Where is the ASTRO response/guidance on how clinics should be operating amid the coronavirus outbreak?

[RSAOaky]

Now would seem like a perfect time for our governing body to give some guidance. I am aware of at least one clinic where a physician has been diagnosed with COVID-19. Practically speaking, we come in contact with one another on a daily basis. If one person is exposed, be it a patient, a physician, a therapist, or a nurse, every single person should be quarantined. Unfortunately when given the rare opportunity to show true leadership, the response has been much like that of the white house. Vague suggestions without actual policy and leave it to the individual clinics to figure it out for themselves.

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[Chartreuse Wombat]

Expect a notification today.

 

[RickyScott]

Now would seem like a perfect time for our governing body to give some guidance. I am aware of at least one clinic where a physician has been diagnosed with COVID-19. Practically speaking, we come in contact with one another on a daily basis. If one person is exposed, be it a patient, a physician, a therapist, or a nurse, every single person should be quarantined. Unfortunately when given the rare opportunity to show true leadership, the response has been much like that of the white house. Vague suggestions without actual policy and leave it to the individual clinics to figure it out for themselves.

Radiation oncologists should robustly exercise robust caution with themselves and their patients while upholding quality, safety, and best practices. We encourage you to prudently take precautionary measures in difficult times and circumstances.
(i was able to craft such an insightful statement after attending a leadership course by ASTRO)

 

[medgator]

Too busy fighting Urorads and throwing their hands up in the air about 35 unmatched positions this year....

 

[RollTideRadOnc]

I can’t wait to see which enterprising individuals turn COVID-19 into a well-timed and high profile editorial for career advancement! My smart money is on those same brilliant climbers who have correctly identified the low hanging fruit regarding inclusion and social justice as just the ticket our field needs as the most important issues in radiation oncology (since we have apparently nothing of a more technical value to contribute).

 

[scarbrtj]

ASTRO wants every rad onc in the clinic directly supervising. Trying not to be in clinic is for swarthy, shady, medically inept MDs says ASTRO. Maybe fighting corona can be one of those alternate career path things though?

 

[Gfunk6]

ASTRO has published an official FAQ here: FAQs - COVID-19 Resources - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

I've taken the liberty of putting my summary of the most relevant questions below:

4. Are there guidelines for a practice to follow if a patient tests positive for COVID-19? If a patient is seen at an outpatient clinic, should the clinic be quarantined?

ASTRO Response: We don't know
What my practice is doing: 14 day quarantine for all such patients recommended. If they are on-treatment then break is necessary to avoid impacting other patients and staff. For patients who have prolong treatment breaks it their radiation course, we plan to use the guidelines published in Practical RO re: experiences from Puerto Rico. (Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural Disaster on Radiation Oncology Patients)

5. Is it recommended that patients on treatment and neutropenic but who are not hospitalized wear a mask outdoors? Is an N95 necessary?

ASTRO Response: We don't know
What my practice is doing: For all staff we've distributed N95 masks - however wearing them or not is at their discretion

6. How should radiation oncology departments prepare for significant resource depletion and/or staff shortages with the COVID-19 outbreak?


ASTRO Response: They want you to define "minimum staffing requirements" then stick to them. They do not define how to calculate this "minimum"
My Practice: 2 RTTs minimal on each machine and one supervising MD (ideally is RO MD, but in urgent situations will sub an MO MD for COVID-19); all dosi working remotely; physics working remotely to the extent possible; if we fall below thresholds then we will have to consolidate XRT in other centers

7. Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors?

ASTRO Response: No


--------------------------------

The Trump administration has issued an "1135" waiver which allows you to bill telehealth encounters as regular follow-up codes. This still allows you to stay in touch with patient without magnifying mutual risk by having them come to clinic.

