ROCR

[thecarbonionangle]

ROCR: Realistically Only Reducing Reimbursement

CMS thinks you're an a$$hole for determining your own value. ASTRO laughs at you while excluding you from the conversation and spends nothing in its budget worth mentioning, to make reimbursement a priority for you.

I propose a new model. One you will truly be able to "get behind" and vociferously support. FYPM#.

In this model, you pay me what another highly trained expert procedural based physician specialist gets. You know, like a neurosurgeon. Or interventional cardiologist.

Now, its true, the only way they could possibly screw me out of my leverage is to make sure there are plenty of hungry, poorly trained, desperate masses willing to take my place. They surely wouldn't go that route right? I mean, that would be terrible for patients.

Just kidding, they don't actually care about patients. Or physician quality. Its about the money.

ITS ALWAYS ABOUT THE MONEY. No amount of waving alphabet soup (ROCR, APM, QI/QA/Accreditation/MIPS) will distract me from understanding this core principle.

FYPM#

"But Sirspam, I can't do anything. I'm just a schmuck trying to make a living out here!"

QUIT PAYING ASTRO. JOIN ACRO. 100.0% of non academic physicans should be in ACRO and 0% in ASTRO (unless of course, they are grifting for something or referrals).

Do something.

I did love the subtle dig at Neha/thumb on scale by ACRO stating that both are great people but only Sameer bothered to be an ACRO member. I predict a Sameer win, BIGLY!

---

Members don't see this ad.

 

[thecarbonionangle]

I agree, and importantly, many in this cabal... whatever you want to call it... they aren't doctors.

Have a look at the board of the NAPT About NAPT: The Voice of the Proton Community - NAPT

Another thing to think about, sausage. No not hot dogs but the sausage making. Congress/DC is heavily influenced by money. The proton lobby buys politicians. McCain went to Mayo for GBM protons?, Biden’s son went to “the Mecca” for same, both died as protons were never going to cure them more than photons. Politicians are told, look if you or your family get cancer, you want to be able to go to Inova, Hopkins, Maryland, NYPT etc etc. they say yes of course, don’t worry proton sacred cow is safe. It will never be cut. Those who are obsessed with this are only wasting their time and basically pounding water at the pool party. You might as well grab a hurricane baby and take a sip and smile.

 

[NotMattSpraker]

Another thing to think about, sausage. No not hot dogs but the sausage making. Congress/DC is heavily influenced by money. The proton lobby buys politicians. McCain went to Mayo for GBM protons?, Biden’s son went to “the Mecca” for same, both died as protons were never going to cure them more than photons. Politicians are told, look if you or your family get cancer, you want to be able to go to Inova, Hopkins, Maryland, NYPT etc etc. they say yes of course, don’t worry proton sacred cow is safe. It will never be cut. Those who are obsessed with this are only wasting their time and basically pounding water at the pool party. You might as well grab a hurricane baby and take a sip and smile.

Yes, investors too.

Obsessed is a strong word, but I have been talking about it a lot

I agree it's a waste of time from a policy perspective. But I don't think it's a waste of time in conversations among people who work in healthcare, patients, etc. We all poke fun at medical oncology, it is worthwhile to try to prevent that kind of corruption from becoming mainstream in Rad Onc.

We have one tool and almost all ROs benefit very little from the proton push. The physician wRVUs are the same. No reason to let these businesspeople ruin it.

 

[thecarbonionangle]

I just meant it as in for practical purposes it is a waste of time as i think it will never be cut. Of course it is ok to talk about it. For me the better thing for us to obsess about as a field is growing our footprint. We need all the allies for this, a coalition, and we will need the proton lobby for this, their money, power and influence. NAPT is probably the most effective lobby group we have. We should learn from them. The truth is PP has the proton lobby to thank for killing APM. What is the enemy of your enemy to you? A friend? A useful idiot? Whatever if it works!

 

[sirspamalot]

I just meant it as in for practical purposes it is a waste of time as i think it will never be cut. Of course it is ok to talk about it. For me the better thing for us to obsess about as a field is growing our footprint. We need all the allies for this, a coalition, and we will need the proton lobby for this, their money, power and influence. NAPT is probably the most effective lobby group we have. We should learn from them. The truth is PP has the proton lobby to thank for killing APM. What is the enemy of your enemy to you? A friend? A useful idiot? Whatever if it works!

I'm going to have to angrily agree with you lol.

 

[NotMattSpraker]

I just meant it as in for practical purposes it is a waste of time as i think it will never be cut. Of course it is ok to talk about it. For me the better thing for us to obsess about as a field is growing our footprint. We need all the allies for this, a coalition, and we will need the proton lobby for this, their money, power and influence. NAPT is probably the most effective lobby group we have. We should learn from them. The truth is PP has the proton lobby to thank for killing APM. What is the enemy of your enemy to you? A friend? A useful idiot? Whatever if it works!

I will do a career change before I lie to patients in order to sell radiotherapy fractions.

They’re going to have to meet me in the middle and at least tell the truth.

 

[RickyScott]

I will do a career change before I lie to patients in order to sell radiotherapy fractions.

They’re going to have to meet me in the middle and at least tell the truth.

That disqualifies working at a number of nci centers.

 

[Rad Onc SK]

Just catching up to this evolving thread. Long, long day in clinic followed by family stuff.

I saw some great questions and/or comments. My thoughts,…

Q: Why not go for 15-20% raise? AAYGO.

Q: Payment stability. A: ROCR is going through Congress. More stable than CMS with rises more likely to happen since PC linked to MEI and TC linked to HIPPS.

Q: adaptive. A: An adaptive code doesn’t exist. One is needed because it is really work but 77301 is not the right code, although it’s being used right now. That (further) increases the risk of a 77301 resurvey/reevaluation (which would be bad).

Q/C: “ASTRO only spends $150k a year on PAC”. A: ASTRO spends quite a bit on lobbying and advocacy activities. I believe it’s between 12 and 15%. The number is on the annual dues statement, which may be why few people in this forum see it (relax, it’s just a joke) ASTRO PAC has about $150k in hard money each year.

Q: HP service. A: Always room for talented and motivated volunteers in HP, especially if they are from PP. (Gotta be an ASTRO member though.) Extra points for being a SBO. That’s what really got me moving. Tough to get this demographic engaged since practice coverage is tough. I get that. I lived it. We had 8 docs for 5 hospitals requiring FT coverage and we also had 3 CAH in OK. My partners supported me. I remain incredibly proud of the high-quality care. We provided to patients all across the state. Our group was, and remains, awesome. I still talk to them all the time, including our practice manager and this heavily shapes my thinking and approach to things, in case you cared.

