Bye bye APM, we hardly knew thee...

[Tigerstang]

Mandatory CMS radiation oncology model goes on the backburner

Originally, the agency was eying an implementation date as early as Jan. 1, but the new regulatory agenda lists July 2022 as a target date for the bundled payment model.

www.medtechdive.com

---

Members don't see this ad.

 

[medgator]

Back burner. Not really dead...

Funny reading those comments, I guess Varian>Accuray

 

[fiji128]

Given. Why would Epic comments carry any weight with this?

 

[fiji128]

This must be a misquote from the Accuray CEO, at one would hope so,

"We believe that the proposed national payment rates and subsequent adjustments will likely result in increased utilization of hyperfractionation and SBRT treatments," Accuray CEO Joshua Levine told investors in August. "As an original pioneer in the areas of hyperfractionation and SBRT, we believe Accuray is well positioned to benefit from the likely changes in clinical practice that will result from implementation of the APM."

 

[Mandelin Rain]

Medical students, take heed. This is great news.

 

[medgator]

This must be a misquote from the Accuray CEO, at one would hope so,

"We believe that the proposed national payment rates and subsequent adjustments will likely result in increased utilization of hyperfractionation and SBRT treatments," Accuray CEO Joshua Levine told investors in August. "As an original pioneer in the areas of hyperfractionation and SBRT, we believe Accuray is well positioned to benefit from the likely changes in clinical practice that will result from implementation of the APM."

Yes. Probably meant to say hypo. Fwiw dragon changes it to hyper a lot when I dictate also

 

[medgator]

Medical students, take heed. This is great news.

Is it? 2022 we may back to where we were yesterday with hundreds of extra grads looking for jobs

 

[Mandelin Rain]

The way they were trying to roll this out last minute to save 260 million over 5 years was so ham handed and stupid. Just allow medicare to negotiate IO rates and you could save 400,000,000% more. Alas Azar wanted his cost saving "splash" in oncology. Glad it blew up in his face.

 

[Mandelin Rain]

Is it? 2022 we may back to where we were yesterday with hundreds of extra grads looking for jobs

Well the grad problem is a tangentially related, but obviously different problem.

In 2022, we may have a whole new administration with different priorities etc... At the very least allows more time to prepare and comment for a sensible solution. Also 3 more years on 6-8% higher reimbursement.

 

[taserlaser]

Just pushes things back a bit, and still contributes to a culture of uncertainty. Now that the word is out on how it is predicted to affect RO staffing needs, with the uncertainty pushed back 2 years I don’t see people investing in new RO staff unless absolutely needed. Good for people currently employed, but still is lipstick on a pig for future graduates in my opinion.

 

[Mandelin Rain]

This definitely isn't the deus ex machina to save the field, but I'm happy it's happening. If only for the simple fact we had no idea how we were going to manage two different sets of rules across all the different zip codes we cover. It was ridiculous from the outset.

 

[medgator]

This definitely isn't the deus ex machina to save the field, but I'm happy it's happening. If only for the simple fact we had no idea how we were going to manage two different sets of rules across all the different zip codes we cover. It was ridiculous from the outset.

Yeah that was a crazy thought.... The idea of linacs within the same practice falling under different reimbursement schemes

 

[Mandelin Rain]

Yeah that was a crazy thought.... The idea of linacs within the same practice falling under different reimbursement schemes

Like, do we need more billers? Less? Are we even participating? Any information? Please!


Good ****ing riddance. Eat it Azar.

 

[Gfunk6]

This is fantastic news - even a brief respite from this is welcome.

 

[evilbooyaa]

Awesome. Do it properly and give practices enough heads up to actually coordinate, ask questions, and figureo ut how to do it properly. A rare victory for US Rad Oncs.

 

[Chartreuse Wombat]

Surprised nothing from ASTRO. Do we believe this? If true, likely the result of industry/hospital lobbying rather than ASTRO I must say.

 

[medgator]

Surprised nothing from ASTRO. Do we believe this? If true, likely the result of industry/hospital lobbying rather than ASTRO I must say.

I'm sure they'll take credit for it sometime next week via mass email

 

[evilbooyaa]

Surprised nothing from ASTRO. Do we believe this? If true, likely the result of industry/hospital lobbying rather than ASTRO I must say.

Time to take ASTRO dues and put them towards Varian, ViewRay, Hitachi, and EPIC?

 

[scarbrtj]

Surprised nothing from ASTRO. Do we believe this? If true, likely the result of industry/hospital lobbying rather than ASTRO I must say.

Varian & friends all the way IMHO.
EDIT: Did Wall St presage APM's demise??? Hmmm. (NYSE: VAR)

 

[metallica81788]

Forgive my ignorance, but is this APM ruling separate from the general supervision ruling that was set to start in January 2020 or not?

