RO APM Dies!

[Chartreuse Wombat]

Delayed until July 1, 2021.

Now's the time to call your senators and congressmen. We have time to fight. I don't care what you think about ASTRO. Get your asses on their website and send the form letter to your legislators. It's not that hard.

Where is the link?

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Members don't see this ad.

 

[Mandelin Rain]

Delayed until July 1, 2021.

Now's the time to call your senators and congressmen. We have time to fight. I don't care what you think about ASTRO. Get your asses on their website and send the form letter to your legislators. It's not that hard.

Seems like good news, but ALSO Seema Verma (from last week)...

As Verma looked to the future of value-based care, she emphasized that mandatory participation — and the threat of harsher downsides for failing to meet benchmarks — will be vital to success. In particular, Verma pointed to increased risk requirements in the Medicare Shared Savings Program (MSSP), which covers ACOs, as a factor in its recent savings figures.

Steel yourselves for mandatory participation and harsher downsides in July 2021.

 

[Mandelin Rain]

Where is the link?

Verma tweeted it

 

[Chartreuse Wombat]

Verma tweeted it

No the link to send a letter to your representatives

 

[DireMoose]

I think this is what that refers to:

https://www.votervoice.net/mobile/ASTRO/Campaigns/77433/Respond

 

[Chartreuse Wombat]

I think this is what that refers to:

https://www.votervoice.net/mobile/ASTRO/Campaigns/77433/Respond

Many thanks

 

[Haybrant]

Aha, but the goal is to be financially independent or FIRE before the mid-50's. Whether practicing medicine or some other industry is the best avenue to achieve those ends is a whole other discussion...

Mid 50s come on; goal is mid 30s. Work for tech start up, start something, private equity, crypto/options trader do anything but train for 15 years of your life learning things and taking tests that are ultimately useless in your day to day.

 

[deleted941485]

Seems like good news, but ALSO Seema Verma (from last week)...

As Verma looked to the future of value-based care, she emphasized that mandatory participation — and the threat of harsher downsides for failing to meet benchmarks — will be vital to success. In particular, Verma pointed to increased risk requirements in the Medicare Shared Savings Program (MSSP), which covers ACOs, as a factor in its recent savings figures.

Steel yourselves for mandatory participation and harsher downsides in July 2021.

Hahaha. The threat of harsher beatings is vital to extracting value. Nov 3rd isn’t that far off.

 

[medgator]

HHS sounds like a dumpster fire... Maybe APM will burn down with it?

‘A mass exodus’: HHS staffers jumping ship amid pandemic, fears of Trump loss

"I've personally seen people working on their resumes inside the office," a senior official added. "It's no secret."

www.politico.com

“‘Trump health official’ already gives people a certain impression, and that’s with the president in office,” said one former official who departed HHS this year and said that landing a high-profile job at many national health associations was a “likely non-starter,” but argued that there are ample opportunities for administration veterans to work for conservative lawmakers, lower-profile policy shops and other firms seeking to understand the regulatory environment.

The frustration also extends up to the most senior levels of the health department, where officials like FDA chief Hahn and CDC chief Redfield have been, at turns, isolated and berated for their perceived failings in the coronavirus response. The two men joked about quitting to open a restaurant, The New York Times reported

 

[Lamount]

I’m hoping that ASTRO is already lobbying Biden’s people on APM

 

[domestique]

Early chatter is Biden is going to nominate Romney to run HHS. We'll see if this happens but my read is this would be a positive development for our field.

 

[medgator]

Early chatter is Biden is going to nominate Romney to run HHS. We'll see if this happens but my read is this would be a positive development for our field.

Kasich is also supposed to get a cabinet position supposedly. Interesting to see how 45 has reshaped the parties. Romney would be a good pick, romneycare was the model for the eventual ACA

 

[fiji128]

APM seems to fit very nicely with socialized medicine, not sure why anyone thinks dems would be trying to walk away from that.

 

[Chartreuse Wombat]

Early chatter is Biden is going to nominate Romney to run HHS. We'll see if this happens but my read is this would be a positive development for our field.

I sincerely doubt that this will happen. Why would Romney leave a Senate seat for HHS? I get that Biden will want to show that he is not beholden to the far left but Romney can be much more influential in a closely divided Senate.

 

[DebtRising]

No party is going to walk away from a program that produces savings and rad onc does not have the lobbying power to overcome. APM is ‘law’, and cuts to rad onc will continue.

