The proposed CMS alternative payment model has arrived

[deleted941485]

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Also, doesn’t CMS every now and then make these ridiculous proposed cuts like 15-20% across the board and then after a comment period walk it back to like 1-2% just so they can come back next year and repeat again?

 

[DukeNukem]

My malignant "academic" employer is already increasing my RVU expectations for the same (low) salary and lowering my (meager) bonus potential next year in preparation for the reimbusement changes. Is this happening to anyone else?

 

[RickyScott]

My malignant "academic" employer is already increasing my RVU expectations for the same (low) salary and lowering my (meager) bonus potential next year in preparation for the reimbusement changes. Is this happening to anyone else?

i thought they were only testing it out in 5 regions which have not yet been named. the chances of you being in one of 5 regions is probably low, so to go ahead and pre-emptively reduce salaries based on this excuse is just an example of exploitation taking place because of oversaturation of residents.

 

[DukeNukem]

Yeah you're probably right. Got a 5% pay raise last year and a 10% bonus because I had exceptional productivity by all metrics and perfect patient satisfaction scores.

I think they're mad that happened, so now they're cutting my benefits to offset the pay increase and getting me back down in bonus.

The national changes are probably a false alarm, red herring, etc.

Rad onc: a great specialty in which to waste your talent.

 

[medgator]

i thought they were only testing it out in 5 regions which have not yet been named. the chances of you being in one of 5 regions is probably low, so to go ahead and pre-emptively reduce salaries based on this excuse is just an example of exploitation taking place because of oversaturation of residents.

I thought it was mandatory for 40% of the specialty?

 

[deleted941485]

Yeah you're probably right. Got a 5% pay raise last year and a 10% bonus because I had exceptional productivity by all metrics and perfect patient satisfaction scores.

I think they're mad that happened, so now they're cutting my benefits to offset the pay increase and getting me back down in bonus.

The national changes are probably a false alarm, red herring, etc.

Rad onc: a great specialty in which to waste your talent.

Most of the shops (PP and community) I have talked to have already cancelled any plans for new hires regardless of weather or not they are selected for the payment model They fully expect that no
Matter What happens with this program. there is more downside risk than upside. Even if they find the program ineffective CMS will just continue to reduce payments across he board anyway.

 

[Irradi8or]

The purpose of the model is to reduce expenditures - no doubt about that. It'll hurt both the slow adopters of hypofx and the early/appropriate adopters (as written, may hurt the early adopters/efficient practices more). However, financial exposure in the model may not be great as it's only straight Medicare patients and no MA. Looking at my payer mix, this is actually a relative small proportion of my patients, as majority of my medicare patients have a secondary/MA plan. How about the rest of you?

 

[Reaganite]

The purpose of the model is to reduce expenditures - no doubt about that. It'll hurt both the slow adopters of hypofx and the early/appropriate adopters (as written, may hurt the early adopters/efficient practices more). However, financial exposure in the model may not be great as it's only straight Medicare patients and no MA. Looking at my payer mix, this is actually a relative small proportion of my patients, as majority of my medicare patients have a secondary/MA plan. How about the rest of you?

I think its naive to think this wont impact commercial rates. Many payors reimburse as a percentage of prevailing medicare rates.

 

[Irradi8or]

I think its naive to think this wont impact commercial rates. Many payors reimburse as a percentage of prevailing medicare rates.

No name calling please. I agree this will eventually impact rates, but not immediately. Also, the adjustments on this Model are hard to follow and I already have APM bundled payment relationships with several commercial payers. I've been discussing this Model with them as well. However, it's unclear how quickly those other will follow suit.

 

[xrthopeful]

Most of the shops (PP and community) I have talked to have already cancelled any plans for new hires regardless of weather or not they are selected for the payment model They fully expect that no
Matter What happens with this program. there is more downside risk than upside. Even if they find the program ineffective CMS will just continue to reduce payments across he board anyway.

Yo this sounds like bs lol

Who all have you talked to? Two guys?

 

[medgator]

Yo this sounds like bs lol

No different than the folks trying to tell us how great the RO job market is these last couple of years

 

[Reaganite]

No name calling please. I agree this will eventually impact rates, but not immediately. Also, the adjustments on this Model are hard to follow and I already have APM bundled payment relationships with several commercial payers. I've been discussing this Model with them as well. However, it's unclear how quickly those other will follow suit.

Definitely didnt intend for it to be a disparaging comment...at the same time, do any of us believe the payors we bemoan here who use evicore, deny evidence based imrt, find any way they can not to pay us, etc. arent going to take their golden opportunity to cut rates in response to medicare cuts?

 

[medgator]

Definitely didnt intend for it to be a disparaging comment...at the same time, do any of us believe the payors we bemoan here who use evicore, deny evidence based imrt, find any way they can not to pay us, etc. arent going to take their golden opportunity to cut rates in response to medicare cuts?

Evicore and payors like Cigna, Humana etc couldn't adopt breast Hypofx fast enough when Astro updated its guidelines, yet still continue to deny approvals for imrt in locally advanced/stage III lung despite the data coming out from 0617.