 

[scarbrtj]

I have a problem withe the telehealth part insomuch as what I've heard is that it can be by phone but "only if the phone allows for audio-video interaction between the qualified provider and the beneficiary."
1) What if the patient is blind? Or the doctor? Still have to video chat for it to be kosher?
2) What does "allows for" mean exactly? Must be used? Or video only could be used if necessary?
3) What if a poor person doesn't have a so-called smartphone? What if the camera is cracked? What if you're in a cell phone deadzone and can't get the video to work, just the audio?
4) Why the heck would me seeing a patient's face make any difference in full communication by phone? To tell if he's lying? To see if she's vomiting or something?

 

[KHE88]

Anybody else dealing with administration who still has their head stuck in the sand pretending this isn't a big deal?
I am encountering a lot of resistance trying to take steps that mimic responses in other clinics because "we don't have a case here yet." At the same time, they admit there is not widespread testing and a backlog on available testing.

They are more worried about losing revenue from cancelled follow-ups (LOL!). My suggestion to minimize RTTs was met with "What are they going to do at home? We can't justify paying them if they are home doing nothing."

Great, lets keep everyone together in the office, that way everyone gets sick and the LINAC gets shut down. How much lost revenue is that? Not to mention, you know, the curative cancer patients metting out because they had a one month break in RT.

I am being told that we can't ban visitors because the benefit of the psychological impact on the patients (patient satisfaction! Press Ganey wooo!!!!) outweighs the risk of infection.

I'm basically being looked at like I'm insane conspiracy theorist. Anyone else dealing with this level of simple thinking and focus on keeping business as usual because of $$$? Focus is on how we can bill for telephone calls. Seriously?

The "I-told-you-sos" are going to be bittersweet.

 

[KHE88]

I have a problem withe the telehealth part insomuch as what I've heard is that it can be by phone but "only if the phone allows for audio-video interaction between the qualified provider and the beneficiary."
1) What if the patient is blind? Or the doctor? Still have to video chat for it to be kosher?
2) What does "allows for" mean exactly? Must be used? Or video only could be used if necessary?
3) What if a poor person doesn't have a so-called smartphone? What if the camera is cracked? What if you're in a cell phone deadzone and can't get the video to work, just the audio?
4) Why the heck would me seeing a patient's face make any difference in full communication by phone? To tell if he's lying? To see if she's vomiting or something?

I am flat out refusing to let them bill for phone calls. They can fire me. I prefer sleeping at night with a semblance of professional integrity and a moral compass.

 

[Mandelin Rain]

Anybody else dealing with administration who still has their head stuck in the sand pretending this isn't a big deal?
I am encountering a lot of resistance trying to take steps that mimic responses in other clinics because "we don't have a case here yet." At the same time, they admit there is not widespread testing and a backlog on available testing.

They are more worried about losing revenue from cancelled follow-ups (LOL!). My suggestion to minimize RTTs was met with "What are they going to do at home? We can't justify paying them if they are home doing nothing."

Great, lets keep everyone together in the office, that way everyone gets sick and the LINAC gets shut down. How much lost revenue is that? Not to mention, you know, the curative cancer patients metting out because they had a one month break in RT.

I am being told that we can't ban visitors because the benefit of the psychological impact on the patients (patient satisfaction! Press Ganey wooo!!!!) outweighs the risk of infection.

I'm basically being looked at like I'm insane conspiracy theorist. Anyone else dealing with this level of simple thinking and focus on keeping business as usual because of $$$? Focus is on how we can bill for telephone calls. Seriously?

The "I-told-you-sos" are going to be bittersweet.

My guess. You live in Trump Country.

 

[scarbrtj]

I am flat out refusing to let them bill for phone calls. They can fire me. I prefer sleeping at night with a semblance of professional integrity and a moral compass.

