Where is the ASTRO response/guidance on how clinics should be operating amid the coronavirus outbreak?

[evilbooyaa]

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Temporarily disagreeing. As your understanding grows more fulsome the disagreement will disappear 🙂 Just like the direct supervision mandate disappeared... which I recall folks 'round here saying would never happen. But we were a supervision island in an ever more turbulent river so it wasn't hard to read the tea leaves. It's tough to predict the future, but if things are already happening (supervision relaxations, "telehealth," etc.) doesn't it become easier? No one can be sure anything currently underway today will be temporary or that previously reliable things will continue to exist. Telehealth and general supervision streamlines healthcare delivery in positive ways. CMS told ASTRO general supervision never damaged a single DNA base pair as far as they could tell (much to ASTRO's chagrin). From my limited experience thus far, telehealth seems to be a net positive too.

I no longer have to ask "use your imagination." Now I can say use your eyes.

I think you are too focused on Rad Onc as a specialty and missing the widespread changes that are being made or at least proposed as part of the response to COVID-19.

Do we think trauma docs running pneumonia/URI ICU patients will be normal after COVID-19?

Do we think people who are not in primarily hospital-based medicine are going to contniue doing inpatient admissions on viral illnesses after COVID-19 passes?

Do we think all the lockdowns that are being put nation and worldwide are not going to be lifted after COVID-19?

Do we think that the NBA/NHL will never come back after COVID-19?

This path of creating a trend with 2 data points leads to conclusions that seem illogical and silly. Again, I'm not saying that CMS may not change the rules permanently (just like they did with direct vs general supervision at hospital based practices), I was mostly trying to get away from calling ASTRO hypocritical. I'm glad to see the goal posts are being moved though as we now discuss whether this change for freestanding centers will become permanent - that means I'm winning.

 

[Mandelin Rain]

If there was at federal rule stating "there will be no more professional basketball games" that the NBA was actively fighting and then the NBA came out and said, "in our estimation there should be no professional basketball, but we also think there should be no college, highschool, or youth basketball", I think it'd be highly unlikely that you'd see the NBA again.

ASTRO faced a long uphill task to have CMS reconsider the rule. Whatever the cause, asking for the exact opposite, hurts their case. It would be like making a plan to climb Everest, and once you get to the base you grab a shovel and start digging.

 

[deleted1002574]

They are not okay (until 2 days ago) with a freestanding center's physician taking an emergency few hours off. Well, for Medicare patients. Clearly, the risk does not apply to non-Medicare patients, who can be safely treated without physician presence.

 

[scarbrtj]

I was mostly trying to get away from calling ASTRO hypocritical. I'm glad to see the goal posts are being moved though as we now discuss whether this change for freestanding centers will become permanent - that means I'm winning.

Ok Charlie Sheen but if supervision changes for good in the future it proves the previous policy was hypocritical.

 

[evilbooyaa]

Ok Charlie Sheen but if supervision changes for good in the future it proves the previous policy was hypocritical.

No it doesn't. Separate out the issues at play here instead of lumping everything together. Supervision changes are not ASTRO's purview. They are CMS's purview.

Difference between ASTRO's position changing in response to COVID-19 (what is being called hypocritical) and what CMS deems is necessary as the minimum standard (of which they can tell ASTRO to shove it with zero consequences).

I am arguing against the former, while we seem to have moved the goal posts to the latter. I'm not disagreeing that CMS may eliminate all supervision requirements in the future, they would be within their right to do so, just as they did for hospital based facilities prior to the outbreak.

Now if ASTRO comes out in the future, after COVID-19 passes, and publishes a statement "Please allow for general supervision or supervision by non rad oncs", then you'll have a leg to stand on in calling their previous policy hypocritical. Whether CMS changes the rules or not has no bearing on whether ASTRO is hypocritical.

 

[deleted1002574]

If the reason for supervision is propping up reimbursements/job market under the guise of safety, I guess we should be supportive of that.