 

[deleted941485]

No party is going to walk away from a program that produces savings and rad onc does not have the lobbying power to overcome. APM is ‘law’, and cuts to rad onc will continue.

Nobody walks away from screwing RO or docs in general.

Romney as head of HHS. The architect of the ACA prototype. You guys are living in a fantasy if you think a changed in power means anything positive for an RO.

 

[Lamount]

No party is going to walk away from a program that produces savings and rad onc does not have the lobbying power to overcome. APM is ‘law’, and cuts to rad onc will continue.

I mean, maybe... but he is also someone with more of a personal interest in cancer care. There are any number of ways APM can be framed where it incentivizes under treatment of cancer patients.

 

[DebtRising]

I would hope you are right. I can’t see any force in this environment that would negate cuts to us, and APM is implemented for the sole purpose of cuts. That is the mission. It was rushed out by Azar or Seema in their power struggle to show HHS was doing something on onc costs without hurting pharma. It is a tremendous effort on CMS end and their ROI is cut costs.

 

[theradiator]

I mean, maybe... but he is also someone with more of a personal interest in cancer care. There are any number of ways APM can be framed where it incentivizes under treatment of cancer patients.

Look at Biden's Cancer Moonshot and see how many radiation studies were funded

 

[Ray D. Ayshun]

Look at Biden's Cancer Moonshot and see how many radiation studies were funded

Lol. Have the recent completed/funded radiation studies helped our bottom line? Seems like the more funded studies we have, the less there is to do.

 

[deleted941485]

Lol. Have the recent completed/funded radiation studies helped our bottom line? Seems like the more funded studies we have, the less there is to do.

Idk but it seems most of the studies done by RO these days are used to justify less not more.

I don’t understand why we keep coming back to this. There is NOTHING out there in our favor. We squabble over marginal changes but the broader trends are already in place.

If you’ve been practicing for the last 10 years it has been a nightmare. It started out alright and went to **** very quickly

 

[scarbrtj]

Radiation Oncologists Urge Congress to Advance Bills That Protect Patient Access to Cancer Care During Pandemic​

Radiation Oncologists Urge Congress to Advance Bills That Protect Patient Access to Cancer Care During Pandemic

November 18, 2020 — Radiation oncologists across the country will meet virtually with members of Congress this week to urge lawmakers to pass legislation that will safeguard access to high-quality, value-based health care for people with cancer.

www.itnonline.com

 

[OTN]

Updates just issued re: the APM. Will go for a 4.5-year period, from July 2021 to Dec 2025.

More interestingly, the correction document now states that physician group practices will see an increase of 1.6% in Medicare FFS revenues, while hospital outpatient departments will see an 8.7% reduction in Medicare FFS services. (Changed from 6% and 4.7% reductions, respectively, previously.)

I guess the "private practices charge less, but they treat for longer so it's more or less even" was not correct.

Document: Medicare Program; Specialty Care Models To Improve Quality of Care and Reduce Expenditures; Correction

 

[msuxrt]

Within the recent COVID-relief package signed by Congress was a statement delaying the RO Model until at least January 1, 2022.

SEC. 133. DELAY TO THE IMPLEMENTATION OF THE RADI6 ATION ONCOLOGY MODEL UNDER THE MEDI7 CARE PROGRAM.

Notwithstanding any provision of section 1115A of the Social Security Act (42 U.S.C. 1315a), the Secretary of Health and Human Services may not implement the radiation oncology model described in the rule entitled ‘‘Medicare Program; Specialty Care Models To Improve Quality of Care and Reduce Expenditures’’ (85 Fed. Reg. 14 61114 et seq.), or any substantially similar model, pursuant to such section before January 1, 2022.

As any additional information is provided, we will keep you posted. As we move closer to 2022, we will also be providing updates and resources. Be sure to check back with RCCS.

Happy New Year!

CRC Admin

 

[Irradi8or]

Within the recent COVID-relief package signed by Congress was a statement delaying the RO Model until at least January 1, 2022.

SEC. 133. DELAY TO THE IMPLEMENTATION OF THE RADI6 ATION ONCOLOGY MODEL UNDER THE MEDI7 CARE PROGRAM.

Notwithstanding any provision of section 1115A of the Social Security Act (42 U.S.C. 1315a), the Secretary of Health and Human Services may not implement the radiation oncology model described in the rule entitled ‘‘Medicare Program; Specialty Care Models To Improve Quality of Care and Reduce Expenditures’’ (85 Fed. Reg. 14 61114 et seq.), or any substantially similar model, pursuant to such section before January 1, 2022.