Well I gotta say, just today, I spoke with a couple patients by phone. One, a lady 57yo who long story short is gonna need some repeat XRT (I treated her ~1 y ago) and the call went... well. She was pleased. I was pleased. We make people get dressed, buy gas, fight traffic, wait in a waiting room, wait in an exam room, and talk to them for less than an hour 99% of the time and less than 15 min most times. Meeting people virtually, whether phone or facetime, is way more convenient. And if there's a clinical field that un-relies on physical examination less than rad onc I don't know it. Yes, yes. We are REAL doctors. But we are also "radiologists" after all, or at least the missing link between radiology and pure clinical cognitives; examiners more of images than the flesh. Telehealth is a weird word anyways. Healthcare is healthcare. Making a patient come in for 30 seconds of my hands to his skin or his butt and however many minutes of eye contact may seem antediluvian to the next generation. I mean, I'm all for touching the skin and the butt when it's necessary. But does it truly make a difference in rad onc decision-making to a significant degree? Plenty of complex things can be done "remotely" and other professions don't put awkward prefixes on their activities. Ever heard of telelaw? Me either.

 

[Mandelin Rain]

I have definitely noticed that one block of voters is taking this seriously (sometimes too seriously like pure panic), and one who thinks it's "no big deal" "just another flu" "media hype" "conspiracy from China".

Unfortunately, just taking cues from the commander in chief.

 

[KHE88]

Red States handling this way differently, that is for sure (heck, go to www.redstate.com and you'll see what I mean). I'm in one and the difference between here and NE and Midwest is incredible. >50% of Fox News viewers believe this is an overreaction. Yes, it will be bittersweet, but being right sure does feel good. But, less good if you have the virus.

I fully agree with you, but why the hate on telemedicine? I think it's useful now, but also useful in general to streamline care.

Meeting people virtually, whether phone or facetime, is way more convenient.

You missed my point. What I'm saying is that I don't want the hospital to send the patient a bill because I called them and told them their PSA and made sure they were doing ok in a 3 minute call. I actually agree with you on the uselessness of many follow-ups in my clinic and minimize them.

Do we really want to turn into lawyers where we are billing our time in 0.1 hour increments on the phone or email with patients? I do this on a day-to-day basis already and never bill for it. I have a big problem with being told I have to do this now.

Legitimate stuff, like teleconferenced consults that take 60 minutes. Sure. Bill a level 5 and go nuts.

 

[KHE88]

I have definitely noticed that one block of voters is taking this seriously (sometimes too seriously), and one who thinks it's "no big deal" "just another flu" "media hype" "conspiracy from China".

Unfortunately, just taking cues from the commander in chief.

There are many on the right, myself included, who have been saying this is a big deal for a long time. So I hate when people try to bring politics into this rather than approach the facts as facts. And there were even some on the fringe right who were convinced this was a Chinese-engineered bioweapon designed to kill a lot of us and wreck our economy. Definitely weren't trying to claim it was just a mild flu hoax.

 

[Gfunk6]

You missed my point. What I'm saying is that I don't want the hospital to send the patient a bill because I called them and told them their PSA and made sure they were doing ok in a 3 minute call. I actually agree with you on the uselessness of many follow-ups in my clinic and minimize them.

Do we really want to turn into lawyers where we are billing our time in 0.1 hour increments on the phone or email with patients? I do this on a day-to-day basis already and never bill for it. I have a big problem with being told I have to do this now.

Legitimate stuff, like teleconferenced consults that take 60 minutes. Sure. Bill a level 5 and go nuts.

The "1135" waiver is being issued in response to the COVID-19 pandemic. It allow us to (a) maintain some semblance of patient care, (b) minimizes traffic through our clinic which can put our staff and patients at risk, and (c) does not destroy physicians/health systems cash flow.

It is a compromise and a temporary one.

In my opinion, said compromise is better than either than continuing to bring non-urgent patients to the clinic and facilitate COVID-19 spread or simply calling patients gratis.

 

[seper]

Patience, in a few days you will notice rapid shift towards disaster preparedness. I did in my center (medium sized Midwest town).

Anybody else dealing with administration who still has their head stuck in the sand pretending this isn't a big deal?
I am encountering a lot of resistance trying to take steps that mimic responses in other clinics because "we don't have a case here yet." At the same time, they admit there is not widespread testing and a backlog on available testing.

They are more worried about losing revenue from cancelled follow-ups (LOL!). My suggestion to minimize RTTs was met with "What are they going to do at home? We can't justify paying them if they are home doing nothing."