This should really surprise no one and if commercials sniff a way to cut reimbursement from CMS, they'll implement it yesterday

 

[scarbrtj]

Like a dumb American citizen who hadn’t read the Mueller report, I hadn’t thoroughly read CMS’ RO model proposal. Well I’ve read both now. The Mueller report was inscrutable and wishy-washy. But CMS’ report is clear in its genesis and goals: the push to hypofractionation. You can read it between most of the lines: “You guys have all these short treatments now and so why are we still paying you so much damn money?” CMS is trying to dictate care—incentivize one form, disincentivize others—here. THIS SHOULD HAVE BEEN THE PURVIEW OF DOCTORS ONLY. But alas we’ve all been asleep at the wheel or playing silly oneupmanship games of how low can you go. You had to be a total dummy not to see this coming.

 

[Gfunk6]

ASTRO has finally issued a draft response to CMS regarding the RO APM.

Document attached

Here is the TL;DR version:

1. In general ASTRO agrees with the spirit and intent of the RO APM. Therefore the crux of their response is to make it better/delay implementation rather than get rid of it.

2. Don't make participation mandatory - make it voluntary up-front like OCM

3. The case rates per ICD-10 code are flawed. For instance, brain mets or bone mets takes into account palliative, two-beam treatment rather than SRS/SBRT. These case rates need to be bumped up a bit.

4. If practices have already adopted hypofractionation, then they will be penalized because the RO APM is trying to reduce existing costs by provider. These practices/providers should therefore not be penalized for "doing the right thing."

5. Eliminate 5% waiver on incentive payments to freestanding centers [not certain what this is, could nof find it in original APM proposal. Anyone with insights?]

6. New technology (e.g. MRI guided linacs) should be paid fee-for-service for a limited time so as to not hurt programs that upgrade.

7. Delay most requirements until at least July 2020.

 

[deleted941485]

ASTRO has finally issued a draft response to CMS regarding the RO APM.

Document attached

Here is the TL;DR version:

1. In general ASTRO agrees with the spirit and intent of the RO APM. Therefore the crux of their response is to make it better/delay implementation rather than get rid of it.

2. Don't make participation mandatory - make it voluntary up-front like OCM

3. The case rates per ICD-10 code are flawed. For instance, brain mets or bone mets takes into account palliative, two-beam treatment rather than SRS/SBRT. These case rates need to be bumped up a bit.

4. If practices have already adopted hypofractionation, then they will be penalized because the RO APM is trying to reduce existing costs by provider. These practices/providers should therefore not be penalized for "doing the right thing."

5. Eliminate 5% waiver on incentive payments to freestanding centers [not certain what this is, could nof find it in original APM proposal. Anyone with insights?]

6. New technology (e.g. MRI guided linacs) should be paid fee-for-service for a limited time so as to not hurt programs that upgrade.

7. Delay most requirements until at least July 2020.

So ASTRO doesn’t like it but k owns it’s inevitable so basically stalling for time. Which I hate to say it might not be the worst decision.

Why don’t they just wait until after he election in a year?

I mean Christ by the time you get a chance to retool your practice for APMs. The new administration is going to want to rework whatever deals the prior one has set.

Hell you might not even have a practice by the end of 2021.

 

[medgator]

Hell you might not even have a practice by the end of 2021.

Private practice still exists in the UK and Canada

 

[deleted941485]

Private practice still exists in the UK and Canada

Hahahahaha. Yeah I’ll send my resume right over. Cant wait to enter “private” practice in the Medical socialist paradise so many lucrative opportunities. Give me a break.

Medgator, I respect you but don’t insult the collective intelligence of the people on this board with nonsense like this.

 

[medgator]

Hahahahaha. Yeah I’ll send my resume right over. Cant wait to enter “private” practice in the Medical socialist paradise so many lucrative opportunities. Give me a break.

Medgator, I respect you but don’t insult the collective intelligence of the people on this board with nonsense like this.

Tell me about all those Canadian doctors living under bridges. Have you even met one? Lol give me a break.

Btw, pmh is one of the few listings on the ASTRO site that actually lists a salary range (FFS compensation structure?!?!?) Not exactly going to be signing up for medicaid with that

American Society for Radiation Oncology (ASTRO), ASTRO Radiation Oncology Career Center|Find Your Career Here

American Society for Radiation Oncology (ASTRO) - Find your next career at ASTRO Radiation Oncology Career Center. Check back frequently as new jobs are posted every day.

careers.astro.org

Canada figured out long ago that private needed to exist alongside its government run UHC

Canada's Private Clinics Surge as Public System Falters (Published 2006)

The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise. Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients...

www.nytimes.com

Quit trolling with the FUD until you have something to back it up

 

[taserlaser]

I would say private practice RO is essentially nil in Canada. FFS does not necessarily mean PP.

 

[medgator]

I would say private practice RO is essentially nil in Canada. FFS does not necessarily mean PP.

