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deleted1168505
Ahhh, Simul. Welcome to the getting-so-pissed-off-that-you-walk-in-and-quit-with-nothing-else-lined-up club! Glad I'm not the only member and you got something way better.
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Maybe Sameer can answer.
What is the point of lying about this webinar? I don't understand.
What is the point of lying about this webinar? I don't understand.
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I feel like that in the field of medicine in general, which is why I’m saving and investing so much now. I can see myself one day just not showing up to work.
Sad thing is I feel like that day is coming sooner rather then later and actually wouldn’t mind doing something else.
Sad thing is I feel like that day is coming sooner rather then later and actually wouldn’t mind doing something else.
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Putin-esqe
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deleted1168505
I think the whole world is underestimating the effect AI will have on all of us in very short order.
Fun game though, ask Google bard specifics about how much radiation oncologists make ("What are the average collections for a radiation oncologist", ask about MGMA in certain regions, etc).
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This. In between the lines of anything and everything I say about rad onc is this. The reverse idea is equally as true: over hiring is supported by overutilization. Rad onc could cost society half as much money tomorrow, we could have half as many docs, and all the remaining docs would make more than now.
Rad Onc SK
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I think that might be my fault. It probably is. I collated the most common questions and/or criticism from this thread (ex: PPS exempt and protons) and sent them to ASTRO staff, asking them to make sure they addressed those first. That took time. I think there were questions from the audience which were taken/addressed, but many of the talking points were taken from this forum.
Sorry. Obviously, this wasn't taken well. I was trying, in good faith, to make sure the biggest issues were addressed.
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deleted1111261
It is sometimes the only choice.
Once you figure out something is broken and unfixable, gotta walk away
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Isnt the single biggest issue: how will the ROCR affect salaries (which are not professional collections for most radoncs!)and employment opportunities/job market?
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I posted during the town hall- the question about the 90 day exclusionary period - which they answered. Personally, I see the exclusionary period as flawed and potentially detrimental to care, but if you "trust" that these additional episodes of treatment are counted into the base rate then maybe you feel better.
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Will impact utilization which affects us all.
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Say it louder for the people in the back! 😃
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You posted a question on teams?
I was wondering if Q&A was just turned off for me and the couple people I was texting with during the session. Knowing how Dave Adler operates, that seemed entirely possible to me. Then I saw someone raise their hand and that went unanswered. The few others I asked said they had no Q&A box. You would be the first I've heard that could post a question.
If anyone was wondering, here is my question, which is pretty reasonable and remains unanswered. What defines adaptive for exclusion? My best guess is now "whatever we need it to be so SCAROP is happy".
I've had enough of this insanity at this point. I'm not going to trust or engage people who can't even give a straight answer about small implementation details like whether there was a live audience Q&A during their "town hall".
Hey Sameer, I know you are trying. I wish you the best of luck going forward. But, as Simul put it...
Yea.
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Yes, on Teams. They directly quoted my question back to me. Was planning to ask a workforce question after this but got called away.
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I definitely could not participate in the “Town Hall” and chat was turned off. I could not even raise a hand. Not a friendly town! Kind of like town halls Napoleon ran in ‘Animal Farm’ 
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How did you watch the webinar?
Are you on an ASTRO committee by chance?
I ask because I used one of my hospital emails to register/watch. The "ROCR Town Hall" chat is still visible on my organization's Teams page.
I opened it today because that Colin kid was downloading the recording (I guess). When I tried to get the recording myself, it said I wasn't part of the ASTRO SharePoint.
I also couldn't chat or use the QA...but I bet people who are already within ASTRO could.
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deleted1111261
Mine was turned off too!
Phenomenal
Phenomenal
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I’m a member but not on a committee- they wouldn’t want me lol. Clicked on the emailed link which opened teams within chrome.
Wondered why I wasn’t seeing more questions spawned by SDN.
Wondered why I wasn’t seeing more questions spawned by SDN.
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We could not even see that ANY questions were being asked
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deleted1111261
They completely blocked access
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So only paid members could ask questions?
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Hahahaha ok...wait...wait...
First, I live my life with the adage "Hanlon's Razor": Never attribute to malice that which is adequately explained by stupidity.
If I log into my Teams right now:
This is what I see now, and then. "Chat is turned off for this meeting".
When I try to get the link for the recording:
https:// astroit-my.sharepoint.com/✌️/g/personal/colin_whitney_astro_org [meeting code]
When I try to get the Stream:
Most importantly, the QA:
I would bet anything the security settings of the meeting were "Default", meaning only people who have ASTRO SharePoint permission (or some other type of permission) could access it.
So we have:
1) Default Teams settings, where you needed to register using the "correct" email
1A) This was done accidentally
1B) This was done purposefully to give the illusion of Town Hall
2) ExOkie is an ASTRO plant and outright lying
Option 1A seems like the ASTRO we know and love...
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Only paid members can use ROhub iirc. So would not surprise me
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Infuriating but not surprising.
