What is an average # of CT simulations per year for a community rad onc?

[AmericanoWithCream]

Does anyone have a reference for how many CT simulations per year is average for a community rad onc? Thanks!

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[medgator]

150-450, depends on how busy of a practice you are at, whether it's a urorads factory etc

 

[scarbrtj]

20/day under treatment... equals about 4 new consults a week... equals about 200 sims/year

 

[Becquerel]

20 patients under beam means 20 x 255 treatment days = 5100 treatments / year. If you are able to do this off 200 new starts that means that your average new start receives 25.5 fractions. Tough to imagine that is sustainable in a generalist practice with traditional levels of hypofractionation (16-21 fx breast, <10 fx palliation, etc), even if you are doing zero brachy/sbrt. 50%-ish of cases are palliative. If some of those 200 new starts are brachy or SBRT then 20 on beam is an even more difficult number to achieve.

I think 20 on beam per doc is about right for a higher quality pp group with a broad case mix and modern treatment paradigms that does some brachy/SBRT. If you assume 18-20 fx per external beam new start on average, then you are at 255-285 new starts per year per MD plus some brachy.

 

[PhotonBomb]

20 patients under beam means 20 x 255 treatment days = 5100 treatments / year. If you are able to do this off 200 new starts that means that your average new start receives 25.5 fractions. Tough to imagine that is sustainable in a generalist practice with traditional levels of hypofractionation (16-21 fx breast, <10 fx palliation, etc), even if you are doing zero brachy/sbrt. 50%-ish of cases are palliative. If some of those 200 new starts are brachy or SBRT then 20 on beam is an even more difficult number to achieve.

I think 20 on beam per doc is about right for a higher quality pp group with a broad case mix and modern treatment paradigms that does some brachy/SBRT. If you assume 18-20 fx per external beam new start on average, then you are at 255-285 new starts per year per MD plus some brachy.

well said, agreed.

 

[medgator]

20 patients under beam means 20 x 255 treatment days = 5100 treatments / year. If you are able to do this off 200 new starts that means that your average new start receives 25.5 fractions. Tough to imagine that is sustainable in a generalist practice with traditional levels of hypofractionation (16-21 fx breast, <10 fx palliation, etc), even if you are doing zero brachy/sbrt. 50%-ish of cases are palliative. If some of those 200 new starts are brachy or SBRT then 20 on beam is an even more difficult number to achieve.

I think 20 on beam per doc is about right for a higher quality pp group with a broad case mix and modern treatment paradigms that does some brachy/SBRT. If you assume 18-20 fx per external beam new start on average, then you are at 255-285 new starts per year per MD plus some brachy.

So if no brachy, those numbers could be higher, I do minimal brachy at this point (maybe a vag cylinder a few times a year), and carry 25-35 depending on seasonality. Haven't counted up my sims from last year, but wouldn't be surprised if they are close to 400. Hypofractionation and SBRT allows you to treat many more pts annually.

Another point is skin ca setups where you are treating with electrons and don't need a CT sim to do that, a decent chunk of volume could end up being skin cancer in a given practice, and regardless if it is electron or HDR treatment, it won't show up in your CT sim count

 

[Tigerstang]

I do about 400 annually, maybe a little higher

 

[AmericanoWithCream]

Thank you all!
Is there a metric/standard, however broad, you can present to your CEO/CFO to demonstrate if you are below/at/above 'average'?

 

[scarbrtj]

Thank you all!
Is there a metric/standard, however broad, you can present to your CEO/CFO to demonstrate if you are below/at/above 'average'?

I previously did some calcs based on Medicare data that the average RVUs per rad onc in the US is about 8333/year. I know that's low-ish, but it's probably a Mendoza line of sorts.

 

[BobbyHeenan]

Our group has covered 4-5 hospitals (1-2 linacs per site) over the past 10 years. Typically 1 doctor per site, though at times has been up to 1.5 FT docs at 2 linac sites.

CT sims have ranged from 200-~800 per site. I'm at one of the busier sites and did > 500 one year (but some of those are repeat CT sims for changes in anatomy and/or boosts). I suspect for de novo new patients I've only been at 400's on a busy year. My MGMA numbers are > 90% of country but I'm busier than I'd like; I do a lot of evening and weekend notes and evening and weekend inpatient consults and contours to keep up. We are just waiting on APM/mid level supervision rulings to decide on whether or not we want to hire.

 

[AmericanoWithCream]

I previously did some calcs based on Medicare data that the average RVUs per rad onc in the US is about 8333/year. I know that's low-ish, but it's probably a Mendoza line of sorts.

My difficulty is that I'm not RVU based and the admin may only look at # CT sims or total # treatments (or TBL of reimbursement and profit). I'm trying to sort out how to demonstrate how productive we are against some type of national average, but it's so variable.

 

[Mandelin Rain]

Believe me, your admin looks at revenue generated With much greater interest than number of sims/otv.

 

[ramsesthenice]

My difficulty is that I'm not RVU based and the admin may only look at # CT sims or total # treatments (or TBL of reimbursement and profit). I'm trying to sort out how to demonstrate how productive we are against some type of national average, but it's so variable.

Easier said than done, but I wouldn't worry about it until someone says something or you have a sense you are getting screwed. Treat the patients that need treating. Build relationships with as many of your local referring partners as you can with the goal of improving access to your (no doubt) high quality services. I agree with mandeline that while they may be looking at those as surrogate metrics they are 100% not what they care about at the end of the day. Actual revenue generated is king. If machine capacity is not where it should be, they may push to kick things up because technically that is "lost" revenue but if the overall balance sheet is good they will care much less.

 

[Becquerel]

RVUs will give you an idea of how much money your employer is making off your professional effort. RVU data will not tell you how well compensated you are compared to your peers since there is significant variability in RVU production per unit of MD effort. RVU production is highly dependent on case mix, conversion rate from consult to sim, brachy utilization, geographic practice cost index and payer permissiveness for IMRT and IGRT. Number of new starts is probably a better proxy than RVUs for MD effort, though it's still highly imperfect.

Your value to the organization is unlikely to be closely linked to RVUs or new starts. Think of it from their perspective - if they replaced you with another MD tomorrow, what would they lose? The answer to that Q is your value to them, and it's largely related to your relationships with referring MDs and your ability to generate new business that another generic MD would fail to do. It's feasible that you could offer value in terms of high revenue generating practice patterns (e.g. more fractionation, more technology utilization), though that's not a sustainable value proposition to most organizations since, over the long-term, aberrant practice patterns will be discovered by outsiders (including referring MDs)and risk injuring the business. As health care systems are increasingly purchasing and employing the upstream referring physicians (with effective, even if not legal, control over their referral practices), the value of high quality, well-liked radiation oncologists to the system is diminishing.

If you are just trying to argue that your workload is higher than it should be and you deserve more compensation, then starting with MGMA RVU data is probably your best bet. The numbers are low for generalist private practice physicians and should paint you in a favorable light. It's unlikely you'll find a better data point to go with than that.