Similar compensation structure, as opposed to being salaried with some unattainable rvu bonus structure

 

[deleted941485]

Tell me about all those Canadian doctors living under bridges. Have you even met one? Lol give me a break.

Btw, pmh is one of the few listings on the ASTRO site that actually lists a salary range (FFS compensation structure?!?!?) Not exactly going to be signing up for medicaid with that

American Society for Radiation Oncology (ASTRO), ASTRO Radiation Oncology Career Center|Find Your Career Here

American Society for Radiation Oncology (ASTRO) - Find your next career at ASTRO Radiation Oncology Career Center. Check back frequently as new jobs are posted every day.

careers.astro.org

Canada figured out long ago that private needed to exist alongside its government run UHC

Canada's Private Clinics Surge as Public System Falters (Published 2006)

The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise. Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients...

www.nytimes.com

Quit trolling with the FUD until you have something to back it up

Lol. Dude I don’t know what you took this morning or the screed you just posed. Or what it supposedly proves.

They’re ain’t no PP rad Onc in Canada. Quit trolling.

Doctors under bridges? Red herring man totally beneath you.

 

[medgator]

Lol. Dude I don’t know what you took this morning or the screed you just posed. Or what it supposedly proves.

They’re ain’t no PP rad Onc in Canada. Quit trolling.

Doctors under bridges? Red herring man totally beneath you.

Ok so you like the salaried structure with a possible rvu bonus working for an MBA here. Got it.

Not sure how FFS in Canada is some awful socialist situation to work in compared to that

 

[deleted941485]

Ok so you like the salaried structure with a possible rvu bonus working for an MBA here. Got it.

Not sure how FFS in Canada is some awful socialist situation to work in compared to that

Come on. You made a ridiculous statement about PP in socialized countries. Just own it. Most if not all rad oncs in the UK or Canada will
Never see anything like what we have in the US. They just don’t happen.

The whole public/private healthcare is nonsense too in other countries where it’s like 90/10 anyway and doesn’t even really apply to oncology.

It’s preposterous to even have this debate but his is RO and this is what we do.

 

[medgator]

Come on. You made a ridiculous statement about PP in socialized countries. Just own it. Most if not all rad oncs in the UK or Canada will
Never see anything like what we have in the US. They just don’t happen.

Did you even click on the posting for PMH that I linked to? They aren't exactly making peanuts treating everyone with radium needles and Cobalt machines run by horses

 

[deleted941485]

Did you even click on the posting for PMH that I linked to?

Dude I’ve already seen and viewed this job on several occasions on several classifieds. Its been floating around. It’s an academic job at known academic center that expects you do to do academic things and only proves my point.

PP RO is not a thing in Canada.

 

[medgator]

PP RO is not a thing in Canada.

But good ol capitalist FFS is. Glad we cleared that up

 

[deleted941485]

But good ol capitalist FFS is. Glad we cleared that up

You are all over the place.

You made a false statement about PP in Canada for rad Onc then went on a rampage about FFS and then capitalism.

Take the night off seriously.

 

[medgator]

You are all over the place.

You made a false statement about PP in Canada for rad Onc then went on a rampage about FFS and then capitalism.

Take the night off seriously.

Says the guy who started it all by ranting about "socialist" medical systems he's never actually experienced

 

[OTN]

Physicians in Canada across specialties are paid well for a single-payer system because they all have the option of bailing to the US if things get bad. If the US goes to a single-payer system I would fully expect Canadian physician incomes to also drop.

 

[imhopeful432]

ASTRO has finally issued a draft response to CMS regarding the RO APM.

Document attached

Here is the TL;DR version:

1. In general ASTRO agrees with the spirit and intent of the RO APM. Therefore the crux of their response is to make it better/delay implementation rather than get rid of it.

2. Don't make participation mandatory - make it voluntary up-front like OCM

3. The case rates per ICD-10 code are flawed. For instance, brain mets or bone mets takes into account palliative, two-beam treatment rather than SRS/SBRT. These case rates need to be bumped up a bit.

4. If practices have already adopted hypofractionation, then they will be penalized because the RO APM is trying to reduce existing costs by provider. These practices/providers should therefore not be penalized for "doing the right thing."

5. Eliminate 5% waiver on incentive payments to freestanding centers [not certain what this is, could nof find it in original APM proposal. Anyone with insights?]

6. New technology (e.g. MRI guided linacs) should be paid fee-for-service for a limited time so as to not hurt programs that upgrade.

7. Delay most requirements until at least July 2020.

Regarding the 5% bonus. The professional participants get a 5% bonus for being in the APM due to CMS rule saying that any practice participating in an advanced APM gets a 5% bump.

But the document states that the technical fees do not get the 5% bump because the way that MACRA law is written - it only applies to the actual physician payments. The problem is that the RO-APM model includes significant discounts (to save Medicare money) on both the professional and technical side. On average, rad oncs nationally will make it up on the professional side due to the 5% Advanced APM bonus, but they'll lose on the technical side because of the discounts without the 5% APM bonus.

So ASTRO is saying either 1) Reduce the discounts or 2) give the 5% APM bonus to technical payments too.