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5Gy X 3What dose/fractionation/schedule are you guys using for keloids?
5Gy X 3What dose/fractionation/schedule are you guys using for keloids?
We do 4 x 5 Gy5Gy X 3
Today's rule release? Aren't you flying an airplane right now?Monthly!
Do I need to teach you guys everything on how to sustain a radonc practice after today's rule release?
Anybody reatreating arthritis a year later? 2 years later? Yearly?
Of course! This is considered standard of care, if clinical benefit was achieved with the prior course of radiotherapy.Anybody reatreating arthritis a year later? 2 years later? Yearly?
Micro dose monthly!Of course! This is considered standard of care, if clinical benefit was achieved with the prior course of radiotherapy.
I am not aware of an upper limit. I have treated some with 3-4 courses over years.
Apologies if already posted elsewhere- looked and couldn't find it. Lots of potential here.
If 5gy is not very harmful for the heart, would be a real problem for protons
I wouldn't. Nothing will happen, but anything that does will be blamed on you.Anyone do the German OA regimen while a patient is getting chemo? He’s getting q2 week 5FU, leucovorin, and antibody
I would.Anyone do the German OA regimen while a patient is getting chemo? He’s getting q2 week 5FU, leucovorin, and antibody
If you would do a chest CT on someone like thisAnyone do the German OA regimen while a patient is getting chemo? He’s getting q2 week 5FU, leucovorin, and antibody
so nothing will be blamed on grenz?I wouldn't. Nothing will happen, but anything that does will be blamed on you.
Haha! I have a few percent getting pain flares and such. Something weird happens and then all around town “that quack Parikh is doing weird ****”so nothing will be blamed grenz?
Pain flare through LDRT is actually a good sign!Haha! I have a few percent getting pain flares and such. Something weird happens and then all around town “that quack Parikh is doing weird ****”
I absolutely agree. I tell my patients this as well.Pain flare through LDRT is actually a good sign!
You can tell your patients about that. Anecdotally, those with pain flare are the ones that benefit the most, long term.
It‘s a bit like the skin rash from cetuximab for H&N cancer.
Is this during the treatment course or after?I absolutely agree. I tell my patients this as well.
Obviously the plural of "anecdote" is not "data", but at this point, the volume of this observation in my practice is such that I'm trying to figure out a timeline/plan to do some sort of prospective observation trial on it.
I would also expand this to seeing any change at all is a "good" sign. Meaning it doesn't just have to be a pain flare, it could be transient improvement, or alteration in the perception of pain (sharp vs dull etc) - all of that increases my optimism for a particular case.
Is this during the treatment course or after?
Anybody done it for AI-induced joint pain and notice a difference vs standard OA?
Is this during the treatment course or after?
Anybody done it for AI-induced joint pain and notice a difference vs standard OA?
I think would be worthwhile evaluating essentially independently of OA. Treat LDRT for AI joint pains like we used to prophylactically radiate mens breast tissue who were going on Bicalutamide.I've done it for AI-induced joint pain.
The tough part about a trial for AI-induced vs OA would be time. The earlier we get to OA to treat it the better, but we can almost never get to it as early as we can AI-induced joint pain. Hard to control for that variable.
I've done it for AI-induced joint pain.
The tough part about a trial for AI-induced vs OA would be time. The earlier we get to OA to treat it the better, but we can almost never get to it as early as we can AI-induced joint pain. Hard to control for that variable.
There are no NCDs for any treatment any radiation oncologist in America does for any condition. So they have come up with the stupidest, or smartest, reason ever to deny.Had a Medicare advantage payer ask me for "Medicare guidelines" showing radiation is approved for OA/plantar fasciitis before they would approve it. Anyone run into this and use anything from Medicare to get these treatments approved?
WOW.Had a Medicare advantage payer ask me for "Medicare guidelines" showing radiation is approved for OA/plantar fasciitis before they would approve it. Anyone run into this and use anything from Medicare to get these treatments approved?
And I forgot to add:WOW.
That's quite the tactic they're trying out.
Was it the MA payer who asked you, or the benefits manager contracted by the payer?
Regardless, per the Medicare guidelines:
View attachment 379552
Part B covers medically necessary radiation treatments in an outpatient clinic.
At this point in time, I don't believe there is an NCD that specifically says "LDRT for OA is covered". Which would be insane...because Medicare guidelines are not like NCCN guidelines. There are many treatments we give daily that aren't explicitly defined in the guidelines.
Of course, outpatient radiation therapy is obviously covered. So if we (the physicians) think a service is "medically necessary", Medicare should cover it.
Let's look at what they definitely WON'T cover:
View attachment 379555
Here is what I stick to for "medically necessary" arguments:
1) I don't diagnose them with OA/PF myself, they come with an existing diagnosis.
2) This basically always means they've tried and failed at least one, usually multiple other types of treatments.
3) Symptomatic OA/PF that has failed prior lines of therapy = LDRT is medically necessary
4) For things like OA, it's significantly cheaper to do LDRT than a joint replacement (couple thousand dollars with no inpatient stay vs $100,000 and inpatient time, etc)
5) There is a mountain of evidence in the literature to cite
To ask you for proof of Medicare coverage is insane. I would "reverse Uno" them and explain your medical necessity argument...and demand they show you where it's NOT covered in Medicare guidelines.
To whom did you market?I have 13 arthritis consults on my schedule over the next month.
I did no marketing. Started using it with my cancer patients. Those patients spread the word to their other docs, family members, friends.To whom did you market?
How late is your center running/how far out are new starts? I gotta say, if OA pushed me into extended hours I’d regret opening the spigotI did no marketing. Started using it with my cancer patients. Those patients spread the word to their other docs, family members, friends.
Now I have consults from PCP's, Orthopods, Pain clinics, self referrals. I had one patient come from over 4 hrs away.
No late hours. Starts within 5-10 days unless there are insurance approval delays.How late is your center running/how far out are new starts? I gotta say, if OA pushed me into extended hours I’d regret opening the spigot
How late is your center running/how far out are new starts? I gotta say, if OA pushed me into extended hours I’d regret opening the spigot
What’s your average pro reimbursement and/or wRVU per patient?I have 13 arthritis consults on my schedule over the next month.