As any additional information is provided, we will keep you posted. As we move closer to 2022, we will also be providing updates and resources. Be sure to check back with RCCS.

Happy New Year!

CRC Admin

This took lobbying from many of us and from multiple societies... I'm sure folks on SDN helped contribute too

 

[Krukenberg]

This took lobbying from many of us and from multiple societies... I'm sure folks on SDN helped contribute too

this lobbying is exactly the reason that everyone dropping ASTRO membership is cutting off one’s nose to spite the face. The way to change ASTRO is to collectively get involved with the org and push for it. It’s not a big society...just a few like-minded docs could make a difference.

 

[RadOncDoc21]

this lobbying is exactly the reason that everyone dropping ASTRO membership is cutting off one’s nose to spite the face. The way to change ASTRO is to collectively get involved with the org and push for it. It’s not a big society...just a few like-minded docs could make a difference.

I’ll save my praises after 2022. I’ve seen this can get kicked down the road enough to know that the end is inevitable.

Either way, I paid my membership fee this year just because I rather stick it to my admins to reimburse me for it.

 

[drewdog1973]

this lobbying is exactly the reason that everyone dropping ASTRO membership is cutting off one’s nose to spite the face. The way to change ASTRO is to collectively get involved with the org and push for it. It’s not a big society...just a few like-minded docs could make a difference.

No. They don’t speak for me.

Just because the Nazis supported some things I believe in (health insurance for all, sturdy automobiles, and artisinal sausage) doesn’t mean I blindly send them money because we agree on a few things.

I just did a full Godwin. Deal with it.

 

[RickyScott]

No. They don’t speak for me.

Just because the Nazis supported some things I believe in (health insurance for all, sturdy automobiles, and artisinal sausage) doesn’t mean I blindly send them money because we agree on a few things.

I just did a full Godwin. Deal with it.

If apm did not exist, would the outlook of job market over next 5-10 years change. Not by much. Oversupply dwarfs everything else.

 

[drewdog1973]

If apm did not exist, would the outlook of job market over next 5-10 years change. Not by much. Oversupply dwarfs everything else.

Yup. By far. And ASTRO president adding spots at a "residency" program in WV. You want us to send these clowns more money?

 

[medgator]

this lobbying is exactly the reason that everyone dropping ASTRO membership is cutting off one’s nose to spite the face. The way to change ASTRO is to collectively get involved with the org and push for it. It’s not a big society...just a few like-minded docs could make a difference.

You mean the clowns who let CMS roll back supervision regulations by not arguing to cover rural critical access hospitals the same as everywhere else all these years because they were too busy attacking private practice rad oncs who joint ventured with urologists?

With a clown chair adding/creating spots at a recently accredited bottom tier residency no less, as Drewdog alluded to.

"Fool me once shame on you...."

 

[medgator]

If apm did not exist, would the outlook of job market over next 5-10 years change. Not by much. Oversupply dwarfs everything else.

Supervision reg changes have already done a lot of damage in 2020. ASTRO was and continues to be asleep at the wheel there by never arguing the case properly from day 1 by allowing the CAH exemption

 

[scarbrtj]

Supervision reg changes have already done a lot of damage in 2020. ASTRO was and continues to be asleep at the wheel there by never arguing the case properly from day 1 by allowing the CAH exemption

In science it only takes one piece of contradicting data to invalidate a whole hypothesis. The CAH exemption was that. And it was never mentioned or acknowledged by the supervision hypothesizers. It was almost... like... rural or solo practice radiation oncology didn't exist in the eyes of ASTRO. Inconceivable!

 

[Krukenberg]

You mean the clowns who let CMS roll back supervision regulations by not arguing to cover rural critical access hospitals the same as everywhere else all these years because they were too busy attacking private practice rad oncs who joint ventured with urologists?

With a clown chair adding/creating spots at a recently accredited bottom tier residency no less, as Drewdog alluded to.

"Fool me once shame on you...."

ASTRO, like all organizations, fundamentally consists of people. If more PP docs would get involved in the organization, their interests would be better represented. It’s insane to propose crippling our specialty’s ability to lobby government when the alternative is totally achievable. Other specialties’ society boards have much more PP representation than ASTRO.

