ASTRO Position Statement on the U.S. Radiation Oncology Workforce

[RickyScott]

The issue is no one knows what the contracted reimbursement/adjustment is. But even if they get (about) 25% billed rate, Penn is probably getting (around) 400-500% Medicare which is probably (in the range of) 2.5-5x what the private practice down the street is getting.

So when our dear RickyScott warns of academic centers getting 3-5x what he does for the same service and you call him "crazy" or some other such word. Well... he ain't.

I
These are not the "billed" rate. This is what penn actually recovers! 3-5X was a gross underestimation when it comes to penn. I dont know what the average charge per unit means, but posting the insurance negotiated actual prices/money delivered to upenns bank count is legally mandated. Jan 1,2021
For example, UNITED healtchcare reimburses UPENN $13,659.88 or $12,414.79 from blue cross ppo. per 3D plan according to their contract!

Sum of Avg Charge per Unit CMS Medicare Aetna HMO (Non CAP)/PPO Aetna Medicare IBC HMO IBC PPO IBC Medicare Cigna Cigna Healthspring Medicare Health Partners Medicaid Health Partners Medicare KYST First Medicaid KYST First Medicare United Community Medicaid Horizon HMO/POS Horizon PPO Horizon Medicare United Healthcare United Healthcare Medicare

77295

3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

$27,877.30 avg charge per unit​

$1,317.07 cms​

$2,841.95 aetna hmo​

$1,396.10 aetna medicare​

$12,414.79 ibc hmo​

$12,414.79 ibc ppo​

$1,317.07 ibc medicare​

$9,478.2 cigna​

$1,356.59​

$545.42​

$1,422.44​

$597.92​

$1,396.10​

$594.70​

$7,805.64​

$12,544.79​

$1,317.07​

$13,659.88​

$1,396.10​

---

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[RadOncMegatron]

Oh, the joys of the internet. Tis crazy all this! We all in our gut knew this was happening, now its here for us to see.

I have mentioned this before as well, but the more academics do not respect the community, the community vs academic war is going to get UGLY.

 

[OTN]

I
These are not the "billed" rate. This is what penn actually recovers! 3-5X was a gross underestimation when it comes to penn. I dont know what the average charge per unit means, but posting the insurance negotiated actual prices/money delivered to upenns bank count is legally mandated. Jan 1,2021
For example, UNITED healtchcare reimburses UPENN $13,659.88 or $12,414.79 to blue cross ppo. per 3D plan according to their contract!

Sum of Avg Charge per Unit CMS Medicare Aetna HMO (Non CAP)/PPO Aetna Medicare IBC HMO IBC PPO IBC Medicare Cigna Cigna Healthspring Medicare Health Partners Medicaid Health Partners Medicare KYST First Medicaid KYST First Medicare United Community Medicaid Horizon HMO/POS Horizon PPO Horizon Medicare United Healthcare United Healthcare Medicare

77295

3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

$27,877.30 avg charge per unit​

$1,317.07 cms​

$2,841.95 aetna hmo​

$1,396.10 aetna medicare​

$12,414.79 ibc hmo​

$12,414.79 ibc ppo​

$1,317.07 ibc medicare​

$9,478.2 cigna​

$1,356.59​

$545.42​

$1,422.44​

$597.92​

$1,396.10​

$594.70​

$7,805.64​

$12,544.79​

$1,317.07​

$13,659.88​

$1,396.10​

I await our academicians heavily invested in exposing financial toxicity to immediately investigate what can only be described as near-criminal levels of overcharging.

I mean, if they don't, do they really have ANY leg to stand on whatsoever when it comes to this debate? Could they really convince themselves they're anything other than a smokescreen for an organization which chronically overcharges the very patients they claim to fight for?

 

[Gfunk6]

I
These are not the "billed" rate. This is what penn actually recovers! 3-5X was a gross underestimation when it comes to penn. I dont know what the average charge per unit means, but posting the insurance negotiated actual prices/money delivered to upenns bank count is legally mandated. Jan 1,2021
For example, UNITED healtchcare reimburses UPENN $13,659.88 or $12,414.79 from blue cross ppo. per 3D plan according to their contract!