Great, lets keep everyone together in the office, that way everyone gets sick and the LINAC gets shut down. How much lost revenue is that? Not to mention, you know, the curative cancer patients metting out because they had a one month break in RT.

I am being told that we can't ban visitors because the benefit of the psychological impact on the patients (patient satisfaction! Press Ganey wooo!!!!) outweighs the risk of infection.

I'm basically being looked at like I'm insane conspiracy theorist. Anyone else dealing with this level of simple thinking and focus on keeping business as usual because of $$$? Focus is on how we can bill for telephone calls. Seriously?

The "I-told-you-sos" are going to be bittersweet.

 

[medgator]

Well I gotta say, just today, I spoke with a couple patients by phone. One, a lady 57yo who long story short is gonna need some repeat XRT (I treated her ~1 y ago) and the call went... well. She was pleased. I was pleased. We make people get dressed, buy gas, fight traffic, wait in a waiting room, wait in an exam room, and talk to them for less than an hour 99% of the time and less than 15 min most times. Meeting people virtually, whether phone or facetime, is way more convenient. And if there's a clinical field that un-relies on physical examination less than rad onc I don't know it.

Med onc

 

[medgator]

That's gold

 

[KHE88]

How do you keep politics out of it? Politicians are making decisions that affect our real lives. Leadership comes from the top. I'm not blaming you or people that are on the right. But, to say "keep politics out of it", when political solutions are what are needed is disingenuous. We need political leadership, not the Oklahoma governor going to a packed restaurant and Instagraming it or Devin Nunes telling people to go to the pub or hot new restaurants "because it's easy to get into right now"

Trust me, I'd feel sheepish if the left was the one saying it's nothing. But, it is what it is.

Sorry, I thought it was clear that I meant partisan politics, not that I meant politicans shouldn't be involved in the response to this, which would be an odd thing to suggest. To the point that people are being pigeonholed into under or over-reacting and having that affect how they interpret the data on this. In the media, both sides are guilty of this. And I have definitely seen people on both sides ignoring the problem and freaking out about it and all stages in between. I don't think it's right to just look at this and say those on the right are downplaying it and those on the left are exaggerating it. Because that affects how people view your opinions on this when you try to discuss it intelligently as they will interpret what you say with bias if coronavirus has somehow become a partisan political issue (and apparently it's racist to call it Wuhan flu because, well, lets make everything racist if we can, despite infections are often labeled by where they originated such as Spanish flu, West nile virus, etc. My issue with this it's not a "flu.").

 

[KHE88]

It is partisan, @KHE88 .. This is actually the problem.

View attachment 298960

To be fair, it's not completely one-sided. But from the start, they have said this is another way to impeach, that the liberals are creating a hoax, that it isn't deadlier than the flu, that it is not infectious, that we should not isolate and we should go out to restaurants/pubs (who T F in America says "pub" by the way, except some millennial a-hole that studies abroad in the UK for 4 months and now calls it that). This is political. This is creating conflict with the opposing view. Not because they studied the epidemiology or the disease itself or its consequences.. no, no, no. It was always to "own the libs".

But, what do you think the reason is for DJT / right wing types calling it "China Virus" or "Wuhan Virus" when the WHO has named it COVID19? It's not necessarily racist, and I wish you could see that everyone isn't calling everything racist. Should I on the left call it the Trump flu? Does that help things? Why do you think this is useful or helpful? It has a name. Why rename it? When the politicians utilize messaging such as re-naming something that has a name to "China Virus" - is this good for society, for us, as a people? You have spoken about identity politics being a poison. Isn't this the same? Why call it that? Why single them out?

I don't know in modern times using that nomenclature. SARS, MERS, Bird Flu, H1N1, Ebola was named after a location, but it was an eponym translating to Black River. AIDS was called the Gay Plague. Should we have kept that name or be more scientific about things? Yes, it does infect more gay people. Do you want to go back to that nomenclature?

