ASTRO Town Hall Discussion (Poll % on site)

[elementaryschooleconomics]

I 'm not advocating for virtual care. I'm advocating for general supervision.

Good point, me too.

I'm a staunch advocate of the status quo!

(disclaimer: basically only for this, I never get to say that sentence and took the opportunity)

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[TheWallnerus]

1. Is there anything that you can do better, in terms of clinical care, virtually as opposed to in person?

Reach more people.

Why has virtual care "exploded" in other specialties (radiology included)? HUGE DEMAND.

The premise of the question is a little loaded too, as being there in person is not an option 100% of the time (truly solo rad oncs), so in those cases being available by phone, video, etc., must be better than nothing.

We can't forget that Ron D was promulgating the myth that image checking from home was fraud as recently as ~2016, so "virtual supervision" putting a knife in that and other nonsense ("I had friends reported to hospital admin for leaving the clinic to grab lunch at the hospital cafeteria") makes us better doctors, too, I would argue because it gives us autonomy and improves quality of life.

 

[TheWallnerus]

At MUSC, according to Brian Lally, they have zero work from home policies and do not authorize any physician image checking remotely off-site. Weird stuff. Anti-doctor stuff imho. Should you only have the privilege of remote/virtual work if you're not a solo or rural rad onc??? That's what would happen with a return to direct. There would be a carve out for solo/rural, but it would be penurious: they couldn't be virtual.

 

[medgator]

At MUSC, according to Brian Lally, they have zero work from home policies and do not authorize any physician image checking remotely off-site. Weird stuff. Anti-doctor stuff imho. Should you only have the privilege of remote/virtual work if you're not a solo or rural rad onc??? That's what would happen with a return to direct. There would be a carve out for solo/rural, but it would be penurious: they couldn't be virtual.

Big ACRO guy. I guess we know where they stand too then. Disappointing

 

[communitydoc13]

HUGE DEMAND.

Yes, of course. If there were a "huge demand" for radonc services relative to docs available, I would be advocating for expansion of virtual services.

Also...The MUSC stuff is weird IMO. In a big academic center, docs should be working from home a fair bit IMO. While I doubt an exam or a sim or even the RTTs day is necessarily better without a doc on-site, there are probably a fair number of folks who can read, write and think better at home.

 

[RO28]

If ASTRONews starts coming in the mail with Oncology Today and the Cleveland Clinic Hawaii CME Conference O' The Month post card Im gonna lose it.

you should see my inbox...not sure whats worse, my gmail inbox, my actual physical inbox or my aria task pad

to be clear, i do all the tasks, I just don't use the task pad.

 

[RO28]

Jordan Johnson rocking a Pablo Escobar painting in his office was something.

Right?? I have SO.MANY.QUESTIONS

 

[TheWallnerus]

Yes, of course. If there were a "huge demand" for radonc services relative to docs available, I would be advocating for expansion of virtual services.

And thus, very Mufasa and Simba like, we circle back to ASTRO.

In the equation of supply and demand, ASTRO's letter... and numerous other of their past behaviors... shows their repeated ability to be lazy instead of energetic. Brittle minded instead of creative. Mean instead of loving. Self-serving instead of magnanimous. Deaf instead of listening.

And it shows why one of the stupidest things I think you can do as a practicing rad onc right now is not support virtual or not, but to be an ASTRO member.

 

[BobbyHeenan]

If that is the case they are doing an absolutely terrible job.

Also, in my opinion, its lazy to say "people cant understand what we do". Its also offensive to our colleagues. Teach them and don't dumb down the nuance or hide the uncertainty. I understand its easier to just say the simple thing but its a way worse strategy. Same one that destroyed the public's trust in medicine through COVID.

Screwing up "The Value of Radiation" argument to CMS is like snatching defeat from the jaws of victory. The world wide narrative around radiation right now is that it is an incredible value that is under utilized in cancer care. Just parrot our international colleagues that are much better at this than ROs in the US. You don't even need an original thought, Dave, you're good.