Off to bed. Have a great night everyone!

(Big family weekend. I’m gonna try to unplug for the next few days. See you next week!)

 

[Jaguaranna27]

Just catching up to this evolving thread. Long, long day in clinic followed by family stuff.

I saw some great questions and/or comments. My thoughts,…

Q: Why not go for 15-20% raise? AAYGO.

Q: Payment stability. A: ROCR is going through Congress. More stable than CMS with rises more likely to happen since PC linked to MEI and TC linked to HIPPS.

Q: adaptive. A: An adaptive code doesn’t exist. One is needed because it is really work but 77301 is not the right code, although it’s being used right now. That (further) increases the risk of a 77301 resurvey/reevaluation (which would be bad).

Q/C: “ASTRO only spends $150k a year on PAC”. A: ASTRO spends quite a bit on lobbying and advocacy activities. I believe it’s between 12 and 15%. The number is on the annual dues statement, which may be why few people in this forum see it (relax, it’s just a joke) ASTRO PAC has about $150k in hard money each year.

Q: HP service. A: Always room for talented and motivated volunteers in HP, especially if they are from PP. (Gotta be an ASTRO member though.) Extra points for being a SBO. That’s what really got me moving. Tough to get this demographic engaged since practice coverage is tough. I get that. I lived it. We had 8 docs for 5 hospitals requiring FT coverage and we also had 3 CAH in OK. My partners supported me. I remain incredibly proud of the high-quality care. We provided to patients all across the state. Our group was, and remains, awesome. I still talk to them all the time, including our practice manager and this heavily shapes my thinking and approach to things, in case you cared.

Off to bed. Have a great night everyone!

(Big family weekend. I’m gonna try to unplug for the next few days. See you next week!)

All excellent points, Sameer, and totally agree that the ASTRO health policy committee(s) could greatly benefit from a more diverse perspective, particularly from the community oncology side and those who are employed physicians in non-academic hospital systems (a growing demographic particularly among early career radoncs) as well as the various types of private practice settings (small business owner of a radonc solo practice, multi-doc radonc practice, multi-doc multi-specialty practice, etc etc). Until ASTRO has better transparency and better actual diversity of practice setting representation on its committees, not much will change.

I remain hopeful for the future though, as a perpetual optimist.

I’m not blind to reality tho.

On the ACRO GREC call last night, members were made aware that there’s an EviCore alternative payment model already in use - single payer, no input from docs, entirely insurance company driven, and that’s frightening.

The lack of transparency of ASTRO in developing ROCR as well as flawed rollout and blundered attempt at the FAQ page will hurt us in the end. We need to move away from fraction-based care (doesn’t make sense in the hypofrac era), but we need to do so in a way that doesn’t have add-ons like the accreditation penalty.

As has been brought up on this thread, perhaps we need the proton lobby folks to help get this anywhere close to Congress, and the points about current politician favoritism regarding protons are accurate. So ok, proton carve out stays. Adaptive carve out - ok maybe that stays, since there aren’t ICD codes yet. And the PPS-exempt carve out, although I detest it, kinda a whole giant beast to tackle.

So where does that leave us? Essentially with ROCR. Rather than accepting it as-is, though, I would like to see the accreditation financial penalty removed entirely or at least softened to a “peer review” requirement as Spraker suggested. If the goal is quality, just make solo docs flying cowboy/gal review their cases with other peers to avoid harming patients. You don’t need accreditation to deliver high-quality, guideline-concordant care. Maybe ASTRO could even utilize the MDQA committee or some other QI committee or the mentor match program (existing volunteers and committee infrastructure) to help offer peer review to solo docs and those not connected with immediate peers (such as those relying on locums for coverage when they go on vacay).

Of all the “hills to die on” so to speak, I think it would be manageable for ROCR to take out or soften the accreditation reqt because there’s a clear conflict of interest with the Astro Apex accreditation, even if they give credit to ACR or ACRO accreditation. It is shady ethically and simply not professional for the accreditation requirement to be in ROCR. I’ll die on this hill. As an employed rural doc in a practice covering 5 sites and 6 linacs with 3.2 docs (one doc works 2 days a week, the other 3 radoncs including me are full time), we simply don’t have time or adequate administrative support to do accreditation. And yet our care is world class. We (Aspirus Wausau) is the HIGHEST accruing site onto NRG NCORP trials in the entire country!! From a town of 40,000 in central Wisco. Our quality of care is exceptional, and it is routinely scrutinized and audited by NCI, CTSU, and NCORP. We’re not accredited yet because we don’t have the administrative manpower to do it and my practice doesn’t see it as worthwhile on the radonc side. I’ve personally been involved with other accreditation processes including a breast cancer one and we had to hire separate staff and an outside consultant to get that done. Accreditation is a HUGE investment of time and administrative burden.

The only potential angle I see here is if accreditation would somehow help get rid of other administrative burden such as MIPPS… which if that’s the case, ASTRO HP ppl should shout that from the rooftops. But I still think it’s unethical for Astro and ROCR to penalize practices financially who aren’t accredited yet.

My two cents. Morning musings. From Denver. Lol.

-AB

 

[RickyScott]

Just catching up to this evolving thread. Long, long day in clinic followed by family stuff.

I saw some great questions and/or comments. My thoughts,…

Q: Why not go for 15-20% raise? AAYGO.

Q: Payment stability. A: ROCR is going through Congress. More stable than CMS with rises more likely to happen since PC linked to MEI and TC linked to HIPPS.

Q: adaptive. A: An adaptive code doesn’t exist. One is needed because it is really work but 77301 is not the right code, although it’s being used right now. That (further) increases the risk of a 77301 resurvey/reevaluation (which would be bad).

Q/C: “ASTRO only spends $150k a year on PAC”. A: ASTRO spends quite a bit on lobbying and advocacy activities. I believe it’s between 12 and 15%. The number is on the annual dues statement, which may be why few people in this forum see it (relax, it’s just a joke) ASTRO PAC has about $150k in hard money each year.

Q: HP service. A: Always room for talented and motivated volunteers in HP, especially if they are from PP. (Gotta be an ASTRO member though.) Extra points for being a SBO. That’s what really got me moving. Tough to get this demographic engaged since practice coverage is tough. I get that. I lived it. We had 8 docs for 5 hospitals requiring FT coverage and we also had 3 CAH in OK. My partners supported me. I remain incredibly proud of the high-quality care. We provided to patients all across the state. Our group was, and remains, awesome. I still talk to them all the time, including our practice manager and this heavily shapes my thinking and approach to things, in case you cared.

Off to bed. Have a great night everyone!

(Big family weekend. I’m gonna try to unplug for the next few days. See you next week!)