I don't think it's racist. It's just stupid.

I agree with you. Calling it the Wuhan flu is stupid. It's not an influenza strain. But trying to say it's racist or somehow insensitive for doing so is equally as stupid. I have no idea what the motivations are for people to point out that it came from China. But China is not blameless in this in regards to the activities with the exotic meat markets and the way it was mishandled initially. Calling it the Wuhan virus is not the same thing as calling AIDS the gay plague. I don't understand how it's insensitive to refer to diseases as to where they originated. As if the people there are somehow dirtier or something? I'm not sure what's going through people's heads sometimes, but IMO getting upset about saying whether or not this came from China or a foreign country is PC-culture run amok.

 

[metallica81788]

You both cannot help yourselves can you

This was a good discussion for a while

 

[KHE88]

You make everything about race or PC culture. Not one person here mentioned race and it has never been the point. Nobody is upset. Nobody is saying we shouldn't mention where it came from. We need to know where it came from. We can't erase that. China malfunctioned. I don't know what nomenclature system that determines names based on the way the originating country handled it. After knowing a lot about the disease, the US mishandled it. Should we call it the "American Bungling Things Virus" That name sucks, too.

Biologists have named it. What's wrong with being precise? Why are "anti-PC" people anti-science?

There are definitely people upset that a geographic location is being referred to when the virus is mentioned. Check twitter. And I have a problem with PC culture and people automatically jumping to the R-word at the slightest possible hint of something that might be the tiniest bit offensive without knowing intent. Regardless, I have agreed with you already that it should be called the scientific name, I agree with most everything you said, and I'm not sure how I triggered you, but I have nothing else to add to this conversation.

 

[evilbooyaa]

Well, anyways. ROFallingDown deleted his posts so KHE you kinda just look like a guy yelling at a cloud.

Let's try to get back on topic - not gonna hand out warnings b/c to say politics is not involved in this at all is burying of the head in the sand, but I agree with folks self-deleting their posts when they realize the off-topic nature of them.

 

[Chartreuse Wombat]

Accepted COVID-19 Articles - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

ASTRO journals are publishing the latest research about COVID-19 as it relates to radiation oncology.

www.astro.org

 

[RickyScott]

Sdn should submit one on predicted number of radiation docs retiring this year or next following market crash.

 

[radoncgrad2019]

Sdn should submit one on predicted number of radiation docs retiring this year or next following market crash.

No way to count

 

[medgator]

Sdn should submit one on predicted number of radiation docs retiring this year or next following market crash.

And the ones who might be affected by covid19 from a health standpoint, some docs on ROhub have expressed personal concern

 

[radoncgrad2019]

Anyone that likes KHE posts does make their politics clear!

 

[Mandelin Rain]

Sdn should submit one on predicted number of radiation docs retiring this year or next following market crash.

I know this isn't of utmost importance, but I'm wondering if we'll start hearing of graduating residents not having their expected jobs waiting for them at the end of this.

1. Retirement funds have cratered for everyone.
2. First quarter and second quarter revenue (both tech and pro) will crater for everyone.
3. We've yet to hit the point where new diagnoses are not being made. We're still seeing the women that had screening mammos, the people that had screening colonoscopy, and the men that had PSAs drawn a month or two ago. Those patients will disappear soon. All screening/well care in this country was essentially shut down this week. Soon, referrals (even deferrable ones) will completely dry up. Likely right before this crop graduates. It will be months before we start seeing those patients again once this is all over.
4. Admins will notice that their departments can indeed function with less rad onc presence under the new supervision rule.
5. We'll get more used to hypofractionating to increase throughput.

I'm just not seeing a big pro-hire moment here. I hope all signed contracts are honored. But.... I won't be shocked if they aren't.

 

[scarbrtj]

4. Admins will notice that their departments can indeed function with less rad onc presence under the new supervision rule.

