GenesisCare filing for bankruptcy

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That was announced awhile ago by Advocate (original 21c family). Is it moving forward?

I believe Bonita Springs. There was a web announcement awhile back if someone wants to look for it.

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That was announced awhile ago by Advocate (original 21c family). Is it moving forward?

I believe Bonita Springs. There was a web announcement awhile back if someone wants to look for it.
Website is up, absolutely happening

 
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Dosoretz huh?

Funny how it always works out for the myriad father-son teams in rad onc. You never see them #ing with spam in Carlsbad. A coincidence I'm sure.

The number of Rolls Royce per capita is about equal to alligators per capita down there now.

Maybe the nile crocodiles some jerk introduced into the everglades will take over that swamp. Apparently they will eat just about anything.
 
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What exactly is concierge proton therapy? Is this like a house visit paid in cash wire for a 3 am house call to give someone more flomax while you treat to 44fx with protons? Im guessing this is the next big thing. “We offer above and beyond concierge service. The other guys just cater to the peon peasants. Not our thing”
 
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Dosoretz huh?

Funny how it always works out for the myriad father-son teams in rad onc. You never see them #ing with spam in Carlsbad. A coincidence I'm sure.

The number of Rolls Royce per capita is about equal to alligators per capita down there now.

Maybe the nile crocodiles some jerk introduced into the everglades will take over that swamp. Apparently they will eat just about anything.
You are right that the Crocs will win the swamp war. T’is the way
 
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What exactly is concierge proton therapy? Is this like a house visit payed in cash wire for a 3 am house call to give someone more flomax while you treat to 44fx with protons? Im guessing this is the next big thing. “We offer above and beyond concierge service. The other guys just cater to the peon peasants. Not our thing”

Is there really even room to squeeze in proton billboards between the "$1000 next day scalpel free vasectomy" ads every 20 feet along I-75? We will see...
 
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Welcome to ProtonMart, I love you.


middle fingers GIF by Idiocracy
 
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Is there really even room to squeeze in proton billboards between the "$1000 next day scalpel free vasectomy" ads every 20 feet along I-75? We will see...
No because between those, you have the RWNJ pro lifer boards with phone numbers if you are pregnant. Funny how they are often next to the vasectomy ones
 
Rest assured KKR (private equity owner) secured their bag ($) before GenesisCare went down. Don't think for a second they are on the hook for that debt when the music stopped (well after they sucked the marrow out of the business). The "losers" in this situation are the employed physicians... and of course patients. The other winners were the GenesisCare equity holders when they sold out to KKR (2012). This is the (PE) way. (see also the story of KKR-owned Envision Health care: Envision Healthcare - Wikipedia)
KKR likely employed the usual tactics of things like leasebacks (liquidating the real estate), dividend recaps (company borrows money, then. gives it to the PE), operating optimizations (eg layoffs, quality cuts), then strategic bankruptcy (to avoid paying the debt)
Hard to say how much the State of Rad Onc contributed to this, but would definitely be an oversimplification. The actual mechanics involving healthcare (reimbursement, patterns of care, etc) are likely secondary contributors here
communitydoc13 gets it

apropos:
Michael Hiltzik: This company made billions by surprise-billing helpless ER patients

Additionally, for reference:
Assets under management (AUM) in ~2007:
KKR: $15 billion
Blackstone: $79 billion

AUM in 2023:
KKR: ~$459 billion
Blackstone: $1 trillion (as of July 2023)

med students: if you are coming to here to make the big bucks, you are in the wrong forum
 
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What exactly is concierge proton therapy? Is this like a house visit payed in cash wire for a 3 am house call to give someone more flomax while you treat to 44fx with protons? Im guessing this is the next big thing. “We offer above and beyond concierge service. The other guys just cater to the peon peasants. Not our thing”

Concierge proton therapy is associated with 153% OS for chordoma.
 
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US is so well covered by RadOnc that every single GC center may safely close tomorrow. New university satellites will fill whatever residual need remains
 
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Absolutel- they have exact same profit motive as the academics, but any time shift to academic centers, shifting to high cost care.
They refuse to do P2P. They appeal everything. Interesting approach.
 