Thank you for coming on here. In light of the fact that Astro just released a workforce analysis, how do you see a model like the ROCR affecting the job market? A lot of "unnecessary" fractionation is going on out there, and this type of model will decrease hiring and add a bolus of radoncs to the job market whose time/effort was supported by the extra fractions. If we started giving 8Gy x 1 and 5 fraction breast and prostate, my hospital would never hire again, and we could probably eliminate 0.5-1 FTE doc. The pressure on the job market would affect us all, even if you are presently hypofractionating everything, you will face Downward pressure on salaries and lack of mobility. I could definitely see my admin stating “you know there are a lot of desperate radoncs out there..” when time comes for contract renewal.

Second, I would like to thank you for mentioning on twitter that when the baby boom population bubble passes in the 2030s, radonc is in big trouble.

 

[elementaryschooleconomics]

Q/C: “ASTRO only spends $150k a year on PAC”. A: ASTRO spends quite a bit on lobbying and advocacy activities. I believe it’s between 12 and 15%. The number is on the annual dues statement, which may be why few people in this forum see it (relax, it’s just a joke) ASTRO PAC has about $150k in hard money each year.

Alright, well I went into my ASTRO account and checked the invoice from the last time I paid, and also checked the angry "PAST DUE" invoice I currently have.

There is no line item backing up your 12-15% statement. There's no line item at all, actually. There is an empty box for ASTRO PAC donations though! I have no other "statements" in my email or ASTRO account, but I could be looking in the wrong place.

Here's the current ASTRO PAC website:

So in an historical moment where ASTRO released a plan to pass legislation through Congress, drastically changing how the entire specialty is paid, the "war chest" has a whopping $28,404 over halfway through the year.

You're telling us that 12-15% of the annual revenue goes towards lobbying and advocacy activities? Assuming similar revenue to prior 990 statements, that's at least $3 million dollars, with the PAC being a small minority of that money evidently.

Where can we see what you're talking about?

 

[Mandelin Rain]

Another thing to think about, sausage. No not hot dogs but the sausage making. Congress/DC is heavily influenced by money. The proton lobby buys politicians. McCain went to Mayo for GBM protons?, Biden’s son went to “the Mecca” for same, both died as protons were never going to cure them more than photons. Politicians are told, look if you or your family get cancer, you want to be able to go to Inova, Hopkins, Maryland, NYPT etc etc. they say yes of course, don’t worry proton sacred cow is safe. It will never be cut. Those who are obsessed with this are only wasting their time and basically pounding water at the pool party. You might as well grab a hurricane baby and take a sip and smile.

This is my point.

You can't pass legislation without buying the right politicians. And....It almost doesn't matter what the legislation says if you do buy the right politicians. The legislation could say 3% cut or 15% raise. First, because no one will actually read it. Second, because it doesn't matter AT ALL on a 7 trillion dollar congressional budget. Call it the "Protecting Quality Cancer Care for Americans" bill. It's an easy sell for any congressperson.

You don't go through the process of buying the right people in Congress, and ask them to whip you a little less hard.

The motive here is to protect a small slice of the specialty while throwing the majority of the specialty to the wild (while also cash grabbing at burdensome accreditation that's never helped a single patient). It's about having clear legislation separating the big guys from the small guys so there's no future confusion. Consolidation is the goal here guys.

 

[thecarbonionangle]

This is my point.

You can't pass legislation without buying the right politicians. And....It almost doesn't matter what the legislation says if you do buy the right politicians. The legislation could say 3% cut or 15% raise. First, because no one will actually read it. Second, because it doesn't matter AT ALL on a 7 trillion dollar congressional budget. Call it the "Protecting Quality Cancer Care for Americans" bill. It's an easy sell for any congressperson.

You don't go through the process of buying the right people in Congress, and ask them to whip you a little less hard.

The motive here is to protect a small slice of the specialty while throwing the majority of the specialty to the wild (while also cash grabbing at burdensome accreditation that's never helped a single patient). It's about having clear legislation separating the big guys from the small guys so there's no future confusion. Consolidation is the goal here guys.

Absolutely, the US right has mastered the propaganda bill naming game. Dems have begun to catch up. It could be a total ruse bill giving themselves a raise and a ‘tini lunch but call it “protecting the american middle class act” and we in business. Like my girl Sarah used to say, you betcha!

 

[NotMattSpraker]

Just catching up to this evolving thread. Long, long day in clinic followed by family stuff.

I saw some great questions and/or comments. My thoughts,…

Q: Why not go for 15-20% raise? AAYGO.

Q: Payment stability. A: ROCR is going through Congress. More stable than CMS with rises more likely to happen since PC linked to MEI and TC linked to HIPPS.

Q: adaptive. A: An adaptive code doesn’t exist. One is needed because it is really work but 77301 is not the right code, although it’s being used right now. That (further) increases the risk of a 77301 resurvey/reevaluation (which would be bad).

Q/C: “ASTRO only spends $150k a year on PAC”. A: ASTRO spends quite a bit on lobbying and advocacy activities. I believe it’s between 12 and 15%. The number is on the annual dues statement, which may be why few people in this forum see it (relax, it’s just a joke) ASTRO PAC has about $150k in hard money each year.

Q: HP service. A: Always room for talented and motivated volunteers in HP, especially if they are from PP. (Gotta be an ASTRO member though.) Extra points for being a SBO. That’s what really got me moving. Tough to get this demographic engaged since practice coverage is tough. I get that. I lived it. We had 8 docs for 5 hospitals requiring FT coverage and we also had 3 CAH in OK. My partners supported me. I remain incredibly proud of the high-quality care. We provided to patients all across the state. Our group was, and remains, awesome. I still talk to them all the time, including our practice manager and this heavily shapes my thinking and approach to things, in case you cared.

Off to bed. Have a great night everyone!

(Big family weekend. I’m gonna try to unplug for the next few days. See you next week!)

Thanks for coming on here and engaging with this group! Much appreciated.

 

[NotMattSpraker]

Of all the “hills to die on” so to speak, I think it would be manageable for ROCR to take out or soften the accreditation reqt because there’s a clear conflict of interest with the Astro Apex accreditation, even if they give credit to ACR or ACRO accreditation.

I think it should be removed for further development, just like adaptive.

There are a lot of positive ways to leverage a quality requirement including things we have not discussed much, such as staffing. ROCR is a good opportunity to do that.

It would also be nice to see some responsibility put on industry partners so that it is easy for practices to comply with data submission. Or at least some kind of financial support for the effort.