Timeline over about one year:

Must have--------->Don't remove the------->Let's try to do
supervision........supervision!............most work remotely

... well it's just about one of the most ironic sequences I've ever seen. And I've lived through some pretty ironic times. MLK Jr said the arc of the universe bends toward moral justice. The arc of insanity bends toward sanity even if it takes gobs of insanity to make people go sane. A paring down in rad onc was long overdue. It's tough to outwit the universe. It's a terrible, horrible, no good, very bad day to choose to become a rad onc right now.

 

[deleted1002574]

Anyone that likes KHE posts does make their politics clear!

That’s not really fair. He/she has stuff to say that’s not political.

 

[Tigerstang]

Anybody else dealing with administration who still has their head stuck in the sand pretending this isn't a big deal?
I am encountering a lot of resistance trying to take steps that mimic responses in other clinics because "we don't have a case here yet." At the same time, they admit there is not widespread testing and a backlog on available testing.

They are more worried about losing revenue from cancelled follow-ups (LOL!). My suggestion to minimize RTTs was met with "What are they going to do at home? We can't justify paying them if they are home doing nothing."

Great, lets keep everyone together in the office, that way everyone gets sick and the LINAC gets shut down. How much lost revenue is that? Not to mention, you know, the curative cancer patients metting out because they had a one month break in RT.

I am being told that we can't ban visitors because the benefit of the psychological impact on the patients (patient satisfaction! Press Ganey wooo!!!!) outweighs the risk of infection.

I'm basically being looked at like I'm insane conspiracy theorist. Anyone else dealing with this level of simple thinking and focus on keeping business as usual because of $$$? Focus is on how we can bill for telephone calls. Seriously?

The "I-told-you-sos" are going to be bittersweet.

It's like you're sitting right next to me at my clinic

 

[RickyScott]

I know this isn't of utmost importance, but I'm wondering if we'll start hearing of graduating residents not having their expected jobs waiting for them at the end of this.

1. Retirement funds have cratered for everyone.
2. First quarter and second quarter revenue (both tech and pro) will crater for everyone.
3. We've yet to hit the point where new diagnoses are not being made. We're still seeing the women that had screening mammos, the people that had screening colonoscopy, and the men that had PSAs drawn a month or two ago. Those patients will disappear soon. All screening/well care in this country was essentially shut down this week. Soon, referrals (even deferrable ones) will completely dry up. Likely right before this crop graduates. It will be months before we start seeing those patients again once this is all over.
4. Admins will notice that their departments can indeed function with less rad onc presence under the new supervision rule.
5. We'll get more used to hypofractionating to increase throughput.

I'm just not seeing a big pro-hire moment here. I hope all signed contracts are honored. But.... I won't be shocked if they aren't.

Hit the nail here.

 

[medgator]

I know this isn't of utmost importance, but I'm wondering if we'll start hearing of graduating residents not having their expected jobs waiting for them at the end of this.

1. Retirement funds have cratered for everyone.
2. First quarter and second quarter revenue (both tech and pro) will crater for everyone.
3. We've yet to hit the point where new diagnoses are not being made. We're still seeing the women that had screening mammos, the people that had screening colonoscopy, and the men that had PSAs drawn a month or two ago. Those patients will disappear soon. All screening/well care in this country was essentially shut down this week. Soon, referrals (even deferrable ones) will completely dry up. Likely right before this crop graduates. It will be months before we start seeing those patients again once this is all over.
4. Admins will notice that their departments can indeed function with less rad onc presence under the new supervision rule.
5. We'll get more used to hypofractionating to increase throughput.

I'm just not seeing a big pro-hire moment here. I hope all signed contracts are honored. But.... I won't be shocked if they aren't.

6. ASTRO just sent a letter to CMS requesting them to temporarily waive direct supervision for all settings (including freestanding) re: covid19.

 

[RickyScott]

6. ASTRO just sent a letter to CMS requesting them to temporarily waive direct supervision for all settings (including freestanding) re: covid19.

Assuming no adverse events, will give cms more data to completely roll back all supervision requirements at some point. Also, lack of direct supervision will ultimately provide rational for decrease reimbursement.