Sum of Avg Charge per Unit CMS Medicare Aetna HMO (Non CAP)/PPO Aetna Medicare IBC HMO IBC PPO IBC Medicare Cigna Cigna Healthspring Medicare Health Partners Medicaid Health Partners Medicare KYST First Medicaid KYST First Medicare United Community Medicaid Horizon HMO/POS Horizon PPO Horizon Medicare United Healthcare United Healthcare Medicare

77295

3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

$27,877.30 avg charge per unit​

$1,317.07 cms​

$2,841.95 aetna hmo​

$1,396.10 aetna medicare​

$12,414.79 ibc hmo​

$12,414.79 ibc ppo​

$1,317.07 ibc medicare​

$9,478.2 cigna​

$1,356.59​

$545.42​

$1,422.44​

$597.92​

$1,396.10​

$594.70​

$7,805.64​

$12,544.79​

$1,317.07​

$13,659.88​

$1,396.10​

I would like to run a case matched retrospective study comparing Gr2+ financial toxicity at academic centers vs private practice.

Gr5 financial toxicity = bankruptcy?

 

[RadOncMegatron]

I await our academicians heavily invested in exposing financial toxicity to immediately investigate what can only be described as near-criminal levels of overcharging.

I mean, if they don't, do they really have ANY leg to stand on whatsoever when it comes to this debate? Could they really convince themselves they're anything other than a smokescreen for an organization which chronically overcharges the very patients they claim to fight for?

The whole situation is RIDICULOUS. The academic institutions are one of the primary drivers of financial toxicity and we are asking them to fix it? It reminds me of the following:

1. Issues with censorship on Twitter. Twitter response "Don't worry we will set up our own Trust and Safety Council and now everything will be ok."

2. Issues with smoking. Philip-Morris response: "Don't worry we will set up our own Anti-Smoking Campaign and now everything will be ok."

3. Issues with financial toxicity. Academic response: "Don't worry we will set up 1 or 2 docs to do retrospective chart reviews and now everything will be ok."

 

[scarbrtj]

I
These are not the "billed" rate. This is what penn actually recovers! 3-5X was a gross underestimation when it comes to penn. I dont know what the average charge per unit means, but posting the insurance negotiated actual prices/money delivered to upenns bank count is legally mandated. Jan 1,2021
For example, UNITED healtchcare reimburses UPENN $13,659.88 or $12,414.79 from blue cross ppo. per 3D plan according to their contract!

Sum of Avg Charge per Unit CMS Medicare Aetna HMO (Non CAP)/PPO Aetna Medicare IBC HMO IBC PPO IBC Medicare Cigna Cigna Healthspring Medicare Health Partners Medicaid Health Partners Medicare KYST First Medicaid KYST First Medicare United Community Medicaid Horizon HMO/POS Horizon PPO Horizon Medicare United Healthcare United Healthcare Medicare

77295

3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

$27,877.30 avg charge per unit​

$1,317.07 cms​

$2,841.95 aetna hmo​

$1,396.10 aetna medicare​

$12,414.79 ibc hmo​

$12,414.79 ibc ppo​

$1,317.07 ibc medicare​

$9,478.2 cigna​

$1,356.59​

$545.42​

$1,422.44​

$597.92​

$1,396.10​

$594.70​

$7,805.64​

$12,544.79​

$1,317.07​

$13,659.88​

$1,396.10​

3DCRT. A 20th century technology any rad onc department in America can achieve. So I’m offering ~10 times more value for 3DCRT than Penn. Hey United send me all your 3D patients. I’ll give you a helluva deal that’ll knock your socks off.

 

[thecarbonionangle]

How much are these academic proton centres charging for a prostate, standard fractionation lets say? I have heard 40-200k. Anybody have a figure?

