Change in IPSS w Hydrogel

[BobbyHeenan]

Thanks a lot! 4 surprised me, unless I guess you mean for prostate. The standard of care should incentivize people to use brachy for gyn. If reimbursement is a barrier that is news to me and that sucks!

For 2, I guess reasonable people can disagree. APEx and $12,000 every 3 years is a higher burden than MIPS. Much higher. Unless you're already accredited. We are doing this now and its a huge burden and basically our whole team feels its a waste of time.

AGree the APEX thing is a disaster. When you get a captive audience too, that price will only go up, too.

I think MOST important whether we remain FFS or ROCR is index to inflation. whoever/however that can happen will have my vote.

As a measure of good faith, I would like to see proton for prostate and breast to be a flat rate *unless on a randomized trial.*

---

Members don't see this ad.

 

[NotMattSpraker]

AGree the APEX thing is a disaster. When you get a captive audience too, that price will only go up, too.

I think MOST important whether we remain FFS or ROCR is index to inflation. whoever/however that can happen will have my vote.

As a measure of good faith, I would like to see proton for prostate and breast to be a flat rate *unless on a randomized trial.*

Index to inflation (like the raise for freestanding) is also being pushed globally. This is the AMAs big thing. It also seems well received and it sounds like there will be some kind of deal on this for 2025 (rumors).

I was told to expect the actual inflation increase will not be as much as AMA wants, but it would be something.

 

[medgator]

Thanks a lot! 4 surprised me, unless I guess you mean for prostate. The standard of care should incentivize people to use brachy for gyn. If reimbursement is a barrier that is news to me and that sucks!

For 2, I guess reasonable people can disagree. APEx and $12,000 every 3 years is a higher burden than MIPS. Much higher. Unless you're already accredited. We are doing this now and its a huge burden and basically our whole team feels its a waste of time.

ACR and ACRO should be allowed as subs otherwise it reeks of cronyism. ACR was the original and, for awhile, ASTRO partnered with them

 

[BobbyHeenan]

ACR and ACRO should be allowed as subs otherwise it reeks of cronyism. ACR was the original and, for awhile, ASTRO partnered with them

I think they would be, but they'll all raise prices. If you mandate their services it's going to get more expensive.

Not to even mention the potential cost of needing more person-hours to keep up with requirements and/or pulling some folks like nurse navigation away from patient care and into regulatory work. We have had to hire admins across our network for things like Commission on Cancer, APEX, ACR, etc.

 

[medgator]

I think they would be, but they'll all raise prices. If you mandate their services it's going to get more expensive.

Not to even mention the potential cost of needing more person-hours to keep up with requirements. We have had to hire admins across our network for things like Commission on Cancer, APEX, ACR, etc.

A lot of us are already certified, and, as long as all 3 are allowed, I think you'll have enough competition to keep a lid on things.

But yes one has to wonder about the value of accreditation, iirc in dx rads, CMS won't pay if the facility isn't acr accredited

 

[NotMattSpraker]

ACR and ACRO should be allowed as subs otherwise it reeks of cronyism. ACR was the original and, for awhile, ASTRO partnered with them

They are allowed. They were clear about that, almost bragging about it. As if that makes it not a ridiculous conflict of interest lol. Essentially 3 versions of the same program for the same price. Love it.

I am super interested at which of these programs is going to get real flexible on supervision to differentiate themselves.

Or maybe they wont. Because they aren't really independent.

 

[NotMattSpraker]

A lot of us are already certified, and, as long as all 3 are allowed, I think you'll have enough competition to keep a lid on things.

But yes one has to wonder about the value of accreditation, iirc in dx rads, CMS won't pay if the facility isn't acr accredited

I disagree, but don't know the right answer. I do not think there is any competition. ACR is probably the most independent but all of these radiation oncology societies share leadership.

The issues with MIPs are well documented even by MedPAC. It is virtually universally accepted that the program sucks and does not achieve any of the (poorly defined) goals of a quality program.

Accreditation is even worse in my opinion. It is way more prescriptive about things that do not matter even a little, like formatting of H&Ps. The programs are sometimes created by anonymous groups.

MIPs has a cost, but it is administrative. Accreditation has more administrative cost PLUS a subscription fee.

Millions of dollars funneled from practices to societies for no reason.

 

[medgator]

I disagree, but don't know the right answer. I do not think there is any competition. ACR is probably the most independent but all of these radiation oncology societies share leadership.

The issues with MIPs are well documented even by MedPAC. It is virtually universally accepted that the program sucks and does not achieve any of the (poorly defined) goals of a quality program.

Accreditation is even worse in my opinion. It is way more prescriptive about things that do not matter even a little, like formatting of H&Ps. The programs are sometimes created by anonymous groups.

MIPs has a cost, but it is administrative. Accreditation has more administrative cost PLUS a subscription fee.

Millions of dollars funneled from practices to societies for no reason.

Interesting. I know the organizations feel different so I assumed different leadership for their accreditation arms. Would be sad if they were all carbon copies of each other. Hopefully one of them can come to some common sense realization regarding supervision (guessing it WON'T be Apex).

 

[NotMattSpraker]

Interesting. I know the organizations feel different so I assumed different leadership for their accreditation arms. Would be sad if they were all carbon copies of each other. Hopefully one of them can come to some common sense realization regarding supervision (guessing it WON'T be Apex).

I know several have made comments to ACR. I did as well. Sounds like this would be considered, but I am not involved at all so have no idea what is going on there.

 

[WanderingRad3]

Out of curiosity, if one had an opportunity to buy a radiation oncology facility with an old varian accelerator for a very reduced price (maybe under 1M) because it is otherwise going to just close its doors for not being profitable, do you think it could be profitable if marketed as an arthritis treatment center? It’s in a town of about 50k people and about 90 mins from major metroplex. The center was opened by a physicist and there has never been a full time radiation oncologist and most of the patients in the community just go to major metroplex for treatment and that is why it’s likely closing. I was considering it as a second job and potential retirement plan. I’m not ready to give up my current full time job yet.

Thanks a lot! 4 surprised me, unless I guess you mean for prostate. The standard of care should incentivize people to use brachy for gyn. If reimbursement is a barrier that is news to me and that sucks!

For 2, I guess reasonable people can disagree. APEx and $12,000 every 3 years is a higher burden than MIPS. Much higher. Unless you're already accredited. We are doing this now and its a huge burden and basically our whole team feels its a waste of time.

Yes, I mean for prostate (places doing 44 fx via linac they own and not 15/25/28 + brachy....because reimbursement. I have been told this explicitly)
Yeah I agree I don't like the Apex accreditation requirement. I would take the 1% Medicare reimbursement cut and not do it. Better than most quality metric penalties re: MIPS or other models.