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They refuse to do P2P. They appeal everything. Interesting approach.
I also appeal everything; but always do P2P.

They want to waste my time and money... I am going to waste theirs at every opportunity I can.
 
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While the specific business practices of a certain family have done significant damage to American Radiation Oncology in aggregate (massive profits from questionable-to-fraudulent methods leading to intense CMS/government scrutiny, the biggest whistleblower cases in RadOnc history, the sale to GenesisCare which is now in bankruptcy and clinics closing without warning, not to mention two senior members of 21C/GenesisCare holding key positions of power in the ABR and ASTRO) -

The people who are leaving an almost unbelievable amount of damage in their wake are doing just fine. How, you might ask?

Easy - they lobby harder than the American College of Cardiology.

1692475081339.png
 
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Website is up, absolutely happening

A recent article shows they started construction in June, with an $80 million price for a center with an IBA Proteus One half gantry proton machine, PET and MRI on site.

To turn a profit on an $80 million proton vault after 2 years of construction (non- performing asset) requires a lot of patients at good reimbursement rates. I suspect the "concierge" approach is to draw patients from out of town who meet their requirements for good reimbursement.
 
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A recent article shows they started construction in June, with an $80 million price for a center with an IBA Proteus One half gantry proton machine, PET and MRI on site.

To turn a profit on an $80 million proton vault after 2 years of construction (non- performing asset) requires a lot of patients at good reimbursement rates. I suspect the "concierge" approach is to draw patients from out of town who meet their requirements for good reimbursement.
These guys are smart. They often dont put up much of the initial investment, but stand to gain a lot from the operational income. Also into real estate shananigans. Know of 21c sites where Danny owned buildings that he leased to 21c at double market rates then later sold that buildings to reits at inflated prices based on these over market rents.
 
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Genesis docs prescribe EVERYTHING IMRT. bone mets 30 Gy / 10, right whole breast, etc. Basically a Chinese business latched onto American healthcare. maybe I am wrong? doubt
 
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I'm calling BS. GenesisCare at a completely different scale than Advocate.

Bankruptcy was pre-ordained. It may have even been the case that DD and other sellers of 21c knew this was going to happen years ago. Genesis are planting a narrative about the root cause of bankruptcy that is cover. They couldn't bill properly? Please.

In some parts of the world, even Wally Curran is a little person.
 
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I'm calling BS. GenesisCare at a completely different scale than Advocate.

Bankruptcy was pre-ordained. It may have even been the case that DD and other sellers of 21c knew this was going to happen years ago. Genesis are planting a narrative about the root cause of bankruptcy that is cover. They couldn't bill properly? Please.

In some parts of the world, even Wally Curran is a little person.
Absolutely. The debt level was totally unsustainable. Over a billion dollars in debt at 10%+ interest. 21c founders saddled co with debt and got out. Company was offloaded to unsuspecting Chinese investors.
 
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Absolutely. The debt level was totally unsustainable. Over a billion dollars in debt at 10%+ interest. 21c founders saddled co with debt and got out.
Even deeper than that IMO. Bankruptcy may have even been the goal. PE owned businesses declare bankruptcy at 10x the going rate.



Managing pension liabilities alone will make PE work towards bankruptcy.

Evil.
 
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I'm calling BS. GenesisCare at a completely different scale than Advocate.

Bankruptcy was pre-ordained. It may have even been the case that DD and other sellers of 21c knew this was going to happen years ago. Genesis are planting a narrative about the root cause of bankruptcy that is cover. They couldn't bill properly? Please.

In some parts of the world, even Wally Curran is a little person.
Yeah that's why this is so amusing (obviously, not really amusing give the nature and scale of what's happening).

But for a global medical megacorp to blame a local practice, no matter the mafioso nature of that local practice - you're really grasping at straws at that point.
 
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The issue locally is what it's done to the surgical subspecialties that signed on. As in, it's affecting patients. The Genesis linacs could close and affect virtually none of the patients, excepting that they'd probably have to get fewer treatments on more modern (modern) machinery...
 