People absolutely can learn, but I've seen literal CEO's of large cancer systems have minimal knowledge about what the rad oncs do. People can understand it, but at the same time they can obtain positions of power/decision making clout, and still not know what we do.

 

[BobbyHeenan]

At MUSC, according to Brian Lally, they have zero work from home policies and do not authorize any physician image checking remotely off-site. Weird stuff. Anti-doctor stuff imho. Should you only have the privilege of remote/virtual work if you're not a solo or rural rad onc??? That's what would happen with a return to direct. There would be a carve out for solo/rural, but it would be penurious: they couldn't be virtual.

That's a messed up policy.

In the town hall ASTRO leadership said explicitly checking IGRT images from home was perfectly fine with them.

 

[medgator]

ACRO just sent out a supervision survey to its membership and included a link to it's CMS letter from 9/27/2019 regarding supervision (which I imagine is the comment period before CMS made the general supervision rule change in Jan 2020 pre-covid):

Under the current direct supervision regulations, it is impermissible for
providers to bill Medicare for those services requiring direct supervision but performed in the absence of a radiation oncologist.

As a result, a single radiation oncologist operator often cannot attend tumor boards, see patients in the hospital ER to help determine whether an admission is appropriate, assist in initial evaluations, provide brachytherapy procedures in the operating room while treating Medicare patients, or perform consultations on critical inpatients in a timely manner.

We believe regulations could be revised to permit general supervision for limited temporal periods and circumstances that might require the radiation oncologist to be “directly” absent from the site for a specific and time-limited purpose (e.g. participation in a hospital tumor board/conference, performance of a consultation on a hospital inpatient or emergency room patient, performance of a brachytherapy procedure, etc.). We would propose such limited general supervision rules be applied equally in the hospital and non-hospital setting.

ACRO continues to believe that all patients are best served if they have the opportunity to receive state-of-the-art cancer treatments close to home. This is best accomplished if their care providers have the opportunity to participate in ongoing tumor boards and prospective case review as
advocated by virtually all of the nationally certified programs and to provide those occasional
services outside of the actual radiation therapy site, as might be periodically necessary.

This looks 100000x better than the garbage ASTRO has been saying imo, actually looks like it was written by someone who practices IRL away from an overstaffed single-site academic dept

 

[TheWallnerus]

That's a messed up policy.

In the town hall ASTRO leadership said explicitly checking IGRT images from home was perfectly fine with them.

Yes. They are dumb, and by dumb I mean they’re trying to (re)pass a law they don’t understand. In freestanding, the IGRT is billed globally. However the technical part of the code carries the direct supervision requirement under the MPFS. But billing the code globally puts the implication the professional was done under direct, and would make for possible lucrative qui tams (were someone to try and make a case). This was always Ron D’s line of logic; I am sure I’m explaining something here many already understand or know.

 

[elementaryschooleconomics]

I am sure I’m explaining something here many already understand or know.

Based on observing the conversations around this point for many years, I suspect the number of people who understand this point is actually very, very low.

(but yeah, they're probably all on SDN, lol)

Regardless, I don't think this has EVER been tested in any case or challenged anywhere in any official capacity.

But, I've always found this super weird:

For the IGRT code you're talking about (77014 off the top of my head), the "02 - Direct Supervision" is only for TC

Both the global AND the professional carry "09 - Does Not Apply".

Scrolling through the CPT codes, this breakdown seems really uncommon (obviously I haven't meticulously examined ALL codes, though).

1) What was the point of that?
2) Is anyone out there ever ONLY dropping 77014-TC? Seems unlikely, post-2015 bundle.
3) If both the global and professional have the 09 - Does Not Apply, why would anyone make the inductive leap the Direct Supervision is required?

Now, to be clear: I know exactly why Ron and ASTRO think that.

Taking that crew and their conflicts of interest aside, I'm asking in a vacuum, as in, can anyone construct an unbiased argument?

