Too Big to Fail? Anderson in trouble

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I look forward to more lies being told about my practice:


Separately, Buchholz urged MD Anderson physicians to convince their patients to stay at MD Anderson for the duration of their care instead of going home after initial treatment:

“Can’t I just get treatment at home? They built a new cancer center in our city that has state-of-the art equipment.”

I’ve heard this hundreds of times during my career as a radiation oncologist at MD Anderson. I am sympathetic to those who ask the question. After all, radiation treatments for breast cancer typically take 4-6 weeks of daily outpatient treatments. To be displaced from your home, support system and family for that long is tough. In addition, the expenses to stay in Houston for that long are also quite burdensome.

Despite these difficulties, the majority of patients with whom I engage in this conversation elect to stay, because I tell them what makes MD Anderson special. It’s not just experienced and thoughtful decision-making by outstanding subspecialty-trained oncologists, or even our state-of-the-art equipment (although that certainly helps). Rather, it’s the implementation and execution of what we do that leads to superior outcomes."
 
"To fill these slots, we will reduce and, in some cases, eliminate medical acceptance criteria. We will commit to see local patients within 48 hours and consultations from our colleagues within 48 hours."

Still nowhere close to what needs to happen to successfully compete with a competent PP
 
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Extremely interesting article, thank you for posting it. Given the size/strength of MDACC, I have little doubt they will pull out of this in the long-term. But it looks like there will a lot of pain on the clinical faculty/staff side between now and then. I have to wonder why MD Anderson even has a residency program if those some physicians can't be trusted to do whole breast radiation in the community. Maybe building a proton center wasn't such a great idea financially . . .

medgator said:
Still nowhere close to what needs to happen to successfully compete with a competent PP
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Agree. I recently had a very young GBM patient (in her 20s) who had a GTR with very favorable genetics (positive for MGMT hypermethylation + IDH2 mutation). I felt it appropriate for her to get a second opinion at the local academic center where I sent her. She also tried to get a third opinion @ Mayo Rochester.

Eventually, I had to put my foot down and tell her that the benefit of post-op XRT is going to be compromised if she kept delaying treatment start. She opted to stay with us because we did everything efficiently.

Another problem I've noticed with people who get care in academic centers is when they call back with major problems after treatment. They are invariably told, "go to the ED." Easy to say when your doctor (and medical records!!) are hundreds of miles away. I give patients my personal cell phone number and I answer their calls day or night - I will drop anything to answer their call. Once I recall I was on a cruise with one bar on my cell phone reception when I answered such a call on a patient. I am loathe to send patients to the ED and if I do, you better be damn sure either I will show up there myself or communicate everything relevant to the EM physician.

Note that this level of care actually drives down medical costs by reducing unnecessary hospital stays and duplicate labs/imaging. If the purpose of Medicare reforms is truly to bend the cost curve, that ain't gonna happen with academic medical institutions running the show.
 
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medgator said:
"To fill these slots, we will reduce and, in some cases, eliminate medical acceptance criteria. We will commit to see local patients within 48 hours and consultations from our colleagues within 48 hours."

Still nowhere close to what needs to happen to successfully compete with a competent PP
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Yep. 48 hours? Maybe if I'm out of town for 47 of those 48.
 
OTN said:
Yep. 48 hours? Maybe if I'm out of town for 47 of those 48.
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I just same-day'd a brain met consult today, and a cord compression last week. I do get complicated cases in quickly as well, just started a maxillary sinus SCC that was seen within 24 hours of the referral.

Maybe someone should let MDACC know about the "Three A's" of PP (including affability.... some patients don't get the same cozy environment at the bigger centers when we send them out, or they seek a second opinion at the local academic/NCI centers).
 
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Gfunk6 said:
I give patients my personal cell phone number and I answer their calls day or night - I will drop anything to answer their call. Once I recall I was on a cruise with one bar on my cell phone reception when I answered such a call on a patient. I am loathe to send patients to the ED and if I do, you better be damn sure either I will show up there myself or communicate everything relevant to the EM physician.
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I know some MOs I work with who do that, not sure if I feel that comfortable yet, considering I do have some pretty high-maintenance patients in my practice. That being said, our answering service is pretty responsive and I return calls promptly when they come to me.