 

[w00tz]

I feel like I've gotten an uptick of calls and emails from locum recruiters. I know people aren't going on vacation. Maybe there are a bunch of rad oncs that are quarantined or out sick.

 

[RadOncDoc21]

I feel like I've gotten an uptick of calls and emails from locum recruiters. I know people aren't going on vacation. Maybe there are a bunch of rad oncs that are quarantined or out sick.

Definitely not attending conferences... hmmm

 

[seper]

I'd believe it. I know of one place where all attending are getting quarantined for 7 days due to possible exposure

I feel like I've gotten an uptick of calls and emails from locum recruiters. I know people aren't going on vacation. Maybe there are a bunch of rad oncs that are quarantined or out sick.

 

[radoncgrad2019]

I’ve been getting people BEGGING for Locums

I said ‘not today!’

 

[radoncgrad2019]

Ok Charlie Sheen but if supervision changes for good in the future it proves the previous policy was hypocritical.

Scarb got his hand stuck in cookie jar and now claims the cookies should have been his all along.

Come on man. DO. NOT. GO. THERE

 

[scarbrtj]

Scarb got his hand stuck in cookie jar and now claims the cookies should have been his all along.

Come on man. DO. NOT. GO. THERE

1001!

 

[medgator]

1001!

You have quite a fan

 

[RickyScott]

I'd believe it. I know of one place where all attending are getting quarantined for 7 days due to possible exposure

That’s against cdc guidelines now. Thought I saw that Health care workers should not be qurantined unless show symptoms per us gov?

 

[RollTideRadOnc]

One thing I hope COVID19 destroys is the corrupt academic conference culture. It’s should be a crime how public universities and NIH funded departments support faculty members taking lavish trips for what we all know are windowdressed vacations with stays at the Hyatt and outrageous per diems to blow at the bar. It just disgusts me. Maybe this pandemic will force a reexamination. But probably not. *sigh*

 

[radoncgrad2019]

One thing I hope COVID19 destroys is the corrupt academic conference culture. It’s should be a crime how public universities and NIH funded departments support faculty members taking lavish trips for what we all know are windowdressed vacations with stays at the Hyatt and outrageous per diems to blow at the bar. It just disgusts me. Maybe this pandemic will force a reexamination. But probably not. *sigh*

Not just academic practices, tons of people have CME money.

Stay mad!

 

[thecarbonionangle]

One thing I hope COVID19 destroys is the corrupt academic conference culture. It’s should be a crime how public universities and NIH funded departments support faculty members taking lavish trips for what we all know are windowdressed vacations with stays at the Hyatt and outrageous per diems to blow at the bar. It just disgusts me. Maybe this pandemic will force a reexamination. But probably not. *sigh*

frothing at mouth a bit? You mad bro? Don’t hate the player hate the game.

 

[seper]

That’s against cdc guidelines now. Thought I saw that Health care workers should not be qurantined unless show symptoms per us gov?

Being radiation oncologists, all three exposed attendings “show mild symptoms”. There is very little that we can do to help the society right now. The best thing is to stay home and take care of family.


Sent from my iPhone using SDN

 

[Neuronix]

One thing I hope COVID19 destroys is the corrupt academic conference culture. It’s should be a crime how public universities and NIH funded departments support faculty members taking lavish trips for what we all know are windowdressed vacations with stays at the Hyatt and outrageous per diems to blow at the bar. It just disgusts me. Maybe this pandemic will force a reexamination. But probably not. *sigh*

Where do I get that job? I could maybe have one trip like that a year with my travel budget. I make it stretch to a couple a year by going on a tight budget, staying at non conference hotels, and paying for some out of my own pocket.

--Academic rad onc attending

 

[KHE88]

You have quite a fan

You're doing something right then if you've earned the privilege of being on his/her/other naughty list. Welcome to the club!

I’ve been getting people BEGGING for Locums

I said ‘not today!’