 

[BobbyHeenan]

Yes. They are dumb, and by dumb I mean they’re trying to (re)pass a law they don’t understand. In freestanding, the IGRT is billed globally. However the technical part of the code carries the direct supervision requirement under the MPFS. But billing the code globally puts the implication the professional was done under direct, and would make for possible lucrative qui tams (were someone to try and make a case). This was always Ron D’s line of logic; I am sure I’m explaining something here many already understand or know.

It's also another reason why we need clarity from CMS. THere are very clear-cut scenarios that need clear cut rules on..unfortunately gray areas are either abused or milked/weaponized by multiple players (be it qui tams or billing /scare companies)....

1. Can daily IGRT be checked remotely after it is performed, even in a "direct supervision" environment? We need a clear answer here. I would interpret it as the physican is directly avialable to review/supervise the IGRT if needed, but the actual process of signing off on the image/reviewing the image may be done remotely before the next fraction. Like you are saying though, there is some wiggle room in interpretation and that wiggle room can be weaponized. The ASTRO interpretation is that yes, you can check films remotely. But ASTRO doesn't matter, CMS does.

2. If direct supervision is required, does it absolutely have to be a rad onc? yes, we understand it is best to have a rad onc, but in some situations can a formally designated other non rad onc physician and/or physician extender serve as the supervising physician when a rad onc is not immediately available?

 

[TheWallnerus]

It's also another reason why we need clarity from CMS. THere are very clear-cut scenarios that need clear cut rules on..unfortunately gray areas are either abused or milked/weaponized by multiple players (be it qui tams or billing /scare companies)....

1. Can daily IGRT be checked remotely after it is performed, even in a "direct supervision" environment? We need a clear answer here. I would interpret it as the physican is directly avialable to review/supervise the IGRT if needed, but the actual process of signing off on the image/reviewing the image may be done remotely before the next fraction. Like you are saying though, there is some wiggle room in interpretation and that wiggle room can be weaponized. The ASTRO interpretation is that yes, you can check films remotely. But ASTRO doesn't matter, CMS does.

2. If direct supervision is required, does it absolutely have to be a rad onc? yes, we understand it is best to have a rad onc, but in some situations can a formally designated other non rad onc physician and/or physician extender serve as the supervising physician when a rad onc is not immediately available?

Easy questions under virtual

Problematic questions under blanket return to direct (and they were always problematic pre 2020)

 

[elementaryschooleconomics]

1. Can daily IGRT be checked remotely after it is performed, even in a "direct supervision" environment? We need a clear answer here. I would interpret it as the physican is directly avialable to review/supervise the IGRT if needed, but the actual process of signing off on the image/reviewing the image may be done remotely before the next fraction. Like you are saying though, there is some wiggle room in interpretation and that wiggle room can be weaponized. The ASTRO interpretation is that yes, you can check films remotely. But ASTRO doesn't matter, CMS does.

2. If direct supervision is required, does it absolutely have to be a rad onc? yes, we understand it is best to have a rad onc, but in some situations can a formally designated other non rad onc physician and/or physician extender serve as the supervising physician when a rad onc is not immediately available?

1) We have to remember that these rules are ONLY about Medicare billing. They are NOT about the practice of medicine.

If you were a cash-only practice, none of this would exist. As long as you have a license to practice medicine, and follow any applicable state regulations about who can operate X-ray emitting devices for human patients (vs veterinary patients), you can do whatever you want.

By the same logic: if ASTRO wants to claim IGRT has to be Direct Supervision, technically that is only for dates when 77014 is charged. Speaking generally, IGRT is mostly used in definitive cases. For definitive cases, IMRT/VMAT is most often used. IGRT (77014) has been bundled with IMRT since 2015 and cannot/is not charged daily.

Further, this is only in regards to Medicare patients. Private payors will often mimic CMS rules but not always.