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the mafioso nature of that local practice
Who knows the worth of DD at this point. The PE deals from years ago may have even put 100M in his pocket. The 21c bankruptcy itself, shortly after PE cash infusion, is not surprising and who knows the exact terms of that arrangement. (Sometimes PE investment can function as a massive cash infusion for ownership, who have high worth but low liquidity).

Of course, lots of employees get hurt. Patients can get hurt.

I do not know DD, but it is interesting that he still practices and is still a part of such aggressive business ventures.

If I was worth 10M, I would quit and never work for money again.
 
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Who knows the worth of DD at this point. The PE deals from years ago may have even put 100M in his pocket. The 21c bankruptcy itself, shortly after PE cash infusion, is not surprising and who knows the exact terms of that arrangement. (Sometimes PE investment can function as a massive cash infusion for ownership, who have high worth but low liquidity).

Of course, lots of employees get hurt. Patients can get hurt.

I do not know DD, but it is interesting that he still practices and is still a part of such aggressive business ventures.

If I was worth 10M, I would quit and never work for money again.
Currently, the latest publicly available CMS claims data is from 2021 (which is normal, there's always a ~2 year lag).

In 2021, DD was still a Top 10 RadOnc in terms of billing volume.

Now, it's possible the practice is just billing in his name and he's not actually performing all of that (which opens up other issues, of course).

But...you would think he could dial it back a little bit. Maybe just be in the...Top 50?
 
But...you would think he could dial it back a little bit.
I misspoke. I would guess the family itself is worth on the order of 1B. At this level, the family can function as private equity. Pertinent incorporations (stateside at least) are in Delaware (no suprise).


These are the ultra-wealthy masquerading as relatively ordinary people (a very smart branding move). The wealth is global.

Nothing here applies to the rest of us (unless you work with them).

That concierge proton center? It will work. The patients will be international. The payments will be cash.
 
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I misspoke. I would guess the family itself is worth on the order of 1B. At this level, the family can function as private equity. Pertinent incorporations (stateside at least) are in Delaware (no suprise).


These are the ultra-wealthy masquerading as relatively ordinary people (a very smart branding move). The wealth is global.

Nothing here applies to the rest of us (unless you work with them).

That concierge proton center? It will work. The patients will be international. The payments will be cash.
Yeah...in the last few years I've really started getting into this, as in, what is possible if you truly understand and pursue various legal entities/tax code/etc.

The world doesn't really work the way the majority of us think it does (I grew up as what could generously be defined as "lower middle class").

To this day, my Mom is mortified by some of the things I do.

But the #1 rule of money: don't take advice from people who have less money than you. Even if you love them.

"Don't do concierge protons, that will never work"

"lol" - Danny D
 
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Yeah...in the last few years I've really started getting into this, as in, what is possible if you truly understand and pursue various legal entities/tax code/etc.

The world doesn't really work the way the majority of us think it does (I grew up as what could generously be defined as "lower middle class").

To this day, my Mom is mortified by some of the things I do.

But the #1 rule of money: don't take advice from people who have less money than you. Even if you love them.

"Don't do concierge protons, that will never work"

"lol" - Danny D
Didn't Ackerman's proton center basically do just in Jacksonville that after they opened post UF's proton center when patients weren't up for getting treated at 8p+ every night?

In the current environment, feels like there are more than enough proton centers around to avoid that sort of problem, but damned if they don't have the best lobbyists in RT at the moment
 
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Didn't Ackerman's proton center basically do just in Jacksonville that after they opened post UF's proton center when patients weren't up for getting treated at 8p+ every night?

In the current environment, feels like there are more centers, but damned if they don't have the best lobbyists in RT at the moment
This sort of goes into the whole bigger issue of consolidation and UHC crushing the industry etc.

Objectively comparing yearly RVU and conversion factor updates from Medicare? Bad.

P&L sheets from hospitals/hospital systems? Bad.

Yet somehow...the system waddles on. I'll take a wild guess and assume almost everyone reading this has basically experienced every budget meeting/report being doom and gloom - times are tough, we need to tighten our belts, etc. Does it seem like it happens every year, even if CNBC is talking about record S&P earnings?

The systems that are ACTUALLY doing bad are the ones that go bankrupt/close. That is, of course, a real thing.