If ASTRO cares about optics they really should either just remove it or offer some serious discussion of this issue. I know they are dealing with complaints from all angles, but this is an easy one that is currently implemented in a lazy (and ethically dubious) way.

 

[Mandelin Rain]

Is there an evidence-based improvement in any relevant measure for APEX accreditation?

We're an evidence-based specialty. If we're requiring something, it should be supported by evidence.

It's a transparent cash grab and yet another costly burden to heap on small clinics to stretch them further toward consolidation with larger systems.

 

[sirspamalot]

If ASTRO is lobbying, I don't care what %, THEY AREN'T DOING IT FOR MY BENEFIT. Their lobbying is for Proton hustlers and (mostly) exempt big academia.

I don't need "peer review" forced upon me by some remote schmo who may or may not be as good a radonc and neither of us are getting paid for the work. I know of no other specialty that has two other professionals involved (dosim, physics) that requires peer review. None. Surgeons do M&M, and confer with their colleagues before they go in sometimes. Radiologists get graded primarily on their misses. But our nerdish culture says "your work must be seen by others despite your qualifications and training."

"This is the way its done, it sometimes even makes a difference in planning" .. Well allow me to retort..

And before you get your panties in a bunch, keep in mind I was on staff at a major institution, have conducted/written clinical trials, am a state peer review expert, published across the board and worked in a variety of pp settings in my career. in my experience: The number of times where peer review made a difference for me was one time, a minor adjustment in skin coverage volume, doing informal review with a peer.

How did we get here? We created peer review out of academia, but for solo practices or busy practices it becomes unwieldy to force this requirement into a box ("buy our accreditation package, or you won't get your nuggets/cert/$"). Peer review needs to be readily accessible, free, and it isn't. Now what.

Ideally, peer review is limited to those patients where legitimate questions or controversy might arise. I don't need someone "checking" my routine volumes after doing this for 15 years.

There used to be chartrounds.com which I thought was great - you could present your own case too and get credits (CME/ABR MOC) but it no longer is in operation. If they really cared about peer review, ASTRO would set this up and offer it, for free, to radiation oncologists and provide interested academic folks (who have time to kill) some incentive to provide that review. I'd use it for my challenging cases. If our orgs care, truly care, about quality, its time to reinstate this options for real world pp.

While I'm ranting, allow me to continue. The ABR "answer these 2 stupid questions" every week is MOC sham nonsense. Nothing to do with my day to day work, homer simpson trivia. Why not have ABR do what I suggested above and just require you meaningfully participate in the activity a few times a year?

Ok, I should go drink that cup of coffee now.

#defundASTRO
#notamember

 

[deleted1111261]

The people who want peer review don’t want it.

The people that don’t want peer review need it.

I’m seeing this from my PA work every single day.

 

[Mandelin Rain]

The people who want peer review don’t want it.

The people that don’t want peer review need it.

I’m seeing this from my PA work every single day.

Is your PA a board certified physician? What's the point of any of it, if we need permission each time we prescribe a treatment?

It would be absolutely laughable if it was suggested in literally any other medical discipline.

"Sorry, I can't fill your Metformin. Your doctor didn't run it by his partner."

 

[deleted1111261]

Is your PA a board certified physician? What's the point of any of it, if we need permission each time we prescribe a treatment?

It would be absolutely laughable if it was suggested in literally any other medical discipline.

"Sorry, I can't fill your Metformin. Your doctor didn't run it by his partner."

God I wish they were. They are not very good.

 

[deleted1111261]

Anything that is on ASTRO guidelines or NCCN guidelines gets approved, no questions asked.

I’m talking about Florida guys. You know what I’m talking about. You definitely do.

I was actually starting to think maybe I’m too far into the peer review camp.

Let me give a recent one

A person requests IMRT for breast cancer. It is well established that I am a believer and don’t give people crap about it.

Request comes in. Right side + nodes. Sends the DVH. The IMRT triples the heart dose to 6 Gy. On a right sided case.

This is the sort of crap you see. Fundamentally misunderstanding why you use the technology and then using it in a way that harms patient.

I’m sure this person feels “this is a routine case, why am I getting reviewed”

 

[NotMattSpraker]

Is your PA a board certified physician? What's the point of any of it, if we need permission each time we prescribe a treatment?

It would be absolutely laughable if it was suggested in literally any other medical discipline.

"Sorry, I can't fill your Metformin. Your doctor didn't run it by his partner."

Pharmacists review a lot of prescriptions in the hospital, certainly chemo. Some nuance is helpful here. Peer review has some value, the key is in implementation. Also, people just need to recognize that P2P programs are cost control programs not quality programs. We should have never let payers pitch that idea.

ASTRO has or had a peer program! I asked many legal questions that were sort of answered, sort of not. I signed up anyway. Of course it is volunteer based and it is unclear what ASTRO is offering in this arrangement other than a list of people who sign up.

I’m no longer a member now and 100% of my peer review of others sarcoma cases have always been people reaching out via Twitter, text, or email. I’m always happy to help.

 

[communitydoc13]

I'm pro peer review. One of the positive cultural things specific to radonc. Wish my medoncs practiced this way.

I've got good partners. We rarely over-rule each other but fairly frequently influence each other or establish a tiny consensus for high risk cases. Very occasionally we catch something fundamental another one of us misses. We reinforce weekly what represents standard of care to our practice. We occasionally trim fractions or change fractionation due to collective assessment of risk.

Re-irradiation cases, cases without path, elderly patients, SBRT near critical structures, all examples of cases where it's nice to review with your colleagues.

The critical aspect of peer review is the peer part. Mutual respect, no significant power gradient, no ass kissing or inclination to make someone feel bad.

Everybody should have this. Of course, ideally it should be done before fraction 1.

 

[Mandelin Rain]

You should of course review cases with colleagues when you feel you need to. You should routinely communicate with your peers and the literature.

I'm less sure of the value of compulsory peer review of an APPA bone met plan or tangential breast plan. Especially when everyone involved is scrolling on their phones and drinking their 1st cup of coffee.

 

[Rad Onc SK]

Thank you for coming on here. In light of the fact that Astro just released a workforce analysis, how do you see a model like the ROCR affecting the job market? A lot of "unnecessary" fractionation is going on out there, and this type of model will decrease hiring and add a bolus of radoncs to the job market whose time/effort was supported by the extra fractions. If we started giving 8Gy x 1 and 5 fraction breast and prostate, my hospital would never hire again, and we could probably eliminate 0.5-1 FTE doc. The pressure on the job market would affect us all, even if you are presently hypofractionating everything, you will face Downward pressure on salaries and lack of mobility. I could definitely see my admin stating “you know there are a lot of desperate radoncs out there..” when time comes for contract renewal.