So, let's say we live in a world where ASTRO gets IGRT back to Direct Supervision for everyone, and a clinic is unable to have a RadOnc on-site 100% of the time. You would be precisely following the letter of the law if you did daily IGRT for IMRT cases, but the RadOnc was only present for the day 77014 was charged.

2) No. This has legal precedence from a Kentucky qui tam case. This specific point was brought up (in Direct Supervision of radiotherapy, does it have to be a Radiation Oncologist). The court ruled initially, and on multiple appeals - no, no, no. Any doctor will do.

 

[BobbyHeenan]

Easy questions under virtual

Problematic questions under blanket return to direct (and they were always problematic pre 2020)

True.

They don't have to be problematic though.

I'm not for 100% direct supervision but if they go that route I'd like it to be clear that image acquisition/treatment requires in person direct, image review may be remote. It would literally take one sentence.

Same for NP/PA. Just one sentence.

 

[TheWallnerus]

True.

They don't have to be problematic though.

I'm not for 100% direct supervision but if they go that route I'd like it to be clear that image acquisition/treatment requires in person direct, image review may be remote. It would literally take one sentence.

Same for NP/PA. Just one sentence.

God would have to perform just one miracle to prove he’s real. But what fun would that be for human existence.

 

[NotMattSpraker]

you should see my inbox...not sure whats worse, my gmail inbox, my actual physical inbox or my aria task pad

to be clear, i do all the tasks, I just don't use the task pad.

I am a proud task pad neglector. I brag about it and I think they let me do that so I feel like I have control over my career. I do all my work in a very timely manner and communicate like crazy to every through teams and text. I refuse to go in to a different program to mark off that, yes I saw my consult. If I dont do the note, I have another inbox for that plus a staffer that writes me, sometimes even if the note is done!

Right now I have... 557 overdue task pad items. Crushing!

You know whats really weird. I've asked for an Aria trainer like 6 times in 5 years across 3 different companies and I could never get it to take haha. It seems like a really powerful software designed by the devil. I'd love to learn about it some day, or not apparently.

Addendum: 558

 

[RO28]

I am a proud task pad neglector. I brag about it and I think they let me do that so I feel like I have control over my career. I do all my work in a very timely manner and communicate like crazy to every through teams and text. I refuse to go in to a different program to mark off that, yes I saw my consult. If I dont do the note, I have another inbox for that plus a staffer that writes me, sometimes even if the note is done!

Right now I have... 557 overdue task pad items. Crushing!

You know whats really weird. I've asked for an Aria trainer like 6 times in 5 years across 3 different companies and I could never get it to take haha. It seems like a really powerful software designed by the devil. I'd love to learn about it some day, or not apparently.

Addendum: 558

so...I'm at 3064

I agree, I can only handle checking so many boxes day.

 

[medgator]