I would think locums could absolutely crush it in this market. When the prospect is not being able to bill technical and pro for OTVs, I could see admin paying out $5000+/day if their only other option was forgoing billing.

On one hand, we should be stepping up and volunteering fighting this war and not worrying about money.
On the other, hospital admin is focused on retaining their revenue stream and how to bill for telemedicine and spend as little money as possible on this crisis. But as long as the hospital is still sending patients bills, pay up.

Great, great essay from an ED doc posted today. I am struggling to refrain emailing this directly to our CEO:

 

[RadOncDoc21]

We’re all just one patient or coworker slipping through the cracks.

 

[medgator]

We’re all just one patient or coworker slipping through the cracks.

https://www.washingtonpost.com/health/2020/03/21/coronavirus-testing-strategyshift/

Health officials in New York, California and other hard-hit parts of the country are restricting coronavirus testing to health care workers and people who are hospitalized, saying the battle to contain the virus is lost and the country is moving into a new phase of the pandemic response.

As cases spike sharply in those places, they are hunkering down for an onslaught, and directing scarce resources where they are needed most to save people’s lives. Instead of encouraging broad testing of the public, they’re focused on conserving masks, ventilators, intensive care beds — and on getting still-limited tests to health care workers and the most vulnerable. The shift is further evidence that rising levels of infection and illness have begun to overwhelm the health care system.

Health officials are struggling with a complicated message — more people can get tested, but those with mild symptoms should stay home and practice social distancing. Some go so far as to warn that widespread testing at this point could threaten the U.S. response by burning through precious supplies just as a tidal wave of sick people descend on the system

 

[Carotenoid]

Radiation oncologists should robustly exercise robust caution with themselves and their patients while upholding quality, safety, and best practices. We encourage you to prudently take precautionary measures in difficult times and circumstances.
(i was able to craft such an insightful statement after attending a leadership course by ASTRO)

LOVE IT!

 

[Carotenoid]

It's pretty disingenuous for ASTRO to be arguing out of both sides of it's mouth on this issue.

Either not having physician supervision is unsafe and shouldn't be done, or it's not.

It isn't essential for the patient. But it IS essential for revenue. Half the graduating residents would be unemployed (at least in rad onc) if they weren't hired to babysit a machine at MDACC/Yale/Duke/WashU/Baylor/etc etc etc satellite

 

[Carotenoid]

so here's the thing

1) ASTRO has rationale to support supervision rules because this keeps the job market afloat. If supervision rules did not exist, jobs would disappear. this is what ASTRO is supposed to do.
2) Makes sense from CMS perspective to have allowed for the rural exception in interest of public health and access to care
3) all sorts of rules are out the window in the COVID era. this is true for way more important and widespread things than rad onc supervision, but it is true for supervision as well.

none of this (to me) is controversial or confusing. Some of you are playing a constant game of GOTCHA!, when there's nothing to be got.

now u truckin', man!

 

[Carotenoid]

That's gold

gorg

 

[Carotenoid]

I agree with you. Calling it the Wuhan flu is stupid. It's not an influenza strain. But trying to say it's racist or somehow insensitive for doing so is equally as stupid. I have no idea what the motivations are for people to point out that it came from China. But China is not blameless in this in regards to the activities with the exotic meat markets and the way it was mishandled initially. Calling it the Wuhan virus is not the same thing as calling AIDS the gay plague. I don't understand how it's insensitive to refer to diseases as to where they originated. As if the people there are somehow dirtier or something? I'm not sure what's going through people's heads sometimes, but IMO getting upset about saying whether or not this came from China or a foreign country is PC-culture run amok.

China is decimating the wildlife on multiple continents... all the pangolin scales they need, tiger penises, elephant tusks, bear bile... They are absolutely complicit in the COVID epidemic as well - through their blatant disregard for nature.
This, of note, does not mean that EVERY Chinese person (or person of Chinese descent) should be a priori judged to be a villain. There are plenty of scientists and animal right activists in China and in Chinese communities abroad, and most of the rural/less educated people cannot be held accountable since they literally "do not know what they are doing". But one would think that a totalitarian regime like theirs would try and "educate".
I hope this COVID situation instils - in all of us - more respect for our non-human neighbors.