 

[medgator]

Forgive my ignorance, but is this APM ruling separate from the general supervision ruling that was set to start in January 2020 or not?

Yes, completely unrelated. General supervision is happening for HOPPS centers starting 1/1/20

 

[Krukenberg]

Congressional leaders support radiation oncology community concerns about proposed Medicare alternative payment model

This is the reason it was delayed, and is the reason cancelling your ASTRO membership is short-sighted. You want your professional society to be able to lobby Congress as robustly as possible. Fewer members=less congressional donations=less lobbying power.

Rather than cancel memberships, get involved with the organization and donate to ASTRO PAC while clearly stating what you care about in terms of lobbying.

 

[Chartreuse Wombat]

Varian & friends all the way IMHO.
EDIT: Did Wall St presage APM's demise??? Hmmm. (NYSE: VAR)

Interesting. APM announced July 2019 and stock falls...

 

[thecarbonionangle]

Congressional leaders support radiation oncology community concerns about proposed Medicare alternative payment model

This is the reason it was delayed, and is the reason cancelling your ASTRO membership is short-sighted. You want your professional society to be able to lobby Congress as robustly as possible. Fewer members=less congressional donations=less lobbying power.

Rather than cancel memberships, get involved with the organization and donate to ASTRO PAC while clearly stating what you care about in terms of lobbying.

MROGA!! Trump crony Azar on backburner for now, doesn't mean it still will not cook. Much to be seen.....

Uncertainty is still uncertainty and something potential applicants to consider.

 

[elementaryschooleconomics]

Maybe if residencies halt expansion/begin to contract and APM 2.0 is less harsh than 1.0 we won't implode entirely.

 

[medgator]

Maybe if residencies halt expansion/begin to contract and APM 2.0 is less harsh than 1.0 we won't implode entirely.

Way too optimistic.

 

[thecarbonionangle]

Maybe if residencies halt expansion/begin to contract and APM 2.0 is less harsh than 1.0 we won't implode entirely.

I wanna believe you're right, so i'll go with it.

 

[Mandelin Rain]

And VAR/ARAY trending up last month with little mini-spike just a day or two ago.

The supervision rule was released a month ago.

No doctor needed for a linac? Buy another one.

 

[scarbrtj]

Interesting. APM announced July 2019 and stock falls...

And VAR/ARAY trending up last month with little mini-spike just a day or two ago.

 

[elementaryschooleconomics]

Way too optimistic.

I said entirely...

Actually, this has me really concerned. I felt like we were riding some momentum for change this year. Now that Medicare has us in their sights, it's extraordinarily unlikely they're going to let us go completely. But now departments/practices can breathe a mild sigh of relief that APM is being pushed back...which is not good for the prognosis of change.

 

[scarbrtj]

Now that Medicare has us in their sights, it's extraordinarily unlikely they're going to let us go completely.

I do think one day, eventually, CMS will lose its rad onc idée fixe. It's a tune that got stuck in their head because... the IMRT era. They will realize they're wasting a ton of effort for very little monetary savings/reward. Rad onc is exceedingly cost-effective for CMS over time and has been, despite IMRT, very stable in terms of its overall federal outlays. Little blood can be squeezed from this radiation turnip, CMS (if you're reading... hope you are). Rad onc is the cobweb in your walk-in closet, but in the meantime the kitchen's on fire (aka the growing price of oncologic drugs).

 

[Mandelin Rain]

I do think one day, eventually, CMS will lose its rad onc idée fixe. It's a tune that got stuck in their head because... the IMRT era. They will realize they're wasting a ton of effort for very little monetary savings/reward. Rad onc is exceedingly cost-effective for CMS over time and has been, despite IMRT, very stable in terms of its overall federal outlays. Little blood can be squeezed from this radiation turnip, CMS (if you're reading... hope you are). Rad onc is the cobweb in your walk-in closet, but in the meantime the kitchen's on fire (aka the growing price of oncologic drugs).

Yup. Hopefully the next guy isn't a pharma shill and CMS targets where the money actually goes.

 

[Chartreuse Wombat]

I asked ASTRO staff advocacy folks about this story and they say fake news...

 

[Mandelin Rain]

I asked ASTRO staff advocacy folks about this story and they say fake news...

Not sure what this means. ASTRO's involvement is fake news or APM being dead is fake news?

 

[frijoles]

Not sure what this means. ASTRO's involvement is fake news or APM being dead is fake news?

Sent from my iPhone using SDN

 

[PhotonBomb]

 

[evilbooyaa]

4th quarter 2020 is still better than 1/1/2020....

Not sure why ASTRO would continue to be alarmist.

 

[PhotonBomb]

I don’t think her tweet is alarmist at all? It’s literally just correcting all of us and all of twitter who has been talking all day about a delay until 2022....

