Viewray‘s Demise

[drowsy12]

interesting.

Is VIEWRAY for REAL?

---

Members don't see this ad.

 

[elementaryschooleconomics]

interesting.




View attachment 381293



Is VIEWRAY for REAL?

View attachment 381294

Did I just time travel into the 1990s???

 

[Gfunk6]

From LinkedIn:

 

[RadOncDoc21]

From LinkedIn:

View attachment 381297

I hope he has a lot of stock in the company the way he’s acting.

 

[Mandelin Rain]

Thirsty is the only way to describe

 

[wandering star]

I hope he has a lot of stock in the company the way he’s acting.

For what it's worth, my personal interactions with Percy have great. I know the UCLA program that he was from had a pretty strong MR-LINAC bias and I think that can explain his enthusiasm.

No idea if MR-LINAC is (or ever will be) financially viable. I'm sure there are individual cases where it provides clinical utility. It's good that centers that have them can keep them running, even if no new units will be sold.

You can draw parallels to Calypso's rise and fall, where I think they raised a ton of money to build a motion management product, were bought at a total fire sale from Varian, who eventually has used them to improve clinical practice (by a smaller or larger margin, depending on your point of view). If you've seen the graph, it's like they climbed the peak of overinflated expectations to get investor money using hype, then they hit the valley of disillusionment, and eventually they stabilized to the plateau of productivity. Maybe not worth the outlay in retrospect, but providing some value for some patients, which is as much as any of us can ask for.

 

[RadOncMegatron]

Who is the fool that is investing in this??? I wish it the best of luck, but from a financial standpoint, I think it is unwise, especially now with all the press out noting it's financial instability...

 

[evilbooyaa]

MRI-Linac proponents are as fanatical as proton proponents. But protons get paid. realtime MRI guidance needs a CPT code

 

[medgator]

MRI-Linac proponents are as fanatical as proton proponents. But protons get paid. realtime MRI guidance needs a CPT code

Probably deserves at least a modifier or something, not sure proud protons ever deserved that code outside of specific icd codes

 

[BobbyHeenan]

It's worth a long shot investment IMO. If they get a cpt code it's game on, right?

I am very curious though which docs/departments have invested in this now though. Nothing inherently wrong here, but financial disclosures will be interesting.

 

[communitydoc13]

It's worth a long shot investment IMO. If they get a cpt code it's game on, right?

I am very curious though which docs/departments have invested in this now though. Nothing inherently wrong here, but financial disclosures will be interesting.

ROCR? Getting conspiratorial of course. Is a code pending? Are investors part of code advocacy?

 

[RickyScott]

It's worth a long shot investment IMO. If they get a cpt code it's game on, right?

I am very curious though which docs/departments have invested in this now though. Nothing inherently wrong here, but financial disclosures will be interesting.

not sure any docs invested, but some like Percy and Drew where receiving large consulting fees. MRI linacs should have additional codes, but they really ought to be confined to large university centers.

 

[temujim]

Hear just a single deep pockets investor. Dempsey out there talking big. I'd say delusions of grandeur, but he is a brilliant guy so who knows.

 

[NotMattSpraker]

ROCR? Getting conspiratorial of course. Is a code pending? Are investors part of code advocacy?

not sure any docs invested, but some like Percy and Drew where receiving large consulting fees. MRI linacs should have additional codes, but they really ought to be confined to large university centers.

This is rumor status and I would maybe not even believe it. It sounds like there was work being done on a code but collaboration among stakeholders was an issue, so that died. This rumor predated the company going under by several months so Im skeptical its still relevant.

It's remarkable to me that the biology guided RT was able to get a code already. Given how the pay looks, I think this machine will now explode and I still don't even understand why it helps anyone! I want to learn though, Im not convinced it doesnt help.

In this context, that whole thing lends some validity to this in-fighting rumor about why we still don't have an on table adaptive code.

Im not sure if any docs invested or not, but Im not sure why they couldnt. Personally I just wouldnt. Maybe City of Hope bought it or maybe Kanye West (this is the theory I am rooting for). I still dont understand how someone as prominent as Percy could continue to treat and post about it all the time and no one from COH cared so thats why I suspected they may be involved. Viewray put down in writing to stop treating and that letter was leaked all over.