 

[thecarbonionangle]

Some people here WEAK on China!!!

 

[radoncgrad2019]

It isn't essential for the patient. But it IS essential for revenue. Half the graduating residents would be unemployed (at least in rad onc) if they weren't hired to babysit a machine at MDACC/Yale/Duke/WashU/Baylor/etc etc etc satellite

Baylor has no satellites.

Baylor terrible tho don’t get it twisted

 

[KHE88]

China is decimating the wildlife on multiple continents... all the pangolin scales they need, tiger penises, elephant tusks, bear bile... They are absolutely complicit in the COVID epidemic as well - through their blatant disregard for nature.
This, of note, does not mean that EVERY Chinese person (or person of Chinese descent) should be a priori judged to be a villain. There are plenty of scientists and animal right activists in China and in Chinese communities abroad, and most of the rural/less educated people cannot be held accountable since they literally "do not know what they are doing". But one would think that a totalitarian regime like theirs would try and "educate".
I hope this COVID situation instils - in all of us - more respect for our non-human neighbors.

I'm with you on this. Animal rights abuses in China is a major hot button issue of mine. All of this is basically China's fault, with their open air exotic meat markets that have been responsible for basically every prior novel flu and coronavirus outbreak. The Chinese government was aware of the situation a long time ago and tried to hide it, "disappeared" those early on who tried to bring it to light, and lied to the WHO, and the WHO was dumb enough to believe them.

So given that, is Trump's intentional labeling it the "Chinese virus" wrong? I honestly don't think so. This is his way of reminding everyone to hold them (the Chinese government, not Chinese people) accountable. The accusations by the media that he is calling it that to wink and nod at xenophobes to carry out attacks of violence against Chinese people is absurd and horribly dishonest. Only a fool would believe that this is the fault of some random Chinese person. But to let the Chinese government off the hook for this because we are afraid of offending people? How do we shut down the meat markets and the horrible Chinese traditional "medicine" trade in exotic animals when virtue-signalers will say it's culturally insensitive to attack their traditions, even through these tradiations are barbaric by any objective measure? Trump's delivery is obviously, well crude, because that's the way he is. But how do we talk about this and stop this from happening over and over? The Chinese authoritarian government is total garbage and sometimes I wonder if we made a mistake opening up to China rather than letting Communism run its natural course and fizzle out like it did in the USSR and everywhere else it was tried and failed.

Yet, at the same time, I have to realize that we can never underestimate the ability of people to demonstrate new levels of simple-thinking idiocy:

 

[RickyScott]

A lot people of Italian background in New York?

 

[medgator]

A lot people of Italian background in New York?

There may be something weather related as well, a glimmer of hope for those of us in the Sunbelt...

Released on March 10th, one study mapped COVID-19 virality capability by high temperature and high humidity. It found that both significantly reduced the ability of the virus to spread from person-to-person. From the study,

“This result is consistent with the fact that the high temperature and high humidity significantly reduce the transmission of influenza. It indicates that the arrival of summer and rainy season in the northern hemisphere can effectively reduce the transmission of the COVID-19.”

The University of Maryland mapped severe COVID-19 outbreaks with local weather patterns around the world, from the US to China. They found that the virus thrives in a certain temperature and humidity channel. “The researchers found that all cities experiencing significant outbreaks of COVID-19 have very similar winter climates with an average temperature of 41 to 52 degrees Fahrenheit, an average humidity level of 47% to 79% with a narrow east-west distribution along the same 30–50 N” latitude”, said the University of Maryland.

“Based on what we have documented so far, it appears that the virus has a harder time spreading between people in warmer, tropical climates,” said study leader Mohammad Sajadi, MD, Associate Professor of Medicine in the UMSOM, physician-scientist at the Institute of Human Virology and a member of GVN.