All of my referrings have my cell # and invariably I do get calls on vacation to see patients or to give input on cases.... it's what makes our field rewarding, but also it's why we'll never see the 8-12 weeks of vacation that some anesthesia and radiology practices have as a claim to fame.
 
Gfunk6 said:
Extremely interesting article, thank you for posting it. Given the size/strength of MDACC, I have little doubt they will pull out of this in the long-term. But it looks like there will a lot of pain on the clinical faculty/staff side between now and then. I have to wonder why MD Anderson even has a residency program if those some physicians can't be trusted to do whole breast radiation in the community. Maybe building a proton center wasn't such a great idea financially . . .



Agree. I recently had a very young GBM patient (in her 20s) who had a GTR with very favorable genetics (positive for MGMT hypermethylation + IDH2 mutation). I felt it appropriate for her to get a second opinion at the local academic center where I sent her. She also tried to get a third opinion @ Mayo Rochester.

Eventually, I had to put my foot down and tell her that the benefit of post-op XRT is going to be compromised if she kept delaying treatment start. She opted to stay with us because we did everything efficiently.

Another problem I've noticed with people who get care in academic centers is when they call back with major problems after treatment. They are invariably told, "go to the ED." Easy to say when your doctor (and medical records!!) are hundreds of miles away. I give patients my personal cell phone number and I answer their calls day or night - I will drop anything to answer their call. Once I recall I was on a cruise with one bar on my cell phone reception when I answered such a call on a patient. I am loathe to send patients to the ED and if I do, you better be damn sure either I will show up there myself or communicate everything relevant to the EM physician.

Note that this level of care actually drives down medical costs by reducing unnecessary hospital stays and duplicate labs/imaging. If the purpose of Medicare reforms is truly to bend the cost curve, that ain't gonna happen with academic medical institutions running the show.
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I also give all (well, 95% of them) my patients my cell phone. I find they really don't abuse it and love to have it.

You're 100% correct about cost. Our own national internal data from payers with whom we're working shows we're 5x cheaper than MDAnderson and CTCA with the same clinical outcomes- so much for their claim to superiority. If value-based and case-based reimbursement really takes hold, I just don't see how they're going to be able to stay afloat, with all the inefficiencies associated with their model.
 
I spotted that Tom Bucholz knows Phil Mickelson. I liked how he phrased it, "I may have mentioned it before that I know Phil Mickelson." LOL. "May" have. Yeah. Maybe, Tom. I bet you *may* have mentioned it like a few or more times.

And MD Anderson makes $300 million a month? About $3.6 billion a year?? Damn. That means they make more than Abercrombie & Fitch. More than Citrix Inc. More than TD Ameritrade. More than Time Inc. And more than Varian! Cancer: it's a killer, and big business. If the top 10 cancer centers in the U.S. merged that entity would be in the Fortune 100.
 
Glad they found a solution to that multi million $ deficit: "turning holiday parties into potluck events."


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I used to give out my cell# to patients too. That had to stop after one of the local ones tried to sell me drugs on the phone. Oh well, beauty of working in an academic center.
 
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The graduating MDACC residents I've met have had less clinical knowledge than the average graduating radonc resident out there. Too much emphasis on research?
 
XRT_doc said:
The graduating MDACC residents I've met have had less clinical knowledge than the average graduating radonc resident out there. Too much emphasis on research?
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I've noticed the same a well. I think it's the research focus and not a lot of clinical volume compared with other programs.
 
A single payor system can't not come soon enough. Enough with the overtreatment. What's MDACC so worried about if the patients are being well treated. Execs not going to get massive payments this year?
 
I feel that the expertise of the faculty and staff in delivering whole breast external beam radiation demonstrably leads to better outcomes in breast cancer; well worth living in a Houston hotel for 6 weeks.... said no one ever. Except... Tom Buchholz. Evidence given: he's a lousy golfer.

The sad part is these people actually believe it.

The right way, the wrong way, and the MD Anderson way.
 
I do my 25 fx IMRT and then ship off the bulky vaginal cancer patient to MDACC. That's your niche, Houston


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Mandelin Rain said:
I feel that the expertise of the faculty and staff in delivering whole breast external beam radiation demonstrably leads to better outcomes in breast cancer; well worth living in a Houston hotel for 6 weeks.... said no one ever. Except... Tom Buchholz. Evidence given: he's a lousy golfer.