 

[medgator]

I don’t think her tweet is alarmist at all? It’s literally just correcting all of us and all of twitter who has been talking all day about a delay until 2022....

I didn't interpret 2022 to be set in stone. Seemed like that would be the maximal delay with the idea that this is definitely happening. Figured they want to get the kinks out but it sounds like it will happen assuming the current administration gets re-elected next year (hint, hint).

 

[PhotonBomb]

 

[PhotonBomb]

 

[Mandelin Rain]

Medical students, take heed. This is not great news.

 

[evilbooyaa]

I don’t think her tweet is alarmist at all? It’s literally just correcting all of us and all of twitter who has been talking all day about a delay until 2022....

But it is going to be delayed based on that article. The fact that APM will be delayed is not an inaccurate rumor? The tweet makes it seem like 1/1/2020 is still the day that APM will begin as it was previously discussed.

To say that there is or will be a delay, but that delay will likely be much earlier than July 2022 would be a non-alarmist way of saying it.

I see both sides, so whatever I'll drop it.

 

[evilbooyaa]

Medical students, take heed. This is not great news.

I mean it's good news. Some delay is better than haphazardly shoving it down everybody's throats 1/1/2020.

 

[Mandelin Rain]

I mean it's good news. Some delay is better than haphazardly shoving it down everybody's throats 1/1/2020.

I posted it tongue in cheek because I said it was great news earlier in the thread when it was thought to be 2022.

anyway, it isn’t great news in so much that it demonstrates our advocacy is indeed impotent. New Years is a month away. There was no way possible to roll it out then. Based on that, I always assumed it was going to be somewhat delayed, so this became a big yawn.

 

[RadOncDoc21]

I posted it tongue in cheek because I said it was great news earlier in the thread when it was thought to be 2022.

anyway, it isn’t great news in so much that it demonstrates our advocacy is indeed impotent. New Years is a month away. There was no way possible to roll it out then. Based on that, I always assumed it was going to be somewhat delayed, so this became a big yawn.

A lot of what we do in our field is to delay the inevitable.

 

[scarbrtj]

Welp it looks like I’m back to a Blanche Dubois outlook on CMS and rad onc. “I have always depended on the kindness of strangers...”

 

[deleted941485]

I do think one day, eventually, CMS will lose its rad onc idée fixe. It's a tune that got stuck in their head because... the IMRT era. They will realize they're wasting a ton of effort for very little monetary savings/reward. Rad onc is exceedingly cost-effective for CMS over time and has been, despite IMRT, very stable in terms of its overall federal outlays. Little blood can be squeezed from this radiation turnip, CMS (if you're reading... hope you are). Rad onc is the cobweb in your walk-in closet, but in the meantime the kitchen's on fire (aka the growing price of oncologic drugs).

Please the only reason they are fixated on it is because every other interest including pharma lobbying have basically muscled them out of any possible plan to curtail drug prices so they went after the weakest link Rad onc with their IMRT and protons. Anything that will distract from the idea that it’s pharmaceuticals that are breaking the bank.

Azars goal is to lower healthcare expensive for Medicare and he’s going to do that by preserving pharmas share of the pie.

He doesn’t care if surgeons are taking out gallbladders at 10 dollars a pop or you just got 50 dollars for doing an HDR cervix.

 

[Lnsean]

Please the only reason they are fixated on it is because every other interest including pharma lobbying have basically muscled them out of any possible plan to curtail drug prices so they went after the weakest link Rad onc with their IMRT and protons. Anything that will distract from the idea that it’s pharmaceuticals that are breaking the bank.

Azars goal is to lower healthcare expensive for Medicare and he’s going to do that by preserving pharmas share of the pie.

He doesn’t care if surgeons are taking out gallbladders at 10 dollars a pop or you just got 50 dollars for doing an HDR cervix.

Drug costs/expense really only account for like 10% of all healthcare expenditures. There's not much to squeeze there either. Sure, you can squeeze 1 or 2 pts there but it's also like squeezing blood from a rock.

The majority of the cost is probably in administration and end-of-life / unnecessary prolongation of life for those that are terminally ill. If anything, we should take heed from some of the EU countries who tackle end of life care more directly rather than trying to buy an extra 4-6 months at exponential costs, but obviously this will take a whole generational shift on the way we think of death/dying.

Anyways, sorry to hijack the thread, back on topic we go.

 

[medgator]

Drug costs/expense really only account for like 10% of all healthcare expenditures. There's not much to squeeze there either. Sure, you can squeeze 1 or 2 pts there but it's also like squeezing blood from a rock.

The majority of the cost is probably in administration and end-of-life / unnecessary prolongation of life for those that are terminally ill.

Growth in drug spend is unsustainable and likely eclipses growth in cancer spending elsewhere

Americans now spend twice as much on cancer drugs as in 2012

Every new cancer drug cost $100,000 or more in 2017.

www.nbcnews.com