Mehrlicht (keyboard warrior)--- Do you realize how many people today are treating without a doc or any (maybe a retired ER doc) ---the 5 day a week with a locum at $3800 (55% margin to the locum company) a day no longer works and should have bever worked. But linacs had 65% margins so.......
Spot on, these salaries and the disregard to what would happen in the long term also helped get us where we are now. Also if you notice now the admin turn is 3-5 years. The excuse is always it is capitalism.......Agree, never met an admin who cared more about the patients then the top and bottom line. To be fair, that’s not their job but many (not all) do stand in the way of what I would consider increasing the importance of high quality health care even if it means cutting profits.
Just to give some food for thought:
CEOs got smaller raises. It would still take a typical worker two lifetimes to make their annual pay
After ballooning for years, CEO pay growth is finally slowing. The typical compensation package for chief executives who run S&P 500 companies rose just 0.9% last year, to a median of $14.8 million, according to data analyzed for The AP by Equilar. It was the smallest increase since 2015. Still...apnews.com
rural waiver back in the day meant that freestanding or hospital could be general supervisionSomeone please summarize this "Rural Waiver" - I have no clue.. does this mean freestanding centers get to go to General Supervision like HOPPS?
Or that NP's only have to staff the place half the time in HOPPS? Or what exactly??
The whole CAH thing was for hospitals. I assume this is about HOPPS. But some clarity here would help. I think any physician who is willing to let a pseudo-trained NP run the shop and remote in, then show up 1 day a week, is going to find that there will instead be a desire for the hospital to actually hire a starving but competent new/mid-career grad for about the same amount, who will commit to the local docs.
I don't think this business model will fly. I hope it doesn't. Rural Radonc will soon be absorbing the overflow of new trainees and they (perhaps without kids, or unmarried) WILL take those jobs... if the hospitals will have them.
The thing is kids.. radonc isn't just about being the book smartiest doc in the room. In rural america, you need people handling skills. Poor white folks may balk at seeing someone who can't command english (maybe its racist, maybe its ignorance), much less deal with doctors with poor social competence. And if you're not good at this part, the word will spread fast.
We are not all interchangeable widgets... ASTRO/ACRO needs to make sure they say "Be sure to see a board certified radiation oncologist" and not an NP with an occasional TV visit. That is NOT the way our profession needs to go.
Hopefully I'm one of them. I totally support rural truebeams staffed by thoughtful docs. However, that's not the whole story. Many of the setups are using machines that should be in landfills bc they have the CON and setup to essentially print money while hiding behind a "serving a need" banner.
When # shows up, the margins get compressed. My rate is 2800 a day plus expenses. Expenses are pass thru. Agency tries to get 3200-3500 if they can. More for short notice/emergent situations obviously. But they can and do sometimes get even more. Hell, I've charged 4500 a day for emergent babysitting to a place I did not want to go back to..
The days of 55% margins are GONE. Someone like me will find their way there. What this really is.. is a way to circumvent the time honored rulez that say a radonc, in a hospital setting, needs to be generally available. Lets throw in a NP, a television, offer a slightly lower cost to the hospital and.. find a sucker Radonc who will work for a few shekels... WHILE OFFLOADING THE RISK TO THE RADONC WITHOUT THE PAY.
And will your medmal cover this when **** hits the fan. Good luck guinea pigs.
Thats what I thought. Freestanding centers would HAPPILY have one day a week at 5 centers if Medicare didn't require Direct Supervision for them. Meanwhile, HOPPS rural centers benefit from General Sup by allowing folks to work one place, live another.
HELL yes.
It's unusual. The rural hospital I worked at briefly absolutely refused to even let the med onc put their name as supervising. Does it happen somewhere? I'm sure. Does it make it the right solution? No.
Desperation and greed are powerful forces that will lead to dangerous consequences for patients. BO? Not on your life (nor my patients).
There are many community admins out there who wish their radoncs could do some medonc. Training programs should consider this.
We have Medonc/heme volume..
Clinical volume justifying pay? What is the calculation? The total revenue the doc bring into the hospital through diagnostic orders, chemo, biosimilars and IO doesn't justify the pay?
The alternative is shutting the cancer center down. They don't have a choice.
Killing community cancer care.
They interpret it in the way that is most financially advantageous for themselves.
Yaaassss. Maybe JJ can PM us (as in the whole SDN crew). We'll do some recruiting and go into business. NPs are hard to find, but there are a lot more of them that went to regular rural high schools, grew up in small towns, graduated from state colleges and are willing to live away from major metros than there are medoncs like this at this point.
Seems to be slowly displacing injectable ADT. Academic centers I’ve spoken to have already switched to it.
Recommending for most with high-risk, just a matter of whether their insurance will cover.
1.5/4 places were like that.
once or twice in my career, I have written for xeloda and temodar just to get somethin done (medonc out of town) etc
It is inevitable someone would attempt this, and I would rather it is JJ than someone else as he is willing to engage. Its not like if he drops this, it would remain untested. The bad guys are those who created the oversupply.We are hosed.
JJ is probably responding to a real problem on a national healthcare level and working within the domain that he is familiar with. Yes, this solution does not help present or future radoncs. JJ should own this. The narrative that radoncs are overpaid is alive and well.
Locums docs (and travel nurses and travel RTTs) are horrendous value for community hospitals. This issue alone has contributed to solvency issues for multiple community places.
Now, we know that radonc typically makes money for the hospital and that we are not pulling down medonc locums rates (not close), but it doesn't matter. If you can sell value (whatever the eff that is, value does include living in a community, commitment to patients and face to face time, but those are not easily commoditized in markets (yes capitalism)) you will have buyers.
Community hospitals will do stroke care remotely.
Our problem is of course compounded (majorly) by consolidation and in particular, academic medicine losing track of its mission (which is not to provide care for everyone). Not only does being a "private practice" doc no longer mean what it used to, being an academic doc definitely doesn't mean the same. Largely, both will be employed community docs, with the smaller your institution, the greater the value you provide.
Eventually, the best we can hope for is this:
Denmark
By Karsten Vrangbæk, University of Copenhagen In Denmark’s universal, decentralized health system, the national government provides block grants from tax revenues to the regions and municipalities, which deliver health services. All residents are entitled to publicly financed care, including...www.commonwealthfund.org
I know, not a popular take, but you can only let consolidation go so far before you are better off giving block grants to small regions.
This statement not necessary, adds no value - I would guess he is extremely envious of the RT staff who successfully brought qui tam suits in the past. That's not a profitable grift anymore so here we are.
an NCD and LCD is not authoritative as they do not go through a formal comment period. The LCD L 36711 you refer to for Novitas actually was in line with CMS.
I think the delusion level of everyone but actual practicing pp rural radoncs on how this will work is pretty impressive.