But if you've ever walked past a section of your hospital undergoing massive renovations, to sit in a conference room and be told about the "tough times" - it's usually because you're sitting in the wrong room, at the wrong end of the table.

You know, the end of the table where the doctors are told to sit.
 
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This sort of goes into the whole bigger issue of consolidation and UHC crushing the industry etc.

Objectively comparing yearly RVU and conversion factor updates from Medicare? Bad.

P&L sheets from hospitals/hospital systems? Bad.

Yet somehow...the system waddles on. I'll take a wild guess and assume almost everyone reading this has basically experienced every budget meeting/report being doom and gloom - times are tough, we need to tighten our belts, etc. Does it seem like it happens every year, even if CNBC is talking about record S&P earnings?

The systems that are ACTUALLY doing bad are the ones that go bankrupt/close. That is, of course, a real thing.

But if you've ever walked past a section of your hospital undergoing massive renovations, to sit in a conference room and be told about the "tough times" - it's usually because you're sitting in the wrong room, at the wrong end of the table.

You know, the end of the table where the doctors are told to sit.

There’s no shortage of crisis they can throw at you. Anything they can to keep you down.
 
This sort of goes into the whole bigger issue of consolidation and UHC crushing the industry etc.

Objectively comparing yearly RVU and conversion factor updates from Medicare? Bad.

P&L sheets from hospitals/hospital systems? Bad.

Yet somehow...the system waddles on. I'll take a wild guess and assume almost everyone reading this has basically experienced every budget meeting/report being doom and gloom - times are tough, we need to tighten our belts, etc. Does it seem like it happens every year, even if CNBC is talking about record S&P earnings?

The systems that are ACTUALLY doing bad are the ones that go bankrupt/close. That is, of course, a real thing.

But if you've ever walked past a section of your hospital undergoing massive renovations, to sit in a conference room and be told about the "tough times" - it's usually because you're sitting in the wrong room, at the wrong end of the table.

You know, the end of the table where the doctors are told to sit.
Ouch!
 
I also appeal everything; but always do P2P.

They want to waste my time and money... I am going to waste theirs at every opportunity I can.
More importantly, they are wasting patients' time and delaying their cancer care.

GenesisCare has the best approach.

Refuse the "peer to peer" and go straight to appeal. Don't let a "peer" on the other end of the phone make money regarding your treatment recommendations. Cut the "peer" out.

It saves your patient precious time.

Document their name in the chart and give it to the patient. They deserve to know who is advocating for their insurance company. If they fail in the future they deserve to know the name of the person who caused a delay in their care.
 
More importantly, they are wasting patients' time and delaying their cancer care.

GenesisCare has the best approach.

Refuse the "peer to peer" and go straight to appeal. Don't let a "peer" on the other end of the phone make money regarding your treatment recommendations. Cut the "peer" out.

It saves your patient precious time.

Document their name in the chart and give it to the patient. They deserve to know who is advocating for their insurance company. If they fail in the future they deserve to know the name of the person who caused a delay in their care.
33 fx for stage 1 breast is not okay.

IMRT for a nasal ala tiny BCC to spare eyebrows and parotids is not okay.

I understand what you are saying, but what I get from them is not your standard 50/50 stuff we have to argue about.

They practice in a way that creates a market for PA
 
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33 fx for stage 1 breast is not okay.

IMRT for a nasal ala tiny BCC to spare eyebrows and parotids is not okay.

I understand what you are saying, but what I get from them is not your standard 50/50 stuff we have to argue about.

They practice in a way that creates a market for PA
There are a lot of Genesis centers and a lot of radoncs whose jobs are supported by excessive fractionation. When ROCR or consolidation squeeze/ eliminate this bubble of conventional fractionation, they will all hit the job market and this will hurt all of us! An additional 100-200 radoncs on the job market is a real problem. This is why a bit of PA work is so valuable- it tells you whats going on out there. Whether its proton centers treating low risk prostate cancer or using a single involved node to justify RNI in breast cancer vs the Genesis clowns, its not good.
BTW: do you ever see proton centers show comparison plans where the heart is getting a mean of 15 Gy with tangents?
 
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