Wish I’d known…would have forwarded the email to someone on SDN more attuned to the issues to ask questions guised as me
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deleted1111261
Does Astro represent paying Astro members or the RadOnc community as a whole?
I think we have a very clear answer.
I think we have a very clear answer.
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The doc from Tennessee may be well regarded, but was totally disingenuous about breast fractionation under ROCR (indirect workforce question). Hell yes, most of breast, will be 5 fraction, with almost all early breast treated with partial breast vmat. Honestly, this may be better for patients as well.
Her in your face disingenuity only reaffirmed my workforce concerns and that these guys are keenly aware of the implications. Why can’t Astro be straightforward and admit workforce concerns? A: at the same time they were formulating ROCR, they were concocting that bs workforce report.
Her in your face disingenuity only reaffirmed my workforce concerns and that these guys are keenly aware of the implications. Why can’t Astro be straightforward and admit workforce concerns? A: at the same time they were formulating ROCR, they were concocting that bs workforce report.
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Uhhh
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deleted1111261
So
- advertised as a town hall
- first 30 minutes being talked at
- then, some pre submitted softballs asked/answered
- then, the QA was opened to “select” people
- others could see, but not everyone
- then, today a blitz about the town hall and how there was great QA
Why are they like this?
- advertised as a town hall
- first 30 minutes being talked at
- then, some pre submitted softballs asked/answered
- then, the QA was opened to “select” people
- others could see, but not everyone
- then, today a blitz about the town hall and how there was great QA
Why are they like this?
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"who ME? LOL. we're laughing at you not with you bro. Nah we jus kidding yo. But seriously.. You ain't got nothing coming your way. Nothing. Now.. F OFF.."
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Same reason astro surveys chairs on salaries (for collusive purposes) and then makes this info only available to chairs, not the other 99% of their membership.
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LOL, okay, now Im kind of worried that ASTRO will bring this circus to congress and actually anger them, leaving us worse off than if we never did anything at all
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I would love it if congress was an arbiter of reasonableness. ASTROs game may play well for congress. Pull out some testimonials. Get the Stand up to Cancer crowd there for optics. Their toughest audience by far is the one made up of practicing radoncs.
I wish I was joking.
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deleted1111261
There will be way more negative calls then positive.
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The workforce is balanced* (ASTRO, 2023). Consolidation is good (IJROBP Podcast, 2021), but ROCR will unfortunately or fortunately or something... tamper enthusiasm for consolidation a little bit** (ROCR Town-webihall, 2023). Pay no attention to that man behind the curtain (The Wizard, Oz, 1939).
*Balanced... or maybe a little under supply or maybe extreme oversupply, its all good.
**Haha, I had no idea what he was saying either.
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When you predict every possible future outcome you’re never wrong
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“Tamper enthusiasm for consolidation”?
Was that actually said? If so, why might that be? Because ROCR has locked our traditional modality into some pay scheme not worth their time?
But trust us, it’s better to be locked in the “concrete house with no windows” rather than to outside with the proton lobby and huge academic centers who actually wrote the policy. Seriously… trust us.
Was that actually said? If so, why might that be? Because ROCR has locked our traditional modality into some pay scheme not worth their time?
But trust us, it’s better to be locked in the “concrete house with no windows” rather than to outside with the proton lobby and huge academic centers who actually wrote the policy. Seriously… trust us.
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I think his answer was not well thought out tbh.
imo, the better case for ROCR and consolidation is payment neutrality. If the playing field has been uneven, hospitals have had higher pay and freestanding lower, making everyone get paid the same average will hurt the hospitals and help freestanding.
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Neutrality would slow consolidation. The problem is the proton exception which incentives consolidation.
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deleted1168505
How was the biggest issue by far, too many residents, addressed and to what extent?
I’m surprised this hasn’t been cited more frequently here as a positive of ROCR. Facility fees have been a driver of consolidation. Site neutrality goes directly against the interests of academic centers
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I see so many people complaining that there favorite issue isn't being addressed by ROCR.
There are lots of issues facing our field. ROCR targets one particular problem, which is falling reimbursement under FFS. How is a proposed alternate payment model supposed to address resident expansion?
I'm disappointed in the reaction of many here to the effort. I think if we are hoping for an omnibus solution that addresses PPSE, Protons, Residency Expansion and medicare cuts all in one, we're setting ourselves up for disappointment.
ESE said somewhere case rates/bundle payments are coming but has voiced only opposition to ROCR.
I don't understand what folks really expect. Change/improvement will be incremental. Let's get behind wins when we see them and keep fighting for the other issues alongside/as next steps.
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Well the question is, which version of the story do we want to believe?
In late 2021, the Red Journal had an issue on consolidation as @NotMattSpraker mentioned.
They did a podcast on it, with Zietman interviewing Miranda Lam and the new grad from the ROCR Town Hall, Milligan.
Go listen for yourself. Here are key excerpts with the opinion expressed on that podcast, and the opinion expressed on the Town Hall:
AZ:
One sort of economic threat on the horizon is the new alternative payment model, which is going to bundle payments and radiation oncologists specifically will take quite a hit from this. Do you think that is going to drive more groups into consolidation?