Also, for what its worth, The SCAROP-ROCR Party very recently updated their FAQ with this addition highlighted below.

I am sure eventually there could be an OTA code. Or maybe not and people will just abuse the crap out of 77301 until its devalued to nothing. But I guess we do know that it will stay in MPFS FFS for at least 10+ more years. Love the SCAROP-ROCR Party.

For what its worth, I like Percy a lot, just hate to see any doctor acting this way. But certainly he is no different than so many others in and outside our field.

Hopefully Amar gets some shares because everyone falsely accused him of that anyway

I really hope all of this just works out where we can at least see these trials through, there is real promise in upper GI for MRgRT. I also really hope people can come back down to earth a little bit for the sake of Medicine. Stop being mean to Simul and pretending that a linac is saving humanity.

 

[BobbyHeenan]

This is rumor status and I would maybe not even believe it. It sounds like there was work being done on a code but collaboration among stakeholders was an issue, so that died. This rumor predated the company going under by several months so Im skeptical its still relevant.

It's remarkable to me that the biology guided RT was able to get a code already. Given how the pay looks, I think this machine will now explode and I still don't even understand why it helps anyone! I want to learn though, Im not convinced it doesnt help.

Yes.

I hate to be cynical but there is probably some very "interesting" back story or strategy involved there. If everything is on the up-and-up then Viewray and Elekta need to purge that reflexion regulatory team ASAP. They greased the correct wheels.

 

[NotMattSpraker]

Yes.

I hate to be cynical but there is probably some very "interesting" back story or strategy involved there. If everything is on the up-and-up then Viewray and Elekta need to purge that reflexion regulatory team ASAP. They greased the correct wheels.

I have zero idea. Its very interesting and fun to watch but each day I am more and more thankful to just be a spectator.

 

[temujim]

Yes.

I hate to be cynical but there is probably some very "interesting" back story or strategy involved there. If everything is on the up-and-up then Viewray and Elekta need to purge that reflexion regulatory team ASAP. They greased the correct wheels.

RefleXion Announces Initial Close of $105M Fundraising to Commercialize New Cancer Treatment - RefleXion

Funds will allow further commercial penetration and new application development HAYWARD, Calif., Nov. 15, 2023 – RefleXion Medical, a therapeutic oncology company, today announced the initial closing of a $105M equity raise, led by The Rise Fund, TPG’s multi-sector global impact investing...

reflexion.com

 

[BobbyHeenan]

View attachment 381308

RefleXion Announces Initial Close of $105M Fundraising to Commercialize New Cancer Treatment - RefleXion

Funds will allow further commercial penetration and new application development HAYWARD, Calif., Nov. 15, 2023 – RefleXion Medical, a therapeutic oncology company, today announced the initial closing of a $105M equity raise, led by The Rise Fund, TPG’s multi-sector global impact investing...

reflexion.com

Well there you go.

Pharma has so much more regulatory capture then the device/linac manufactures have.

 

[wandering star]

MRI-Linac proponents are as fanatical as proton proponents. But protons get paid. realtime MRI guidance needs a CPT code

It's remarkable to me that the biology guided RT was able to get a code already.

In my book all three of these technologies (protons, MRgRT, BgRT) are in the same category: they are physics ways to get more dose to the right location. At least with protons we've seen the technology misused, being applied to patients mainly for the sake of financial return. But we see this e.g. in fractionation schedules too.

This problem is not unique to medicine. I have two friends who are civil engineers and they complained about the same thing. If you build a bridge, you have engineers on one side trying to meet requirements, and policymakers on the other side creating the requirements. Except there's a problem: the "requirements" for safety are not always appropriate for your specific situation. Sometimes you want to add a safety feature that's not in the requirements, but there's no money for it. Other times you are adding (and paying) for one when it clearly isn't doing anything. It's the problem of prior auth all over again.

Who is the fool that is investing in this??? I wish it the best of luck, but from a financial standpoint, I think it is unwise, especially now with all the press out noting it's financial instability...