Second, I would like to thank you for mentioning on twitter that when the baby boom population bubble passes in the 2030s, radonc is in big trouble.

I think ROCR is a pre-emptive response to where we see the field going. We are going down this path of hypofractionation at a seemingly record pace. There is a Medicare Advantage pilot program going on in Phoenix. I do not know the details. We are not participating. But it is playing a single rate for multiple disease sites. I would like to hear how those finances stack up against ROCR, but I have heard that the practices participating have signed an NDA. I'd love to learn more. My point is that these bundled programs are already here. They certainly are here in my market and I am sure they are in the markets of many people in this forum.

I think the workforce concerns are valid.

I do not have the expertise that other people do in analyzing it, so I look at it in a much simpler fashion. I think the average radiation oncologist works for about 30 years and hangs it up in their early to mid-60s.

In the 1990s, we were also over-training, from what most people felt. If I recall correctly, there were 140-150 new grads/year. That dropped to 104 by the time I graduated in 2004. It went up in the last decade and now I think we are around 190. The way I look at it, and what I am seeing around me, is that people who graduated in the 1990s are now retiring. We're having 3 in our department this year alone. The net positive right now is roughly 50 per year going into the field. We also have 2.3% Medicare growth per year. That is why we are "okay" at this moment in time. The next decade, in my opinion, is going to be a different story. When "my generation" graduates, and if training numbers are not adjusted, then the net positive entering the workforce could be 100 per year. The exact number of practicing radiation oncologists is tough to get, but I think most people feel it is between 4500 and 5000. We could be increasing the workforce by 2% per year in the 2030s, while the annual increase in Medicare enrollees is only 0.9% per year.

Hypofractionation, as you pointed out, is going to allow us to see more patients per doctor. We also are seeing rapid adoption of tools to help contour and plan. Not only will that make us more efficient, but it is also going to make it difficult to defend a 77301 revaluation since intra-service time is the driving factor.

Personally, I do see some POTENTIALLY rough storms I had. This is not a pleasant conversation but I think we have to have it. I do think things are going to be pretty good until the end of the decade. I think once we start looking be on that, things do not look as clear. In the 2040s, the rise in Medicare in roll ease is only going to be 0.4% per year. A 33-year-old new 2023 grad could easily work into the 2050s. The sky is not falling. We can make some course corrections pretty easily, in my opinion. But we need to start having those conversations right now. That is my opinion. I know others would disagree and I can respect that.

I also think we need to expand RT indications. I think we can help patients with benign conditions. I think radiation oncologists need to be in the RPT space. Cancer is going to turn in to a chronic condition for more and more patients, which is great. Were going to be able to keep patient is alive for longer and with great quality of life. This concept of poly metastatic disease is going to be real and there needs to be a role for radiation therapy in this. That is the way I see things.

 

[Rad Onc SK]

Alright, well I went into my ASTRO account and checked the invoice from the last time I paid, and also checked the angry "PAST DUE" invoice I currently have.

There is no line item backing up your 12-15% statement. There's no line item at all, actually. There is an empty box for ASTRO PAC donations though! I have no other "statements" in my email or ASTRO account, but I could be looking in the wrong place.

Here's the current ASTRO PAC website:

View attachment 374247

So in an historical moment where ASTRO released a plan to pass legislation through Congress, drastically changing how the entire specialty is paid, the "war chest" has a whopping $28,404 over halfway through the year.

You're telling us that 12-15% of the annual revenue goes towards lobbying and advocacy activities? Assuming similar revenue to prior 990 statements, that's at least $3 million dollars, with the PAC being a small minority of that money evidently.

Where can we see what you're talking about?

Huh, weird. I don't know why you can't find it. I cannot find a dues invoice, since I delete them once I pay them. I usually delete my receipts but I did find my 2014 receipt, of all things.

I was wrong. It was 28.5% for that renewal cycle. That's the percentage of dues that were allocated for ASTRO's lobbying activity. It's written pretty clearly, IMO, but others might disagree. If it is hard to see for many members, then ASTRO should/can fix it.

Thanks

 

[RadOncDoc21]

I'm pro peer review. One of the positive cultural things specific to radonc. Wish my medoncs practiced this way.

I've got good partners. We rarely over-rule each other but fairly frequently influence each other or establish a tiny consensus for high risk cases. Very occasionally we catch something fundamental another one of us misses. We reinforce weekly what represents standard of care to our practice. We occasionally trim fractions or change fractionation due to collective assessment of risk.

Re-irradiation cases, cases without path, elderly patients, SBRT near critical structures, all examples of cases where it's nice to review with your colleagues.

The critical aspect of peer review is the peer part. Mutual respect, no significant power gradient, no ass kissing or inclination to make someone feel bad.

Everybody should have this. Of course, ideally it should be done before fraction 1.

I’ve had some of my best peer reviews with colleagues I know from residency or may worked with but man there some rad oncs who get some weird kind of high stroking their own egos. I don’t care if you believe 30 Gy in 10 is better, let me do my 20 in 5! Yes, my PTV is 0.001mm bigger then yours!! I’ve asked my team to schedule patients during peer review for a reason.

 

[communitydoc13]

APPA bone met plan or tangential breast plan

That's just a laterality check.

 

[NotMattSpraker]

The critical aspect of peer review is the peer part. Mutual respect, no significant power gradient, no ass kissing or inclination to make someone feel bad.

Huge. Very little discussion of this aspect of safety culture and I suspect its a big, widespread problem.

 

[deleted1111261]

You should of course review cases with colleagues when you feel you need to. You should routinely communicate with your peers and the literature.

I'm less sure of the value of compulsory peer review of an APPA bone met plan or tangential breast plan. Especially when everyone involved is scrolling on their phones and drinking their 1st cup of coffee.

This shouldn’t happen
This is absolute waste of time
I don’t call that peer review
Just going through (bowel) motions

 

[deleted1111261]

I’ve had some of my best peer reviews with colleagues I know from residency or may worked with but man there some rad oncs who get some weird kind of high stroking their own egos. I don’t care if you believe 30 Gy in 10 is better, let me do my 20 in 5! Yes, my PTV is 0.001mm bigger then yours!! I’ve asked my team to schedule patients during peer review for a reason.

That’s not peer review

That’s ‘sturbing.

 

[Mandelin Rain]

That’s not peer review

That’s ‘sturbing.

Peer reviewing a peer review process is very meta.

 

[deleted1111261]

Peer reviewing a peer review process is very meta.

