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I didn't quite understand the "small practices go out" comments.
I guess maybe due to APM just not enough $ to keep the doors open for these places treating only 12 patients, day?
Is that the thinking there?
I guess if you're a small practice operating on a razor thin margin, you're not hypofractionating even during COVID
Like most things related to reimbursement, that particular stipulation makes no sense.Makes sense then.
Makes me feel like APM will hurt me, but not as much as others...though that initial formula for how you're paid it actually was better to have been long coursing everyone and you're penalized for having been treating with short courses over past few years.
Makes sense then.
Makes me feel like APM will hurt me, but not as much as others...though that initial formula for how you're paid it actually was better to have been long coursing everyone and you're penalized for having been treating with short courses over past few years.
Can you clarify? My understanding is that since the APM is based on how much the average charge has been for a typical prostate course, if you already hypofrac, it won’t be a pay cut and will be a bit more actually since many do standard frac so the average is actually higher
However if you do standard frac now, the gravy train over in APM.
So for the BobbyHeenans and Medgators of the world, they may make out okay.
Yes. That’s my understanding. They don’t want any individual clinic to see their reimbursement completely tank. So you get a Multiple the standard APM rate if you’ve been over utilizing, to smooth the drop a bit.I might be wrong, but somewhere in the formula (a multiplier) for what you receive there is a little factor in there for what you would be paid based upon your individual billing on a prostate case over the past few years.
So yes, while the APM formula starts with a base rate of what was typical for the across the country for a prostate case, there's a little "bump" in pay if your particular rate has been high the past few years.
Again, I may be wrong on this but that's the way I understood it.
I can only comment in my neck of the woods. The small practice where I'm located still gives chemotherapy, but they have to have large quantities of cash on hand to pay for said chemo before their reimbursement for it comes back. They're already hanging on by a thread, so a drop in patients for several months- which we're all surely going to see- will interrupt their cash flow significantly.I didn't quite understand the "small practices go out" comments.
I guess maybe due to APM just not enough $ to keep the doors open for these places treating only 12 patients, day?
Is that the thinking there?
Can you clarify? My understanding is that since the APM is based on how much the average charge has been for a typical prostate course, if you already hypofrac, it won’t be a pay cut and will be a bit more actually since many do standard frac so the average is actually higher
However if you do standard frac now, the gravy train over in APM.
So for the BobbyHeenans and Medgators of the world, they may make out okay.
Man you and @radoncgrad2019 need to make a club, assuming you aren't the same poster.
Oh ok, thought i was being fraction shamed for not adopting it in prostate as readily as everyone else . My bad.I’m confused - was giving you guys credit as users of hypofrac
I'm sure evicore will let me know when i can start hypofx all prostate caYes but normofractionaters are protected in the sense that the year on year decrease is capped.
Between APM and covid inspired adoption of hypofrctionation, I expect a lot of small practices to fold.
Kid you not I knew of a few freestanding centers where the doc and his wife were the doc, therapist, receptionist, billing dept, dosimetrists, physicists, social workers and baristas.I think it remains to be seen. Don't underestimate the private guys who have survived this long. They generally have a good handle on the economics of their centers. You'd be surprised how low you can get the overhead once the equipment is paid off. At that point, staffing becomes the big expense, especially therapy and physics. Grind those costs down (and don't hire any new grads or locums) and you can get your overhead so low you're "almost" too lean to fail. You can almost cut your overhead proportionate to your decreased reimbursement. I think they'll be OK, but doubt they'll be hiring anyone any time soon.
there is no way that they had a barista licenseKid you not I knew of a few freestanding centers where the doc and his wife were the doc, therapist, receptionist, billing dept, dosimetrists, physicists, social workers and baristas.
I have actually seen an increase in referrals if you can believe it. I work in an area with a good mix of private and academic satellite surgeons competing for business out of the same hospitals, and I feel like the academic guys have taken a step back, while the private guys are acggressively looking for the cancer cases and expediting their work up and surgeries. I know several of our local hospitals have cancelled elective surgeries, but cancer surgeries are excluded. (I should also mention these are advanced cases...not gleason 3+3s or T1 breasts in 80 year olds!).