 

[Neuronix]

How much are these academic proton centres charging for a prostate, standard fractionation lets say? I have heard 40-200k. Anybody have a figure?

I have personally seen the cash pay bills in the 80k range from one center. This was around 5-10 years ago though.

 

[RickyScott]

3DCRT. A 20th century technology any rad onc department in America can achieve. So I’m offering ~10 times more value for 3DCRT than Penn. Hey United send me all your 3D patients. I’ll give you a helluva deal that’ll knock your socks off.

Therein lies the issue. For this type of insurance policy, United just taking a cut of fee which is paid by the employer. From their standpoint, the higher price the better. For risk adjusted plans like United healthcare medicare, where United has skin in the game, the fee is $ 1,396.10

 

[Chartreuse Wombat]

Therein lies the issue. For this type of insurance policy, United just taking a cut of fee which is paid by the employer. From their standpoint, the higher price the better. For risk adjusted plans like United healthcare medicare, where United has skin in the game, the fee is $ 1,396.10

Where is Zeke Emmanuel when you need him? This is happening at his place.

 

[RadOncDoc21]

Where is Zeke Emmanuel when you need him? This is happening at his place.

 

[RickyScott]

Where is Zeke Emmanuel when you need him? This is happening at his place.

I believe zeke wrote an article with Justin bekelman in Jama about 8gyx1 cost savings?

 

[Mandelin Rain]

These are not the "billed" rate. This is what penn actually recovers!

Dear God!

 

[Mandelin Rain]

Where are you guys finding these numbers?

 

[Mandelin Rain]

@radoncpriceshame would be an instructive twitter handle for someone with some time on their hands

 

[RickyScott]

@radoncpriceshame would be an instructive twitter handle for someone with some time on their hands

Where are you guys finding these numbers?

Transparency in Pricing - Penn Medicine

Access the Charge Description Master (CDM), a list of standard charges made available to provide pricing transparency for each of our hospitals

www.pennmedicine.org

Give penn credit for complying. Mdacc and others refusing

 

[Mandelin Rain]

How is it not criminal to negotiate such disparate rates between the commercial plans and risk adjusted Medicare plans for the same insurer?

I mean, people should be in jail. It's literally just a kickback arrangement.




Are there any professional codes up?

 

[RickyScott]

How is it not criminal to negotiate such disparate rates between the commercial plans and risk adjusted Medicare plans for the same insurer?

I mean, people should be in jail. It's literally just a kickback arrangement.

Mdacc and mskcc take very few/if any risk adjusted plans! (Btw Anecdotally very few of their pts are black)

 

[Chartreuse Wombat]

This paper is the very definition of evergreen.

It's the Prices, Stupid

https://www.healthaffairs.org/doi/10.1377/hlthaff.22.3.89

 

[thecarbonionangle]

Where is Zeke Emmanuel when you need him? This is happening at his place.

He will be back in new admin. I know you’re excited

 

[scarbrtj]

We sure are a bunch of social media naysayers today on this issue are we not.

 

[Chartreuse Wombat]

He will be back in new admin. I know you’re excited

I'm not sure that I am excited about any administrative role for him. The only appointment that I am aware of is his position on the Biden COVID task force.

Given his position on medical intervention in people over age 75 (see link below) will be interesting to see what they recommend about vaccines in the elderly

Why I Hope to Die at 75

An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly

www.theatlantic.com

An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly

The logical conclusion is to withhold vaccines for those over 75 and let nature take "its course swiftly and promptly"

I only invoke him to highlight the discordance. He surely must be aware of this phenomenon and is in a position to change it at UPenn. Hypocrite may be too strong of a word but talk is cheap.

 

[OTN]

Don't worry everyone, academia is on top of it! For example, did you know that MSKCC is saving patients money by using telemedicine?! This is exactly the kind of hard-hitting #financialtoxicity research that helps answer all the tough questions we naysayers have been spouting all day.

 

[fiji128]

Don't worry everyone, academia is on top of it! For example, did you know that MSKCC is saving patients money by using telemedicine?! This is exactly the kind of hard-hitting #financialtoxicity research that helps answer all the tough questions we naysayers have been spouting all day.