​ ​ Update on the American College of Radiation Oncology’s Position on Supervision in Radiation Oncology​ The American College of Radiation Oncology (ACRO) is pleased to release the following update concerning our position on supervision requirements for the delivery of radiation therapy. Since 2019, ACRO has advocated for a uniform level of supervision across sites of service with reasonable exceptions. This topic has been the source of significant discussion over recent months. As such the College has taken a deliberate, methodical, and informed approach to gather feedback from the radiation oncology community. ACRO has conducted two separate surveys on this matter gathering input from both member and non-member radiation oncologists in every state and every practice setting. The findings conveyed include the following: Direct and general supervision have a role in safe, quality care delivery when used responsibly. Some degree of flexibility at the discretion of the Radiation Oncologist is warranted in all sites of service. Certain treatments demand direct supervision at each session, while other treatments may only require direct supervision at the initiation of therapy. Supervision requirements with reasonable exceptions should be unrelated to site of service and geographic location. Variations in supervision requirements based on advances in technology (e.g. “virtual direct supervision”) should be considered after further review in the future. At the end of 2023, ACRO performed the most robust nationwide survey of which we are aware, conducted over five months with participation from over 500 Radiation Oncologists in all practice settings and representing every state across the USA. The study, entitled, “Consensus on Payment Model Reform amongst Radiation Oncologists: The Radiation Oncology Payment Reform Survey” was authored by Dr. Joseph Wilding and colleagues, and presented at the 2024 ACRO Summit with the following key finding: 69% of practicing U.S. Radiation Oncologists agree or strongly agree with site-neutral direct supervision requirements with limited exceptions. This finding reflected general agreement across the community and included responses from Radiation Oncologists in academic hospitals and veterans’ healthcare centers as well as hospital-based and freestanding sites-of-service. ACRO most recently conducted a second survey to gather additional feedback directly from its members. With 142 respondents, the key findings from the survey are as follows: 94% of ACRO Members surveyed believe Radiation Oncologists are the only healthcare providers comprehensively trained in treatment and management of radiation therapy patients. 64% of respondents believe direct supervision should be the standard across sites-of service at the initiation of radiation therapy. 86% of respondents indicated general supervision should be allowed at the discretion of the Radiation Oncologist, after the initiation of radiation therapy. We are grateful for this feedback from the Radiation Oncology community. An informed and thoughtful approach to these complex issues is essential. This feedback will be incorporated into an updated consensus statement to be released by ACRO in the coming days. Sincerely,​ Tarita Thomas, MD, PhD, MBA, FACRO Chair, ACRO Government Relations & Economics Committee​ Dwight E. Heron, MD, MBA, FACRO, FACR, FASTRO ACRO President​

 

[TheWallnerus]

​ ​ ​ ​ ​ ​ ​ ​ ​ Update on the American College of Radiation Oncology’s Position on Supervision in Radiation Oncology​ ​ The American College of Radiation Oncology (ACRO) is pleased to release the following update concerning our position on supervision requirements for the delivery of radiation therapy. Since 2019, ACRO has advocated for a uniform level of supervision across sites of service with reasonable exceptions. This topic has been the source of significant discussion over recent months. As such the College has taken a deliberate, methodical, and informed approach to gather feedback from the radiation oncology community. ACRO has conducted two separate surveys on this matter gathering input from both member and non-member radiation oncologists in every state and every practice setting. The findings conveyed include the following:​ Direct and general supervision have a role in safe, quality care delivery when used responsibly. Some degree of flexibility at the discretion of the Radiation Oncologist is warranted in all sites of service. Certain treatments demand direct supervision at each session, while other treatments may only require direct supervision at the initiation of therapy. Supervision requirements with reasonable exceptions should be unrelated to site of service and geographic location. Variations in supervision requirements based on advances in technology (e.g. “virtual direct supervision”) should be considered after further review in the future. At the end of 2023, ACRO performed the most robust nationwide survey of which we are aware, conducted over five months with participation from over 500 Radiation Oncologists in all practice settings and representing every state across the USA. The study, entitled, “Consensus on Payment Model Reform amongst Radiation Oncologists: The Radiation Oncology Payment Reform Survey” was authored by Dr. Joseph Wilding and colleagues, and presented at the 2024 ACRO Summit with the following key finding: ​ 69% of practicing U.S. Radiation Oncologists agree or strongly agree with site-neutral direct supervision requirements with limited exceptions. This finding reflected general agreement across the community and included responses from Radiation Oncologists in academic hospitals and veterans’ healthcare centers as well as hospital-based and freestanding sites-of-service. ACRO most recently conducted a second survey to gather additional feedback directly from its members. With 142 respondents, the key findings from the survey are as follows: ​ 94% of ACRO Members surveyed believe Radiation Oncologists are the only healthcare providers comprehensively trained in treatment and management of radiation therapy patients. 64% of respondents believe direct supervision should be the standard across sites-of service at the initiation of radiation therapy. 86% of respondents indicated general supervision should be allowed at the discretion of the Radiation Oncologist, after the initiation of radiation therapy. We are grateful for this feedback from the Radiation Oncology community. An informed and thoughtful approach to these complex issues is essential. This feedback will be incorporated into an updated consensus statement to be released by ACRO in the coming days. Sincerely,​ ​ ​ Tarita Thomas, MD, PhD, MBA, FACRO Chair, ACRO Government Relations & Economics Committee​ ​ ​ Dwight E. Heron, MD, MBA, FACRO, FACR, FASTRO ACRO President​