 

[Irradi8or]

I agree that we should consider supporting ASTRO. With what little time I have as a very busy PP doc, I volunteer for some ASTRO committee work and definitely see first hand how impactful it can be. But at the end of the day, it takes many more people than folks like me to move the needle, not only within any organization but also at the CMS and beyond levels. Despite massive lobbies that have had a strong hold on Congress for years, the sudden release of MFN interim FR has put pharma, distributors, and large provider groups into a massive scramble. Yes, there are many lawsuits and yes there's a very good chance the can gets kicked down the road, but writing is on the wall. In MFN, some of the top 50 drugs could see upwards of a 65% cut at current rates and naturally pharma will tweak their costs in the US and abroad (as well as supply) to game the system. However, for us Rad Oncs, we're a smaller specialty with lower spending - although it's no guarantee, if we work together we've got a better chance to minimize the inevitable reductions coming to our specialty and others.

And honestly, I'd just love to have my PP docs on these committees to work with! There's a clear difference in how practical some of the suggestions are from PP folks vs some academic folks on these committees...

 

[RickyScott]

ASTRO, like all organizations, fundamentally consists of people. If more PP docs would get involved in the organization, their interests would be better represented. It’s insane to propose crippling our specialty’s ability to lobby government when the alternative is totally achievable. Other specialties’ society boards have much more PP representation than ASTRO.

APM needs to be put in perspective. Most radoncs are employed and billing simply does not have much of an impact on salary/practice opportunities vs supply of docs. Neurologists, psych (and medonc for that matter) who bill professionally a fraction of radonc have geographic flexibility and similar/higher salaries out of training. What if an apm/cms mandate cut our professional billing by 50%! (it would probably still be higher than psych)?

 

[Neuronix]

I will third what drewdog and rickyscott have posted.

Residency overtraining is the biggest threat to radiation oncology.

ASTRO has done nothing and is doing nothing about this problem.

 

[thecarbonionangle]

we must support ASTRO with membership dues and big contributions to ASTRO PAC. Many of you have it paid for by your practice and institutions, so i do not see the need to fall on this sword. It is the only way to exert political influence. We are only hurting ourselves by weakening our only organization, no matter how limp it already is.

 

[medgator]

we must support ASTRO with membership dues and big contributions to ASTRO PAC. Many of you have it paid for by your practice and institutions, so i do not see the need to fall on this sword. It is the only way to exert political influence. We are only hurting ourselves by weakening our only organization, no matter how limp it already is.

ACRO

 

[RickyScott]

we must support ASTRO with membership dues and big contributions to ASTRO PAC. Many of you have it paid for by your practice and institutions, so i do not see the need to fall on this sword. It is the only way to exert political influence. We are only hurting ourselves by weakening our only organization, no matter how limp it already is.

in theory, I dont disagree with you, but whatever happens with lobbying, billing and government not nearly as important as supply and demand. Why does a psychiatrist make 400k+ when they bill less than half of a radonc?. What if one day CMS cuts our billing by 60-70% so that we are on par with psych or neuro- would graduating radonc residents then start to get 400k 4 day a week job offers and favorable geography? I just fail to see impact of billing and reimbursement in system dominated by large employers vs that of supply and demand factors.

 

[fiji128]

Regarding kicking the APM can down the road for yet another year, I guess that's good for some practices but it is still coming. Not even sure there is any point in delaying it at this point really. So I will rate it as kinda a win for some.

I agree that a huge problem with ASTRO is that its nearly made up of entirely academic physicians. I've submitted myself for ASTRO committee membership a few years back but never heard anything back. Looking from the outside, it definitely gives off the vibe that it is almost exclusively for those trying to climb the academic cursus honorum and that ASTRO exist to serve the interest of only academic departments.

By far the number one thing effecting their junior membership is the over training of the residents. The result of which is the commoditization of its member physicians. This means that in today's world practically anyone can be fairly easily replaced from the admin prospective. This also means that opportunities for advancement or to change positions are exceedingly difficult to find. The current president of the org is essentially the poster child of this disaster. ASTRO continues to be mum on this as the specialty becomes the least competitive in medicine. Therefore, I won't be patting ASTRO on the back about using COVID as a fake reason for kicking the APM can down the road by a year.

 

[RadOncDoc21]

Regarding kicking the APM can down the road for yet another year, I guess that's good for some practices but it is still coming. Not even sure there is any point in delaying it at this point really. So I will rate it as kinda a win for some.