What an absolute joke. Talk about being a hypocrite of the first order. M$KCC is probably the most finically toxic cancer center in the world, which is why they will do everything they can to never publish their rates. If you actually believe the garbage research you publish at least work at a lower cost/higher value institution.

 

[deleted941485]

He will be back in new admin. I know you’re excited

Zeke said he wouldnt have a problem dying at 75...maybe he should save the rest of us the headache and do it now. The guy had obama's ear at one time and will prbably be on team biden screwing over rads all over the country while talking non-stop about single payer. Penn may commit alot of sins but letting Zeke do anything would be like burning your house down to eradicate the rats.

 

[RickyScott]

Don't worry everyone, academia is on top of it! For example, did you know that MSKCC is saving patients money by using telemedicine?! This is exactly the kind of hard-hitting #financialtoxicity research that helps answer all the tough questions we naysayers have been spouting all day.

What an absolute joke. Talk about being a hypocrite of the first order. M$KCC is probably the most finically toxic cancer center in the world, which is why they will do everything they can to never publish their rates. If you actually believe the garbage research you publish at least work at a lower cost/higher value institution.

Would love to know how much they recover for ekgs they do on all brreast pts?

 

[fiji128]

That’s probably CPT code 77470, special procedures for rad onc. Only to be rarely used in cases where there is significant extra work by the physician. They do not want you know what they charge/collect for that.

 

[Mandelin Rain]

Zeke said he wouldnt have a problem dying at 75...maybe he should save the rest of us the headache and do it now. The guy had obama's ear at one time and will prbably be on team biden screwing over rads all over the country while talking non-stop about single payer. Penn may commit alot of sins but letting Zeke do anything would be like burning your house down to eradicate the rats.

Biden is a 78 year old president elect yet to start his 4 year term. Based on what this guy published on people over 75, hard to believe he’ll give him much credence.

“ But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.”

 

[thecarbonionangle]

in the words of Don Jr: “i love it!!!”

 

[Chartreuse Wombat]

Biden is a 78 year old president elect yet to start his 4 year term. Based on what this guy published on people over 75, hard to believe he’ll give him much credence.

“ But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.”

Biden 78 (79 in November)
Pelosi 80 (81 in March)
Schumer 70 (71 in November)
McConnell 78 (79 in February)
Feinstein 87 (88 in June)


"Feeble, ineffectual even pathetic"

Looks like PROGRESS in the next few years

 

[RadOncDoc21]

To be honest it makes me wonder why I’m not a politician. It seems like they got great health care, good quality of life and a long life expectancy. Unless you’re black.

 

[Reaganite]

Don't worry everyone, academia is on top of it! For example, did you know that MSKCC is saving patients money by using telemedicine?! This is exactly the kind of hard-hitting #financialtoxicity research that helps answer all the tough questions we naysayers have been spouting all day.

Good Lord, GTFO. Yeah, we saved you a few bucks on the telehealth consult, but you paid your out-of-pocket maximum for the year from our 3D plan alone.

 

[seper]

do the hospitals still charge facility fees with telemedicine?

 

[OTN]

do the hospitals still charge facility fees with telemedicine?

If you're getting $13k for a 3d plan, does it matter?

 

[RickyScott]

If you're getting $13k for a 3d plan, does it matter?

Would bet money that mskcc recovers more than penn.

 

[seper]

3DCRT. A 20th century technology any rad onc department in America can achieve. So I’m offering ~10 times more value for 3DCRT than Penn. Hey United send me all your 3D patients. I’ll give you a helluva deal that’ll knock your socks off.

this already happens in some markets. Insurances "steer" patients to more cost-effective RadOncs in some parts of AZ

 

[Reaganite]

this already happens in some markets. Insurances "steer" patients to more cost-effective RadOncs in some parts of AZ

Arizona is pretty fascinating. Isn't there actually a large private practice oncology monopoly out there?