I would rate this as way better than the ASTRO letter to CMS

 

[Reaganite]

"ACRO most recently conducted a second survey to gather additional feedback directly from its members. With 142 respondents..."
"At the end of 2023, ACRO performed the most robust nationwide survey of which we are aware, conducted over five months with participation from over 500 Radiation Oncologists."

Post this only to ask does cms even care about our opinions with these kinda numbers?

 

[medgator]

I would rate this as way better than the ASTRO letter to CMS

Yeah because ACRO actually, you know, polled its membership (and even non members supposedly).

What did JM in late Feb do at ASTRO HQ? Just lick his finger and stick it up in the air?

 

[NotMattSpraker]

Yeah because ACRO actually, you know, polled its membership (and even non members supposedly).

What did JM in late Feb do at ASTRO HQ? Just lick his finger and stick it up in the air?

Prostate guy. I don’t think it was up in the air.

 

[RadOncDoc21]

Correct.

From the FAQ:
Many radiation therapy services specifically include physician presence in the CPT code descriptor and are valued accordingly. Changes in physician presence can impact valuation, therefore a shift to virtual supervision is likely to result in reduced reimbursement to radiation oncologists for services.

What if I had an avatar present to represent my physical self?

I’m obviously late to the thread but appreciate the arguments presented.

To all of those who fear the CMS, just know they will come at you regardless. I believe we need to evolve and adapt and not hide behind some misguided necessity of the importance of having a physical presence in the clinic. Instead, we need to justify our importance as radiation oncologist and the cerebral aspect of our field. We have staff to push the buttons and “providers” who can chat about the use of aquaphor to the patients.

As far as safety goes, if someone is going to be a bad radiation oncologist, they will continue to be one rather if they are present or not. It wouldn’t change their plan of giving 97 Gy to the brain stem.

 

[Reaganite]

What if I had an avatar present to represent my physical self?

I’m obviously late to the thread but appreciate the arguments presented.

To all of those who fear the CMS, just know they will come at you regardless. I believe we need to evolve and adapt and not hide behind some misguided necessity of the importance of having a physical presence in the clinic. Instead, we need to justify our importance as radiation oncologist and the cerebral aspect of our field. We have staff to push the buttons and “providers” who can chat about the use of aquaphor to the patients.

As far as safety goes, if someone is going to be a bad radiation oncologist, they will continue to be one rather if they are present or not. It wouldn’t change their plan of giving 97 Gy to the brain stem.

Agree wholeheartedly. I really respect ACRO for bringing the question to its members, but I think their initial response is too convoluted. It doesn't feel like CMS wants to complicate things with all these bullet points and exceptions attached exclusively to supervision for a small specialty like rad onc. Sameer did mention this during the ASTRO town hall. Okay, the doc needs to be there the first day, but not the subsequent days. How is that safer than daily virtual direct? What if you just do ports the first day? Does that count as being there for the first day or does the person need to be treated? What if machine breaks down mid-treatment and you need to complete the first treatment the next day? If we go to ROCR and everything goes to case rate...what if you just convert all your SBRTs to 6 fractions and still collect the full IMRT case rate? Now you don't need to be there? Guys like RonD build careers on this uncertainty.

 

[Gfunk6]

Yay! Another "work group"

 

[Ray D. Ayshun]

View attachment 386139
Yay! Another "work group"

This supervision work group better not meet virtually.

 

[MidwestRadOnc]

View attachment 386139
Yay! Another "work group"

"Changes... are expected in July"?

How do they know changes are expected? Sounds like they are expecting virtual direct to be made permanent and are gearing up to officially challenge it.