I agree that a huge problem with ASTRO is that its nearly made up of entirely academic physicians. I've submitted myself for ASTRO committee membership a few years back but never heard anything back. Looking from the outside, it definitely gives off the vibe that it is almost exclusively for those trying to climb the academic cursus honorum and that ASTRO exist to serve the interest of only academic departments.

By far the number one thing effecting their junior membership is the over training of the residents. The result of which is the commoditization of its member physicians. This means that in today's world practically anyone can be fairly easily replaced from the admin prospective. This also means that opportunities for advancement or to change positions are exceedingly difficult to find. The current president of the org is essentially the poster child of this disaster. ASTRO continues to be mum on this as the specialty becomes the least competitive in medicine. Therefore, I won't be patting ASTRO on the back about using COVID as a fake reason for kicking the APM can down the road by a year.

Well said... you have spoken!

 

[TheWallnerus]

Anybody heard anything... from ASTRO. Are they making progress.

T-minus 1.44E2 days until APM. See that "1.44" number a lot in our field, especially existentialist physics calcs. 12x12=144, and the sum of all positive integers equals -1/12. I could go on, but I won't.

Feels like a quiet before the storm.

 

[thecarbonionangle]

Anybody heard anything... from ASTRO. Are they making progress.

T-minus 1.44E2 days until APM. See that "1.44" number a lot in our field, especially existentialist physics calcs. 12x12=144, and the sum of all positive integers equals -1/12. I could go on, but I won't.

Feels like a quiet before the storm.

these are antediluvian times. The haves in the field are sneaking out back doors in their yachts with bags of cash while the rest is pissed on and is told that it is rain. You’ll be ok you know how to swim!

 

[Irradi8or]

I'm a bit surprised that hospital systems and associations haven't been more vocal or influential re: RO APM. Hospitals use technical profits to cross-subsidize other areas of the hospital. Based on CMS' analysis and the estimate that ~80% of physician group practices (PGPs) will get a +5% incentive payment in the PC while TC participants will not, HOPDs seem to be in the biggest losing position here. Freestanding to lose overall too due to the cuts to the TC. This will all just put more and more pressure on physician groups at these centers, where could imagine hospitals continuing to wring out any profit from their radiation departments through further cuts to employment contracts.

 

[TheWallnerus]

could imagine hospitals continuing to wring out any profit from their radiation departments through further cuts to employment contracts.

"One rad onc doc covering two hospitals... that's really always been the most efficient in our way of thinking." - Hospital CEO from the year 2025

 

[fiji128]

I'm a bit surprised that hospital systems and associations haven't been more vocal or influential re: RO APM. Hospitals use technical profits to cross-subsidize other areas of the hospital. Based on CMS' analysis and the estimate that ~80% of physician group practices (PGPs) will get a +5% incentive payment in the PC while TC participants will not, HOPDs seem to be in the biggest losing position here. Freestanding to lose overall too due to the cuts to the TC. This will all just put more and more pressure on physician groups at these centers, where could imagine hospitals continuing to wring out any profit from their radiation departments through further cuts to employment contracts.

View attachment 341877

Can this be true? If a HOPD was charging $100 for services rendered in 2021 then those same exact services in 2026 will then bill at only $61! While with the PGP will be getting $128 for their services over that same time. This does not seem like it will stand.

 

[TheWallnerus]

Can this be true? If a HOPD was charging $100 for services rendered in 2021 then those same exact services in 2026 will then bill at only $61! While with the PGP will be getting $128 for their services over that same time. This does not seem like it will stand.

 

[Irradi8or]

Can this be true? If a HOPD was charging $100 for services rendered in 2021 then those same exact services in 2026 will then bill at only $61! While with the PGP will be getting $128 for their services over that same time. This does not seem like it will stand.

Right the kicker here is that the reimbursement in HOPPS is expected to go up outside the RO Model (which is where the TC for HOPDs comes from) over these years, while the MPFS for the PC for physicians is not expected to go up and many of our codes predicted to go down in next few years. So TC reimbursement in the RO Model ends up diverging from HOPPS outside the model so HOPDs get hit moreso. Agree that it's an outcome that hospitals wouldn't just sit back and take...

 

[deleted1111261]

I think ASTRO’s position of “keep it, but make it better” puts us in a very weak position. We have the numbers to show that we are self regulating more than most specialties. If it actually happens, I am quite nervous because it will eventually hit all of us except the Exceptional Eleven.