I agree with evilbooya. Two field tangents probably isnt conformal enough to be called SBRT. I use VMAT it works great.
Interesting idea. However, changing from non adaptive 5 fractions IMRT breast to 5 fraction SBRT breast moves the reimbursement from cheaper than a standard regimen to close to a standard regime. I don't think that insurances/medicare would push back much against this as they would not lose much money if it was widely adopted. Changing from non adaptive 5 fractions IMRT breast to adaptive 5 fraction IMRT breast moves the reimbursement from cheap to expensive. If it was widely adopted you would likely get a lot of push back from medicare/insurance.
Would love to be proved wrong, but I believe medicare requires "personal supervision" for sbrt...meaning u need to be at treatment console. Our group debated this during covid but on review of medicare billing rules we came to the conclusion sbrt required more than "direct supervision" and hence the change to general supervision in hospitals and virtual supervision in freestanding for procedures previously requiring direct supervision did not apply to sbrt.
I think from a safety or quality perspective, one should be there. I have not recently looked at it, but how I am remember it - the wording didn’t break it down by modality (2020). Would have to look again, you may be right. But I feel like it wasn’t specific
Google the Space Coast supervision whistleblower case that was dismissed with prejudice
I have had this argument as well. There is no such language in cms as far as I could tell regarding personal supervision. In fact I have supervised remotely. A doc was on site but I wanted to personally look at the cbct prior to treatment. With the eventual move to remote presence this will come up again.
That’s the ideal outcome for us. In reality, when RadOnc Dept revenues are stabilizing, admins just award themselves bonuses and throw money away in form of corrupt capital spending (i.e. purchases involving kickbacks). I’ve seen it personally over and over again.
Employed docs will see a negative.
CMS is looking to extend tele even now. As a good pattern of practice, we are going to the machine to sign off on the igrt prior to each stereo fraction. Medicolegally, i see no reason why this couldn't be done completely tele in real time with the doc pulling up offline review at another location
Well, hopefully not a paycut.
we will take a paycut because if we halve the patients on beam when breast and prostate go to 5 and palliation to one, a lot of radoncs will be added to the job market (and there will be less hiring) putting downward pressure on salaries.
Actually looking again, all the CPT codes associated with SBRT carry a 9 ("supervision does not apply"). Could have sworn at some point we saw a 2 requiring personal supervision for sbrt treatment delivery, but I don't see it now.
Yeah, I think on our last review we didn’t see it written, but in house policy is anything 5 Gy or higher we are on site. Safety? Idk. But that’s what we came up with.
Same. Silly for 5.2 x 5 breast and 5 x 5 3D rectum though.
Not on technical but professional RVUs are higher for 5Fx SBRT than IMRT. So if you get paid on RVUs then yeah it's beneficial to you, and your technical overlords as well.