Literal LOL

 

[deleted1111261]

This shouldn’t happen
This is absolute waste of time
I don’t call that peer review
Just going through (bowel) motions

For the bone met - the peer review is making sure it’s in standard range (1,5,10) and that dose is 8-30+ and that you’re not missing target. 8 seconds

Tangent breast - breast covered, tumor bed covered entirely, hotspots outside of nipple axilla and imf. V105 < 15%. 42 seconds

 

[NotMattSpraker]

I think ROCR is a pre-emptive response to where we see the field going. We are going down this path of hypofractionation at a seemingly record pace. There is a Medicare Advantage pilot program going on in Phoenix. I do not know the details. We are not participating. But it is playing a single rate for multiple disease sites. I would like to hear how those finances stack up against ROCR, but I have heard that the practices participating have signed an NDA. I'd love to learn more. My point is that these bundled programs are already here. They certainly are here in my market and I am sure they are in the markets of many people in this forum.

I think the workforce concerns are valid.

I do not have the expertise that other people do in analyzing it, so I look at it in a much simpler fashion. I think the average radiation oncologist works for about 30 years and hangs it up in their early to mid-60s.

In the 1990s, we were also over-training, from what most people felt. If I recall correctly, there were 140-150 new grads/year. That dropped to 104 by the time I graduated in 2004. It went up in the last decade and now I think we are around 190. The way I look at it, and what I am seeing around me, is that people who graduated in the 1990s are now retiring. We're having 3 in our department this year alone. The net positive right now is roughly 50 per year going into the field. We also have 2.3% Medicare growth per year. That is why we are "okay" at this moment in time. The next decade, in my opinion, is going to be a different story. When "my generation" graduates, and if training numbers are not adjusted, then the net positive entering the workforce could be 100 per year. The exact number of practicing radiation oncologists is tough to get, but I think most people feel it is between 4500 and 5000. We could be increasing the workforce by 2% per year in the 2030s, while the annual increase in Medicare enrollees is only 0.9% per year.

Hypofractionation, as you pointed out, is going to allow us to see more patients per doctor. We also are seeing rapid adoption of tools to help contour and plan. Not only will that make us more efficient, but it is also going to make it difficult to defend a 77301 revaluation since intra-service time is the driving factor.

Personally, I do see some POTENTIALLY rough storms I had. This is not a pleasant conversation but I think we have to have it. I do think things are going to be pretty good until the end of the decade. I think once we start looking be on that, things do not look as clear. In the 2040s, the rise in Medicare in roll ease is only going to be 0.4% per year. A 33-year-old new 2023 grad could easily work into the 2050s. The sky is not falling. We can make some course corrections pretty easily, in my opinion. But we need to start having those conversations right now. That is my opinion. I know others would disagree and I can respect that.

I also think we need to expand RT indications. I think we can help patients with benign conditions. I think radiation oncologists need to be in the RPT space. Cancer is going to turn in to a chronic condition for more and more patients, which is great. Were going to be able to keep patient is alive for longer and with great quality of life. This concept of poly metastatic disease is going to be real and there needs to be a role for radiation therapy in this. That is the way I see things.

This is the kind of thing where data collection and transparency would be highly valuable in facilitating discussion.

We know that in some settings data is collected then ASTRO leadership reports it differently based on their experience or opinion. The workforce study is an excellent and recent example.

That receipt you shared offers basically nothing and it is not really fair to expect membership to take it as fact given the behavior of the leadership. ASTRO could share their finances with membership.

I totally agree that all of these issues could be quickly corrected and am waiting for ASTRO leadership to have conversations. Im still not seeing it, even with ROCR. As Anna pointed out, they updated an FAQ but dodged the hard questions and then offered up 3 "town hall" settings but never advertised them. ASTRO twitter sends multiple tweets a day, are they planning to advertise this town hall that is a week from tomorrow?

 

[communitydoc13]

I think the workforce concerns are valid.

I think all of this discussion about workforce concerns and more data needed needs to be put into a personal context.

Yes, it is somehow hard to know how many practicing radoncs there are today in the U.S., and disparity in productivity makes it even harder to know what is the effective number of practicing radoncs. Indications, fractionation, general population demographics and behaviors all impact what a theoretical right number might be.

Maybe radonc is the only field that tries to meet a theoretical right number. Certainly most other fields are not coming close.

We don't live in a vacuum. The personal question is, relative to other opportunities in medicine, what does radonc afford an average graduate in terms of job opportunities and flexibility. We don't need high level meta data for this.

I have not been able to recruit a medical oncologist for ages, J1 candidates are now getting offers in major metros. Medoncs in the community are now significantly better paid than radoncs.

Radiology is understaffed.

General surgery is a chronic community need, as is primary care, OB-GYN, Psych (enormous need)

If you are away from a major metro, but coastal, radonc is the only field that you are effortlessly staffing with U.S. MDs with prestige degrees/pedigree.

So clearly, our training relative to opportunity has been an outlier relative to the rest of medicine for some time.

We are going down this path of hypofractionation at a seemingly record pace.

Is this happening for protons? Can we even apply a constant RBE for protons as we move across fractionation schedules (I think probably not).

 

[elementaryschooleconomics]

Huh, weird. I don't know why you can't find it. I cannot find a dues invoice, since I delete them once I pay them. I usually delete my receipts but I did find my 2014 receipt, of all things.

I was wrong. It was 28.5% for that renewal cycle. That's the percentage of dues that were allocated for ASTRO's lobbying activity. It's written pretty clearly, IMO, but others might disagree. If it is hard to see for many members, then ASTRO should/can fix it.

Thanks

Ah...I see now, I was expecting a line item, not a written paragraph.

To clarify, that isn't 28.5% of revenue - that's just out of member dues alone...so it remains significantly less money than let's say, the salary of a certain chair position at a certain institution in New York.

Here's the 2014 990, where it's about 25% of dues:

The most recently available filing, 2020, has it at 17%:

We could speculate endlessly about what this $600k-$800k represents. But I don't want to be utterly negative and instead recognize that ASTRO can indeed "show receipts" for lobbying efforts in excess of $150,000 to the PAC.

(Well, it was $116k in 2020, but let's not split hairs)

 

[elementaryschooleconomics]

Ah...I see now, I was expecting a line item, not a written paragraph.

To clarify, that isn't 28.5% of revenue - that's just out of member dues alone...so it remains significantly less money than let's say, the salary of a certain chair position at a certain institution in New York.

Here's the 2014 990, where it's about 25% of dues:


View attachment 374260


The most recently available filing, 2020, has it at 17%:


View attachment 374261


We could speculate endlessly about what this $600k-$800k represents. But I don't want to be utterly negative and instead recognize that ASTRO can indeed "show receipts" for lobbying efforts in excess of $150,000 to the PAC.

