More like I went into this to be in the oncology space and work with those patients. I just don't have the same level of passion about anything that can be treated with a linac. I'm not saying others don't or that its not useful/helpful. But if payers say they are not covering this I will just move on.
Ya this is where I'm at with it.