 

[Mandelin Rain]

6. ASTRO just sent a letter to CMS requesting them to temporarily waive direct supervision for all settings (including freestanding) re: covid19.

It's pretty disingenuous for ASTRO to be arguing out of both sides of it's mouth on this issue.

Either not having physician supervision is unsafe and shouldn't be done, or it's not.

 

[scarbrtj]

It's pretty disingenuous for ASTRO to be arguing out of both sides of it's mouth on this issue.

Either not having physician supervision is unsafe and shouldn't be done, or it's not.

It's like they've lost all credibility. All those truculent truckas. Am I saying that right? Trucka?

 

[radoncgrad2019]

It's pretty disingenuous for ASTRO to be arguing out of both sides of it's mouth on this issue.

Either not having physician supervision is unsafe and shouldn't be done, or it's not.

Dude, have some common sense.

 

[RickyScott]

It's like they've lost all credibility. All those truculent truckas. Am I saying that right? Trucka?

We all know medically supervision is a crock, especially in light of fact that not required for chemo. Ultimately will be done away with. Of course centers are free to require own additional supervision policies.

 

[evilbooyaa]

Assuming no adverse events, will give cms more data to completely roll back all supervision requirements at some point. Also, lack of direct supervision will ultimately provide rational for decrease reimbursement.

Any rationale for this? We still have to review the things prior to next treatment. Not sure why reimbursement would decrease.

 

[Gfunk6]

6. ASTRO just sent a letter to CMS requesting them to temporarily waive direct supervision for all settings (including freestanding) re: covid19.

Gator or anyone else, could you please provide a link to this letter?

 

[RickyScott]

Any rationale for this? We still have to review the things prior to next treatment. Not sure why reimbursement would decrease.

I guess the idea is that from cms perspective less labor intense. (Mentioned at Acro)

 

[scarbrtj]

6. ASTRO just sent a letter to CMS requesting them to temporarily waive direct supervision for all settings (including freestanding) re: covid19.

This gets back to a point I was trying to previously make re: "guidelines" about dealing with corona during the outbreak. Seems like an intelligent, reasonable MD might think: "hey, I need to stay away from clinic and do as much work as I can remotely as long as I can do it properly... especially if it's any sort of 'virtual' work" (film checking, planning, note signing, etc.... now add in patient consults and f/u too it seems). But there was no guideline! ASTRO said it was "bad" so it didn't matter if you used your own noggin and God-given intelligence to figure out it wasn't bad. Peer pressure said it was bad. Admins said it's bad. Lawyers say it's bad. But in our heart as doctors, we knew it was OK. (They know it in other countries too, and in med onc too in America as pointed out.) And now? ASTRO says it's OK. Now we are all free to think that thought because ASTRO released a letter? A guideline? No way this whole long, sad supervision tale matches up with "common sense" in the traditional sense of the phrase.

 

[medgator]

Gator or anyone else, could you please provide a link to this letter?

 

[scarbrtj]

And just like that supervision became ashes in ASTRO's mouth.

 

[medgator]

Dude, have some common sense.

So it's common sense to never have had general supervision for rural critical access centers from the getgo?

 

[medgator]

I guess the idea is that from cms perspective less labor intense. (Mentioned at Acro)

I've heard similar things from other groups as well along those lines

 

[medgator]

And just like that supervision became ashes in ASTRO's mouth.

In that letter, they even opened the door to non BC and non RO supervision

 

[radoncgrad2019]

So it's common sense to never have had general supervision for rural critical access centers from the getgo?

so here's the thing

1) ASTRO has rationale to support supervision rules because this keeps the job market afloat. If supervision rules did not exist, jobs would disappear. this is what ASTRO is supposed to do.
2) Makes sense from CMS perspective to have allowed for the rural exception in interest of public health and access to care
3) all sorts of rules are out the window in the COVID era. this is true for way more important and widespread things than rad onc supervision, but it is true for supervision as well.

none of this (to me) is controversial or confusing. Some of you are playing a constant game of GOTCHA!, when there's nothing to be got.