The sad part is these people actually believe it.

The right way, the wrong way, and the MD Anderson way.
Click to expand...
All MDA attendings have fallen in line with the company now, not just Buchholz. Every one of my patients is told erroneously that I "won't be able to spare your heart" or I'm "just a general radonc so won't be able to treat their sarcoma the way they could." It's absolutely infuriating that these academic attendings come up with all these bull**** hoops for us to jump through to be board certified, being ACRO accredited, etc, but then throw us all under the bus at every opportunity. Don't even get me started on the Alliance of Dedicated Cancer Centers (ADCC, http://www.adcc.org/). They take completely worthless SEER data with no cofounding variables whatsoever, then claim their survival is higher than the rest of us, even though in my experience only the wealthy and aggressively interested in care have the resources available to bother to travel to these places for treatment. They also erroneously claim their care is cheaper than the rest of us, which is so wrong it's laughable.
 
OTN said:
All MDA attendings have fallen in line with the company now, not just Buchholz. Every one of my patients is told erroneously that I "won't be able to spare your heart" or I'm "just a general radonc so won't be able to treat their sarcoma the way they could." It's absolutely infuriating that these academic attendings come up with all these bull**** hoops for us to jump through to be board certified, being ACRO accredited, etc, but then throw us all under the bus at every opportunity. Don't even get me started on the Alliance of Dedicated Cancer Centers (ADCC, http://www.adcc.org/). They take completely worthless SEER data with no cofounding variables whatsoever, then claim their survival is higher than the rest of us, even though in my experience only the wealthy and aggressively interested in care have the resources available to bother to travel to these places for treatment. They also erroneously claim their care is cheaper than the rest of us, which is so wrong it's laughable.
Click to expand...

The survival curves they show are hilarious. Who in the hell has a 69% 5-year overall survival for all stage breast cancer or a 62% 5-year OS for all-stage prostate cancer?

Really? I bet our 5 year survival for metastatic prostate cancer is approaching 62%
 
I think it's hilarious that MDACC claims to have better equipment than the rest of us when Varian and Elekta are the manufacturers of all of our equipment. I let patients know that and then they understand that they don't need to go the distance to get the same care (whose contours are done by a resident instead of an attending).
 
XRT_doc said:
I think it's hilarious that MDACC claims to have better equipment than the rest of us when Varian and Elekta are the manufacturers of all of our equipment. I let patients know that and then they understand that they don't need to go the distance to get the same care (whose contours are done by a resident instead of an attending).
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Guess the academic elites should have considered what flooding the field with grads would eventually do to the markets in their backyard....
 
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OTN said:
All MDA attendings have fallen in line with the company now, not just Buchholz. Every one of my patients is told erroneously that I "won't be able to spare your heart" or I'm "just a general radonc so won't be able to treat their sarcoma the way they could." It's absolutely infuriating that these academic attendings come up with all these bull**** hoops for us to jump through to be board certified, being ACRO accredited, etc, but then throw us all under the bus at every opportunity. Don't even get me started on the Alliance of Dedicated Cancer Centers (ADCC, http://www.adcc.org/). They take completely worthless SEER data with no cofounding variables whatsoever, then claim their survival is higher than the rest of us, even though in my experience only the wealthy and aggressively interested in care have the resources available to bother to travel to these places for treatment. They also erroneously claim their care is cheaper than the rest of us, which is so wrong it's laughable.
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Very true regarding the ADCC. The GAO (government accountability organization) did a study on this in 2015, with not surprising findings...

http://www.gao.gov/products/GAO-15-199
 
Irradi8or said:
Very true regarding the ADCC. The GAO (government accountability organization) did a study on this in 2015, with not surprising findings...

http://www.gao.gov/products/GAO-15-199
Click to expand...

Surprise, surprise, they are arguing for payment parity, something that should be happening between hospital-based and freestanding radiation oncology.

It all comes down to who has the best lobbyists
 
medgator said:
Surprise, surprise, they are arguing for payment parity, something that should be happening between hospital-based and freestanding radiation oncology.

It all comes down to who has the best lobbyists
Click to expand...

