VATS vs SABR for Stage I operable NSCLC

[Mandelin Rain]

Mandelin Rain meant he multitasks on work-up. Med onc wants to make sure the PET is negative for metastatic disease before getting in for EUS. What I've learned is that you prioritize your big things first (like PET) but get everything else scheduled. If patient is M1 on PET, does he really need the EUS 4 days later? No, but it's easier to cancel then try and schedule an EUS in 4 days.

Bingo.

FWIW, I've had maybe 5 J-tubes placed in 10 years. Guys who were almost completely obstructed and down 50 lbs type thing.

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[maxxor]

Yes. I think much/most of med onc pay is on the E&M side. Maybe different if they own the infusion/pharmacy.

This is my own ignorance (and partially as I dig deeper into my own institution’s billing for PRRT)

Assume your hospital can get 340b pricing. That’s a 22.5% discount on cost but you get to bill Medicare the same ASP +6%. That’s an instant 25% margin on all chemo (or lutathera).

If the med once are employed and on a wRVU model, why can’t the hospital kick some revenue back to them in the form of a better conversion factor?

Versus you guys which get professional and technical reimbursement based on radiation fractions.

 

[ramsesthenice]

can’t the hospital kick some revenue back to them

Thats a good one. Conceptually it makes sense and could be used to build things up. But that requires thinking beyond the bottom line and that will run you afoul with most admins at good sized organizations.

 

[communitydoc13]

Thats a good one. Conceptually it makes sense and could be used to build things up. But that requires thinking beyond the bottom line and that will run you afoul with most admins at good sized organizations.

I wonder if a more economical (so to speak) medonc schedule with less wait time for consult, more time for f/ups, less physician burn out and better patient satisfaction could potentially pay for itself over contracts with hard to reach RVU goals for bonus.

 

[dieABRdie]

If the med once are employed and on a wRVU model, why can’t the hospital kick some revenue back to them in the form of a better conversion factor?

They can if the med oncs are savvy enough to even understand the revenue they generate and also have the clout from a supply standpoint (i.e. if they leave... they might not be replaced)

Unfortunately, most physicians aren't very street smart.

Our med oncs aren't employed, but have worked out a PSA where they are paid in a similar manner by RVUs they generate. They are the only show in town and they know that their practice is the single most profitable part of the hospital system. They are absolutely killing it.

 

[ramsesthenice]

I wonder if a more economical (so to speak) medonc schedule with less wait time for consult, more time for f/ups, less physician burn out and better patient satisfaction could potentially pay for itself over contracts with hard to reach RVU goals for bonus.

Of course it could. In the business world there are mountains of data that human factors changes like these make people more, not less, productive. If you give people gobs of vacation they don't feel like they have to squeeze every last minute out of each and every day possible and surprise surprise, they take fewer days off. But the pervasive logic from administrators is if you make it too easy for employees to do less, they will always choose to do less. And the predominate models are designed to squeeze every last RVU possible our of each and every day.