(Well, it was $116k in 2020, but let's not split hairs)

Just to clarify my own response here, @Rad Onc SK very clearly states percentage of dues in his post.

My original point is ASTRO has a total yearly revenue between $20-$30 million dollars, and spends less than a million dollars on lobbying efforts. Of course we get trampled by CMS.

The AstraZeneca PAC alone consistently does a million dollars a year by itself, as a single PAC for a single drug company. No, we can't come close to pharma money, but...it's embarrassing.

 

[sirspamalot]

I'm less sure of the value of compulsory peer review of an APPA bone met plan or tangential breast plan. Especially when everyone involved is scrolling on their phones and drinking their 1st cup of coffee.

I'm sure that its surely.. not valuable at all.

Please pass the half n half..

 

[RickyScott]

I think all of this discussion about workforce concerns and more data needed needs to be put into a personal context.

Yes, it is somehow hard to know how many practicing radoncs there are today in the U.S., and disparity in productivity makes it even harder to know what is the effective number of practicing radoncs. Indications, fractionation, general population demographics and behaviors all impact what a theoretical right number might be.

Maybe radonc is the only field that tries to meet a theoretical right number. Certainly most other fields are not coming close.

We don't live in a vacuum. The personal question is, relative to other opportunities in medicine, what does radonc afford an average graduate in terms of job opportunities and flexibility. We don't need high level meta data for this.

I have not been able to recruit a medical oncologist for ages, J1 candidates are now getting offers in major metros. Medoncs in the community are now significantly better paid than radoncs.

Radiology is understaffed.

General surgery is a chronic community need, as is primary care, OB-GYN, Psych (enormous need)

If you are away from a major metro, but coastal, radonc is the only field that you are effortlessly staffing with U.S. MDs with prestige degrees/pedigree.

So clearly, our training relative to opportunity has been an outlier relative to the rest of medicine for some time.


Is this happening for protons? Can we even apply a constant RBE for protons as we move across fractionation schedules (I think probably not).

This is spot on and I keep coming back to it ad nauseum. As Sk points out, we nearly doubled residents (more than any other field) and there is no indication that utilization increased more than other specialties. (In fact the opposite).

We have to be worse off in this regard than the other specialties when it comes to supply and demand. sk is trying to make the argument that jobs still may be out there, but yes compared to any other specialty we must have issues.

We are supposed to trust the same people who expanded residencies- and continue to justify it- with this new payment model. What could go wrong? Astros workforce study was such a tour de force that I can’t wait to see what they do with the ROCR?

 

[sirspamalot]

We have to be worse off

I would use the far less delicate language, perhaps this meme sums it up nicely doesn't it?

 

[NotMattSpraker]

This is spot on and I keep coming back to it ad nauseum. As Sk points out, we nearly doubled residents (more than any other field) and there is no indication that utilization increased more than other specialties. (In fact the opposite).

We have to be worse off in this regard than the other specialties when it comes to supply and demand. sk is trying to make the argument that jobs still may be out there, but yes compared to any other specialty we have issues.

I basically feel like now we are supposed to trust the people who expanded residencies (and continue to justify it) with this new payment model. What could go wrong.

Agreed. There is value to workforce analysis, specifically, in convincing people who don't believe the what all these people are reporting from personal experience.

As SK also pointed out, we need to have some hard conversations.

They are going to be hard conversations for people with conflicts of interest that aren't covered in ASTROs COI policy, which I do not agree is strict. An example of these people are radiation oncology department chairs, who hire many graduating residents and run departments that benefit greatly from residents.

Based on personal experience, I do not expect the current president to be open to these conversations.

 

[thecarbonionangle]

Rad onc scheduled for more cuts once again. Surprise! “Leaders” saying things have never been better!!! Keep soaping and ignoring the elephant in the room taking massive dumps. That will sure work out well. Are all of us in a squidgame with SCAROP cabal watching as VIPs?

Radiation Oncology Targeted for More Payment Cuts in 2024​

Medicare Physician Fee Schedule (MPFS)

This evening, the Centers for Medicare and Medicaid Services (CMS) issued the 2024 MPFS proposed rule, with policy changes that would reduce payments for radiation oncology services by approximately

-2% next year. The proposed Conversion Factor (CF) for 2024 would be $32.7476, which is a 3.4% reduction from 2023’s final CF of $33.8872. CY 2024 marks the third year of the four-year phase in of the Clinical Labor Price update, which lowers payments to specialties that use expensive equipment, such as radiation oncology, in a budget neutral environment. Contact Congresstoday to support ASTRO-backed legislation to mitigate the clinical labor cuts.



These continued cuts underscore the need for ASTRO’s proposed Radiation Oncology Case Rate (ROCR) Program, which would secure stable payment rates, improve upon already excellent quality and reduce disparities.



Hospital Outpatient Prospective Payment System (HOPPS)

CMS also released the 2024 HOPPS proposed rule. The Agency is proposing to increase the HOPPS payment rates by a factor of 2.8%. Based on this update, CMS estimates the total payments to HOPPS providers for 2024 would be approximately $88.6 billion — an increase of about $6 billion over 2023. ASTRO will provide members with a summary and detailed analysis of the proposals in coming days and will submit comments to the Agency later this summer.

 

[yesmaster]

Thanks for pointing out, Anna, that ASTRO apex is huge conflict of interest. Apex is also useless and isn’t a marker of quality care.

Peer review, by colleagues, can be helpful. If you’re incredibly smart and your plans are gods gift to cancer patients, then it shouldn’t take that long anyways. We don’t look at peer review palliative cases except by request.

Job market is horrible and will only get worse. I question the hidden agenda and sanity of anybody who believes otherwise. It’s somewhat harder for the academic chair cabal to recruit because they pay badly for what are essentially clinical jobs plus some admin duties plus compulsory participation in educating more rad oncs that we don’t need plus brown nosing culture. But sure, keep lying to med students on Twitter and buying them interview goodie bags.

ROCR I don’t see as being any better than current trajectory. I also wouldn’t help the proton pps exempt grifters if it’s no better than neutral for the community.

 

[RickyScott]

I would use the far less delicate language, perhaps this meme sums it up nicely doesn't it?

Thanks for pointing out, Anna, that ASTRO apex is huge conflict of interest. Apex is also useless and isn’t a marker of quality care.

Peer review, by colleagues, can be helpful. If you’re incredibly smart and your plans are gods gift to cancer patients, then it shouldn’t take that long anyways. We don’t look at peer review palliative cases except by request.