 

[RadOncMegatron]

The whole situation is RIDICULOUS. The academic institutions are one of the primary drivers of financial toxicity and we are asking them to fix it? It reminds me of the following:

1. Issues with censorship on Twitter. Twitter response "Don't worry we will set up our own Trust and Safety Council and now everything will be ok."

2. Issues with smoking. Philip-Morris response: "Don't worry we will set up our own Anti-Smoking Campaign and now everything will be ok."

3. Issues with financial toxicity. Academic response: "Don't worry we will set up 1 or 2 docs to do retrospective chart reviews and now everything will be ok."

Don't worry everyone, academia is on top of it! For example, did you know that MSKCC is saving patients money by using telemedicine?! This is exactly the kind of hard-hitting #financialtoxicity research that helps answer all the tough questions we naysayers have been spouting all day.

Exactly on cue. What I say, huh?

Nothing a good ol' chart review loaded with a P < 0.05 bullet can't handle.

(Off topic: FINALLY SDN HAD EASY ACCESS GIFS!)

 

[RickyScott]

pharm companies almost always help out with copays/pt assistance! Doesn’t mean they aren’t causing financial toxicity to system. Whether it is a 120k drug or 50k course of palliative radiation, throwing some change at the patient is a smokescreen.

 

[Reaganite]

pharm companies almost always help out with copays/pt assistance! Doesn’t mean they aren’t causing financial toxicity to system. Whether it is a 120k drug or 50k course of palliative radiation, throwing some change at the patient is a smokescreen.

Max patient yearly out of pockets I see are typically up to $6,000ish. Great that MSK is helping out with copays, but somebody is flipping the bill for the other portion of your 50K+ SRSs and God only knows K IMRTs. If that isn't the definition of financial toxicity, I don't know what is. Stick to the cost of parking at MSK, fumiko.

 

[RickyScott]

I don’t like rats, but. anyone reporting mskcc to cms? Surely, Dr. Chino must have?

 

[DebtRising]

The statement is a start, I guess. It’s good even with the snark that they acknowledge the workforce reality we have been sharing, or feeing. The APM and supervision changes on top of what is already happening is terrifying. This field needs 0 new residents for the next 2 years with everyone in the pipeline already. Wait till there is more adoption of lax on site MD policies.

But it did not have to be this way. The disconnect in this field between the powers that be and the young generation is massive. Why did it have to be so predatory? No idea. Also interesting the statement took a sly shot at those who soaped in.

No interest in helping Seema one bit. Cut off your nose to spite your face. The mandatory APM was Azars brainchild to shield pharma by targeting us, and she gleefully pushes that forward.

 

[RickyScott]

Max patient yearly out of pockets I see are typically up to $6,000ish. Great that MSK is helping out with copays, but somebody is flipping the bill for the other portion of your 50K+ SRSs and God only knows K IMRTs. If that isn't the definition of financial toxicity, I don't know what is. Stick to the cost of parking at MSK, fumiko

We provide all our pts with free coffee and their choice of cream as well as free parking.

 

[Reaganite]

We provide all our pts with free coffee and their choice of cream as well as free parking.

Just make sure it's not a medicare patient. You may get dinged for inducement

 

[RadOncDoc21]

We provide all our pts with free coffee and their choice of cream as well as free parking.

We give out ginger ale (only one can and the small ones). We are ballerz!

 

[medgator]

Just make sure it's not a medicare patient. You may get dinged for inducement

We charge FMV... Senior coffee is 0.95 at McDonald's

 

[MegaVoltagePhoton]

 

[GapCalc]

"All will be fine."

Translation: I will still have someone to write my notes if we SOAP, so let's stay focused on what really matters.

 

[RickyScott]

"All will be fine."

Translation: I will still have someone to write my notes if we SOAP, so let's stay focused on what really matters.

What really matters is the 1.7 million.

 

[RadOncDoc21]

What really matters is the 1.7 million.

Damn I would gladly take that 0.7 number, they can keep the 1.