Indeed - it's such a vicious cycle. I was at one of the large ADCC institutions for several years and the significantly higher payments at ADCC for similar services performed at non-ADCC institutions was pretty eye opening. Inpatient stays were reimbursed at much higher rates too. Unfortunately, higher payments to these ADCC hospitals and hospitals in general = more money for lobbying, while those of us trying to deliver high value care in freestanding centers have a much more difficult time making the payment parity initiatives into reality. Even the latest round of a payment parity attempt excused hospital based facilities that had broken ground since late 2015, which is a joke, since hospitals basically barely broke ground to get in on their gravy train. Payers around here appreciate having the lower reimbursing option, but the sheer consolidation of provider groups + hospitals is quickly drying up the true freestanding market around my neck of the woods...
 
Docs will eat each other for a relatively bigger piece of the ever-shrinking pie. Meanwhile, nary any attention is paid the fundamental problem of the ever-shrinking pie.

Divide and conquer has worked well on medical school grads.
 
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Mandelin Rain said:
Docs will eat each other for a relatively bigger piece of the ever-shrinking pie. Meanwhile, nary any attention is paid the fundamental problem of the ever-shrinking pie.

Divide and conquer has worked well on medical school grads.
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Is it docs? Or is it the MBAs running many of the docs practices? The share of independent physician practices has been dwindling for years. I doubt the (more and more common) employed physicians are eating each other.
 
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The president just announced his resignation.
https://www.statnews.com/2017/03/08/md-anderson-depinho-resigns/

“I could have done a better job administratively, a better job listening, a better job communicating,” the statement said. “Forgive me for my short comings. I regret them, but I was, and continue, to be committed to saving lives and reduce suffering, to help MD Anderson accelerate the march towards prevention and cure, particularly for the underserved.”

DePinho had been in the top job for five and a half years and had been under a particular spotlight in the past two years, as the hospital’s financial situation deteriorated.

MD Anderson, which is known for pioneering cancer research as well as clinical care, posted a $267 million loss in the 2016 fiscal year and was expecting to lose as much as $450 million2 in 2017, though it brings in about $4 billion in annual revenue. In January, DePinho announced nearly 1,000 layoffs, fueling deeper questions about his spending and management.
Click to expand...
 
seper said:
Hope he puts together a solid prostate LDR program
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futuramafry.jpg
 
MD Anderson outgrew a successful model that was not scalable.
 
Irradi8or said:
Check out the package DePinho gets now...

Recently resigned MD Anderson president takes $1M+ salary package as professor
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Good for him. He asked for a salary and MDA was willing to give it to him.

Of course the attendings that produce actual clinical revenue that are subsidizing that salary (given that he's going to be a cancer biology professor and likely not see patients) can and will have their gripes with it.

Subsidizing the older generation on the backs of the newer ones is not new, but I truly do wonder how much damage the older generation of doctors has contributed to the current issue in healthcare today.
 
Looks like MD Anderson is doing just fine: MD Anderson posts four months of positive operating margins as deficit shrinks to $43.9 million – The Cancer Letter Publications

The initial loss was largely attributed to the Epic transition. Improper billing, decrease in clinical volume (due to the transition and inability to effectively manage work flow) are some of the major contributions. Obviously there were other factors too, but it seems like a majority of the executive board has been ousted and slowly being replaced. Interim chair is a radiation oncologist.
 
LazzzerEyes said:
Looks like MD Anderson is doing just fine: MD Anderson posts four months of positive operating margins as deficit shrinks to $43.9 million – The Cancer Letter Publications

The initial loss was largely attributed to the Epic transition. Improper billing, decrease in clinical volume (due to the transition and inability to effectively manage work flow) are some of the major contributions. Obviously there were other factors too, but it seems like a majority of the executive board has been ousted and slowly being replaced. Interim chair is a radiation oncologist.
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Would be pretty great for the field if Hahn could rise to president at mdacc. Lends legitimacy to our role in oncology for those skeptical ents , uros, med oncs , etc who view us as technicians.


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Hopefully the new tradition of pot luck dinners continues, and that for centuries all will remember the near devastation that led to this ritual.


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4 months of not losing money means less than nothing for their long term prospects which may be good or bad. It's just that the last 4 months provide zero insight into that. If they did the same business during this past 4 months as the previous 4 months, margins would of course be better since they have been slashing expenses aggressively. I wonder who thought it was a swell idea to create an account to post this one inane comment? nice.
 
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