Lam:
My sense is that if we were to look at the data, that there may be an uptick in terms of consolidation. I do think that there is concern.
About practices that may not be able to feel comfortable financially to stay open and look for other practices to merge with other hospitals to work with, or, private equity firms to buy them. And so I do think that there is a real chance that consolidation may increase. I think another interesting component that Dr. Milligan and I have talked about is that the impact that the bundled payments in radiation oncology might have on vulnerable populations. So if we think about some of these practices that have one or two radiation oncologists, if they are randomized into the bundled payment model, they may feel more financial pressures.
and either have to close down or find ways to keep the practice open with less resources. And I think in those cases, we're really hurting some of these populations that may already have difficulty accessing care in our rural areas, in areas that care for, more minorities. And so I think it is definitely of concern on many levels, not just for, potential consolidation and increase in prices.
But, I think just the actual threat of what are going to happen to practices. Are we going to see practices, just the sheer number of radiation practices decrease overall?
AZ:
Is there anything that you can imagine that might change this trend to consolidation? Where is it all going to end?
Milligan:
That's an excellent question. In terms of factors that might slow down or reverse consolidation, it's... It's frankly hard to imagine what those might be.
But perhaps it's just my own lack of imagination that it's a little hard for me to come up with any particular factors that might reverse this trend we've seen. One in 11 dermatologists in the United States practiced in a PE or private equity owned firm. These practices were more likely to hire a larger share of advanced Practice providers like NPs or PAs and really drove much higher patient volumes in private equity owned firms compared to those firms that were not owned by private equity companies.
So patient volumes were five to 17% higher. The use of expensive interventions were, was also significantly higher. And, if we were to see similar trends in radiation oncology might portend a future where radiation oncologists are employed by only a few large firms with owners being hospitals, private equity companies, things like that.
It might portend a further softening of the radiation oncology job market as physicians are hired less frequently than they are now.
AZ:
Boy, that's a real doomsday scenario. I think private equity companies are getting involved in some practices in radiation oncology, though I think they've only just begun.
ROCR Town Hall -
Anne:
This next one is for Dr. Milligan. How would the shift to ROCR impact the trend towards consolidation of practices?
Milligan:
Radiation oncology is consolidating quick. It's one of the most consolidated specialties in the United States. And I think that ROCR will address some of those issues that will certainly make our finances more stable going forward, which can help in the prediction.
And, not having wide confidence intervals in our sensitivity analyses can sort of help not only provide more clarity about where we're going, but also allow you to use your capital a little more wisely. To summarize, ROCR, stabilizes or, at least stabilizes our payments and may address some of the increasing costs as well. So I think it will have it's hard to predict, but I think it will have a positive effect in sort of reducing the rates of consolidation going forward.
The reason consolidation is being talked about as a "benefit" of ROCR here is because it's not a benefit.
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Because falling cms proffesional reimbursement doesn’t really impact vast majority of employed docs,but Astro is implying that it does! Moreover, they are proposing a bundled payment option that will worsen the supply and demand problem (that they created) which will actually hurt employed docs.
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My opposition is not to bundled payments, it's to ASTRO and this version of bundled payments.
The disturbing amateur-hour play they're attempting with ROCR here - no. Just, no.
This is a good first draft of the outline. This isn't even the final outline.
If ASTRO wants to tag ACRO, the ACR, and some real policy consultants, and workshop with the general RadOnc community, and try again - count me in.
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But it does impact non-employed docs. So if we leave the system as is, employed docs are fine, hospitals get more technical rates, and it further accelerates the already-existing trend to consolidation.
It's an interesting bait-and-switch here at SDN where we complained for so long that ASTRO only had academics and ignored PP. They make a proposal to help PP/freestanding and now we're all employed docs who aren't helped by their proposals.
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I expect honest leadership that don't lie about their motives and the effects of their actions. It is a reasonable expectation.
We are getting case rate payment models and we will have to adjust to them. I don't have to support a bunch of selfish leaders along the way.
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So it's style over substance.
I like the idea of getting ACRO and ACR involved.
I'm curious -- what do you think they would alter to the current proposal?
I'm convinced by Join that PPSE is a non-starter. I think protons would be possible but generate a lot of other obstacles to getting this task done on the photon side.
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So you aren't opposed to ROCR because of ROCR, you are opposed to ROCR because ASTRO proposed it... got it.
I'm getting heated. I'll step away for a while
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deleted1168505
It's an interesting bait-and-switch here at SDN where we complained for so long that ASTRO only had academics and ignored PP. They make a proposal to help PP/freestanding and now we're all employed docs who aren't helped by their proposals.
Please explain the net benefit to PP docs vs. employed.
Hospitals will change their preference from employing back to PSAs once they can't make any money off the clinic if that is what's going on.
Or is this going to result in hospitals making more off the clinic/pro-side without passing it down to the employed docs?
I'm struggling to understand how exactly hospitals will adjust employed contracts when they come up for renewal/renegotiation.