Mets don't stop for anyone, just got an add on for tomorrow from Pulmonary for a pt with a lung mass eroding through the scapula....I have actually seen an increase in referrals if you can believe it. I work in an area with a good mix of private and academic satellite surgeons competing for business out of the same hospitals, and I feel like the academic guys have taken a step back, while the private guys are acggressively looking for the cancer cases and expediting their work up and surgeries. I know several of our local hospitals have cancelled elective surgeries, but cancer surgeries are excluded. (I should also mention these are advanced cases...not gleason 3+3s or T1 breasts in 80 year olds!).
- Small practices gone by winter
- Job market even worse as docs close to retirement freak out about their savings
- Cuts to everything in medicine as the federal government tries to figure out how to pay for a $200 billion hospitalization bill.
- Telemedicine appointments more prevalent
Do you not know any baby boomers?Maybe I'm naive but how is it that these old rad oncs don't have enough to retire comfortably? They practiced during the glory years of rad onc reimbursement.
Has anyone witnessed any concrete examples (e.g. not hearsay) of job offers being pulled due to COVID-19?
Makes me feel like APM will hurt me, but not as much as others...though that initial formula for how you're paid it actually was better to have been long coursing everyone and you're penalized for having been treating with short courses over past few years.
Can you clarify? My understanding is that since the APM is based on how much the average charge has been for a typical prostate course, if you already hypofrac, it won’t be a pay cut and will be a bit more actually since many do standard frac so the average is actually higher
However if you do standard frac now, the gravy train over in APM.
So for the BobbyHeenans and Medgators of the world, they may make out okay.
I might be wrong, but somewhere in the formula (a multiplier) for what you receive there is a little factor in there for what you would be paid based upon your individual billing on a prostate case over the past few years.
So yes, while the APM formula starts with a base rate of what was typical for the across the country for a prostate case, there's a little "bump" in pay if your particular rate has been high the past few years.
Again, I may be wrong on this but that's the way I understood it.
Yes. That’s my understanding. They don’t want any individual clinic to see their reimbursement completely tank. So you get a Multiple the standard APM rate if you’ve been over utilizing, to smooth the drop a bit.
completely nonsensical
Guessing that final rule got knocked back for awhile.Here's a detailed analysis this group published pretty recently on the proposed RO Model's payment methodology, and how it does hurt even practices with low baseline historical episode costs. Bottom line is that the proposed RO Model is a cost cutting measure across the board as GFunk stated. I'm hearing in the background that CMS has not only heard these critiques loud and clear but also made substantive changes to the payment methodology for the final rule. We'll have to see it to believe it once that final rule is released...
De-Constructing the Proposed Radiation Oncology Model Payment Methodology: Implications for Practices and Opportunities for Improvement — JCO OP DAiS
By Nikhil G. Thaker, MD Arizona Oncology, Tucson, AZ Stuart Staggs The US Oncology Network and McKesson Corporation, The Woodlands, TX Rehman Meghani The US Oncology Network and McKesson Corporation, The Woodlands, TX The Centers for Medicarejcoopblog.org
Guessing that final rule got knocked back for awhile.
Right now, CMS is trying to accelerate payments to help out practices.
AND an opioid crisis....If MIPS wasn't already a huge joke, how ridiculous does it look now to be scoring me on evaluating a pain score as a quality measure in the middle of a pandemic. Ugh.
AND an opioid crisis....
iGRT™ , Varian's newest iPhone app, allows realtime online CBCT and MR analysis of all your radiation patients under treatment.The key will be, and there is zero reason technically why this can’t happen, is when we can make on line shifts ourselves from our home computer for sbrt on line cone beams.
That
Will be awesome
Unless you need a job soonThe key will be, and there is zero reason technically why this can’t happen, is when we can make on line shifts ourselves from our home computer for sbrt on line cone beams.
That
Will be awesome