Not sure there is a big investment if it's a private entity. When a company dissolves, all stakeholders want to preserve as much value as possible. If you're about the shut down the factories and write off the total thing as a total loss, but then someone steps in and says "I'll pay $5 million for that," then even if the original price was $50 million, it makes sense for them to take it. The shareholders will get a few pennies back on the dollar, better than nothing.

If that new private entity is able to stay in the black by selling services to maintain existing scanners, then good for them. There's the pipe dream that in 10 years enough evidence will accumulate to get an MRgRT CPT code. I'm not holding my breath but it's possible, and if it pans out it'll be much better for society if some form of ViewRay were alive that retains the knowhow to build them anew.

 

[ramsesthenice]

Wow. I personally would have a hard time purchasing one given given the history. That said, if they are organized right and can actually deliver in a timely manner and provide good support, they might make it. We have a Unity and host site visits and I can tell you there is still a lot of interest in these machines. In the right setting, I think it can be a good thing. But, IMO, a lot is misguided. They have their place, but getting one to differentiate your practice in a competitive market…no. I can’t tell you how many times I’ve heard “The practice across town got protons, so now we are considering MR or Reflexion.” Financially, this is the definition of bringing a knife to a gun fight.

As for adaptive coding, we do collect charges for adaptive replans. I will have to follow up because as most of you know, I am allergic to this side of things. But on the Unity, the couch does not move. The most basic plans are submitted as Adapt to Position in which the MLCs are moved instead of the patient but the targets and OARs are not modified. If the targets or OARs are adapted, it’s billed as Adapt to Shape. Both are technically a “new” plan, but ATS definitely recoups more money (and requires a metric **** ton of letters of necessity).

 

[seper]

I’ve been on Reflexion sales pitch call. They want us to do “total metastatic ablation” (like SBRT to 20 lesions). Lately, data on SBRT in metastatic setting have not been good. Payors are not impressed still.

I’d pass

 

[elementaryschooleconomics]

I’ve been on Reflexion sales pitch call. They want us to do “total metastatic ablation” (like SBRT to 20 lesions). Lately, data on SBRT in metastatic setting have not been good. Payors are not impressed still.

I’d pass

Hahahahahaha

They have Johnson & Johnson backing now, we just need to accept this is our future. Total Metastatic Ablation is the FLASH of 2027.

Look at how whipped Augmenix made any RadOnc unfortunate enough to cross paths with a sales rep. Augmenix! We were so desperate to feel that sweet, sweet sales rep attention, we bought THE GOO™ hook, line, and sinker.

If a small biotech startup can convince everyone that the only thing capable of improving VMAT with CBCT is butt needles filled with THE GOO™, just imagine what J&J has in store. Augmenix was the high school varsity team, J&J is the NFL.

Total Metastatic Ablation is definitely exempt from ROCR.

 

[Neuronix]

Have you heard anything about centers that shut down their systems? Are they bringing them back up now?

I wonder how many of the private investors are radiation oncologists.

It makes me a little uncomfortable how emotional some of the physicians are about this machine, but Im happy it's back in play. I wonder if the private investors are also going to fund the randomized pancreas trial that was planned! Would be awesome.

Some never stopped, stopped temporarily only, or limited use but continued for selected applications. This is particularly common in Europe.

Most centers in the USA I think want to get their machines back in use. I can think of one exception that has stated that they will not be coming back online.

Basically, nearly everyone who used one of these machines enjoyed using it and wants it back.

 

[ramsesthenice]

Some never stopped, stopped temporarily only, or limited use but continued for selected applications. This is particularly common in Europe.

Most centers in the USA I think want to get their machines back in use. I can think of one exception that has stated that they will not be coming back online.

Basically, nearly everyone who used one of these machines enjoyed using it and wants it back.

This would have been my assumption. Liking the machine aside, the economics would likely favor salvaging the investment for most centers.

 

[Photoner]

I wonder if some centers still keep the MRIdians working. Don't they break? Perhaps these centers hired some of the former Viewray service engineers, but what happens with the spare parts?

 

[catachip]

I wonder if some centers still keep the MRIdians working. Don't they break? Perhaps these centers hired some of the former Viewray service engineers, but what happens with the spare parts?

Most were up and running about a month or so after the bankruptcy. Some folks hired their own engineers or signed service contracts with third parties. Our center has been treating at normal capacity since the end of November.