Job market is horrible and will only get worse. I question the hidden agenda and sanity of anybody who believes otherwise. It’s somewhat harder for the academic chair cabal to recruit because they pay badly for what are essentially clinical jobs plus some admin duties plus compulsory participation in educating more rad oncs that we don’t need plus brown nosing culture. But sure, keep lying to med students on Twitter and buying them interview goodie bags.

ROCR I don’t see as being any better than current trajectory. I also wouldn’t help the proton pps exempt grifters if it’s no better than neutral for the community.

If things are going to burn down anyway, we should see to it that protons are included, otherwise just setting favorable conditions for consolidations and takeovers, firesales to the “winners”

 

[medgator]

Rad onc scheduled for more cuts once again. Surprise! “Leaders” saying things have never been better!!! Keep soaping and ignoring the elephant in the room taking massive dumps. That will sure work out well. Are all of us in a squidgame with SCAROP cabal watching as VIPs?

Radiation Oncology Targeted for More Payment Cuts in 2024​

Medicare Physician Fee Schedule (MPFS)

This evening, the Centers for Medicare and Medicaid Services (CMS) issued the 2024 MPFS proposed rule, with policy changes that would reduce payments for radiation oncology services by approximately

-2% next year. The proposed Conversion Factor (CF) for 2024 would be $32.7476, which is a 3.4% reduction from 2023’s final CF of $33.8872. CY 2024 marks the third year of the four-year phase in of the Clinical Labor Price update, which lowers payments to specialties that use expensive equipment, such as radiation oncology, in a budget neutral environment. Contact Congresstoday to support ASTRO-backed legislation to mitigate the clinical labor cuts.



These continued cuts underscore the need for ASTRO’s proposed Radiation Oncology Case Rate (ROCR) Program, which would secure stable payment rates, improve upon already excellent quality and reduce disparities.



Hospital Outpatient Prospective Payment System (HOPPS)

CMS also released the 2024 HOPPS proposed rule. The Agency is proposing to increase the HOPPS payment rates by a factor of 2.8%. Based on this update, CMS estimates the total payments to HOPPS providers for 2024 would be approximately $88.6 billion — an increase of about $6 billion over 2023. ASTRO will provide members with a summary and detailed analysis of the proposals in coming days and will submit comments to the Agency later this summer.

Freestanding down, hospitals up. Sky blue, grass green

 

[Rad Onc SK]

Freestanding down, hospitals up. Sky blue, grass green

Yup.

More of the same. And there’s really no reason to think it’s going to get better for high input specialties like Radiology and us.

I know there are a lot of people here who do not like ROCR, but it gets us out of CMS and into much safer waters.

PC updates will be linked to MEI (which is where AMA would like to go)

TC updates linked to HIPPS

Is ROCR perfect? No

Can it improve? IMO, yes. (And I think it will)

I know there’s a lot of distrust towards anything put forward by ASTRO in this forum. But I hope people are modeling their own practice data.

I talked to one of my friends today. He is a dying breed. Solo practice in a hospital. He is paid solely on WRVU. His early math (on his biggest disease sites) puts him up 8%. He was very skeptical and ROCR at first. He is warming up to it really fast.

I’ve made my opinion clear. I don’t think staying in fee-for-service, either in HOPPS or MPFS, is where I want to be in 5 years, much less 10.

Right now, inputs are a mess and we are not getting help on the conversion factor. The former relates to specialties like us and radiology with Large capital inputs. The latter refers to the entire house of Medicine.

I haven’t seen the radiology numbers, but I was hearing that they were expecting (well) over 5% cuts. I’m going to dive into stuff later tonight if I can sneak away from other obligations.

 

[RickyScott]

Yup.

More of the same. And there’s really no reason to think it’s going to get better for high input specialties like Radiology and us.

I know there are a lot of people here who do not like ROCR, but it gets us out of CMS and into much safer waters.

PC updates will be linked to MEI (which is where AMA would like to go)

TC updates linked to HIPPS

Is ROCR perfect? No

Can it improve? IMO, yes. (And I think it will)

I know there’s a lot of distrust towards anything put forward by ASTRO in this forum. But I hope people are modeling their own practice data.

I talked to one of my friends today. He is a dying breed. Solo practice in a hospital. He is paid solely on WRVU. His early math (on his biggest disease sites) puts him up 8%. He was very skeptical and ROCR at first. He is warming up to it really fast.

I’ve made my opinion clear. I don’t think staying in fee-for-service, either in HOPPS or MPFS, is where I want to be in 5 years, much less 10.

Right now, inputs are a mess and we are not getting help on the conversion factor. The former relates to specialties like us and radiology with Large capital inputs. The latter refers to the entire house of Medicine.

I haven’t seen the radiology numbers, but I was hearing that they were expecting (well) over 5% cuts. I’m going to dive into stuff later tonight if I can sneak away from other obligations.

let’s think for a moment abt the radiologists and let’s say they take a 5-10% cut next year, they can still sleep well at night. salaries will still increase and opportunities abound because they are in short supply. At the end of the day, that is all that matters.

 

[Rad Onc SK]

This is spot on and I keep coming back to it ad nauseum. As Sk points out, we nearly doubled residents (more than any other field) and there is no indication that utilization increased more than other specialties. (In fact the opposite).

We have to be worse off in this regard than the other specialties when it comes to supply and demand. sk is trying to make the argument that jobs still may be out there, but yes compared to any other specialty we must have issues.

We are supposed to trust the same people who expanded residencies- and continue to justify it- with this new payment model. What could go wrong? Astros workforce study was such a tour de force that I can’t wait to see what they do with the ROCR?

CMS has proposed a 2024 physician conversion factor (CF) of $ 32.75

It was $31.00 in 1992

We’ve made progress

Plenty of pain to go around - for the entire House of Medicine

ROCR links PC to MEI (where AMA wants to go) and TC to HIPPS.

There’s no guarantees anywhere, but if there’s a tornado coming, I’d rather be in a brick building with no windows, as opposed to a tent on an open field

 

[RickyScott]

CMS has proposed a 2024 physician conversion factor (CF) of $ 32.75

It was $31.00 in 1992

We’ve made progress

Plenty of pain to go around - for the entire House of Medicine

ROCR links PC to MEI (where AMA wants to go) and TC to HIPPS.

There’s no guarantees anywhere, but if there’s a tornado coming, I’d rather be in a brick building with no windows, as opposed to a tent on an open field

To play devils advocate, suppose that the ROCR doubles or even triples reimbursement vs fee for service. Selfishly this may be a negative for employed doctors - most of us- because the hypofractionation that would follow could easily put a lot more docs on the job market and when it comes time to renew my contract, the hospital will have tremendous leverage. And btw, we hypofrac so much more than most. There has been almost no study of how many jobs are “unnecessary” when taking into account hypofract and supervision.