 

[medgator]

"Changes... are expected in July"?

How do they know changes are expected? Sounds like they are expecting virtual direct to be made permanent and are gearing up to officially challenge it.

 

[Reaganite]

"Changes... are expected in July"?

How do they know changes are expected? Sounds like they are expecting virtual direct to be made permanent and are gearing up to officially challenge it.

You can bet your ass ASTRO and RonD are furiously searching billing and coding guidelines to come up with some esoteric way to invalidate a simple CMS proposal for permanent virtual direct. Maybe IGRT will be neither a diagnostic or therapeutic service and since MACs and CMS haven't weighed in on this new type of non-diagnostic, non-therapeutic imaging, personal supervision is required at all sites of service.

 

[TheWallnerus]

You can bet your ass ASTRO and RonD are furiously searching billing and coding guidelines to come up with some esoteric way to invalidate a simple CMS proposal for permanent virtual direct. Maybe IGRT will be neither a diagnostic or therapeutic service and since MACs and CMS haven't weighed in on this new type of non-diagnostic, non-therapeutic imaging, personal supervision is required at all sites of service.

Haha. ASTRO already called CMS unsafe and a danger to patient care at the town hall. Now maybe they will say that Medicare is committing Medicare fraud. Maybe Ron can whistleblow CMS?! So meta.

 

[MidwestRadOnc]

Was ASTRO planning to attack the 2019 general supervision rule as well, then the pandemic just delayed things?

Medicare is committing Medicare fraud.

Next you are going to tell me social security is a Ponzi scheme.

 

[medgator]

Was ASTRO planning to attack the 2019 general supervision rule as well, then the pandemic just delayed things?



Next you are going to tell me social security is a Ponzi scheme.

I believe pyramid scheme may be more accurate? Need more workers to support the beneficiaries!

 

[Reaganite]

In all seriousness, I predict if CMS makes virtual supervision permanent, ASTRO will suddenly have a major hard on for RonD site of service stuff. It'll be the new meta and the new basis for qui tam.

 

[RickyScott]

In all seriousness, I predict if CMS makes virtual supervision permanent, ASTRO will suddenly have a major hard on for RonD site of service stuff. It'll be the new meta and the new basis for qui tam.

Still don’t know why that guys license was revoked.

 

[NotMattSpraker]

View attachment 386139
Yay! Another "work group"

 

[thesauce]

Quick aside: what is ROCR’s path forward? Are they drafting a bill to put before congress?

 

[MidwestRadOnc]

Still don’t know why that guys license was revoked.

Can you make FOIA request if you really wanna know?

 

[RickyScott]

Can you make FOIA request if you really wanna know?

i dont think its a gov agency. called the arrt and all they will confirm is that licenses are only revoked for severe ethical violations. For a "minor" violation like a meth binge, they would just suspend you.

 

[MidwestRadOnc]

i dont think its a gov agency. called the arrt and all they will confirm is that licenses are only revoked for severe ethical violations. For a "minor" violation like a meth binge, they would just suspend you.

I have no idea in this case if a license was actually revoked, but for a physician it would typically be something like:

Possibilities I can think of:
- Felony? Multiple DUIs, Crimes of moral turpitude, assault and battery/rape, etc.
- Stealing controlled meds, coming to work and treating patients drunk, etc.
- Sexual misconduct towards patients and/or staff
- Gross negligence (really insanely bad stuff like giving 70 Gy whole brain or something), operating after smoking crack, etc.

 

[Ray D. Ayshun]

I have no idea in this case if a license was actually revoked, but for a physician it would typically be something like:

Possibilities I can think of:
- Felony? Multiple DUIs, Crimes of moral turpitude, assault and battery/rape, etc.
- Stealing controlled meds, coming to work and treating patients drunk, etc.
- Sexual misconduct towards patients and/or staff
- Gross negligence (really insanely bad stuff like giving 70 Gy whole brain or something), operating after smoking crack, etc.