CMS Impact | July 2019 Newsletter

Recently CMS announced their first rendition of bundled payments for radiation. Even before its release, I received calls from physicians, friends and clients. “I’m never going to survive this.” “My practice/department will collapse.” “I guess we will never buy new equipment.” I think you can relate to the overall tone of these calls. My mission, should I choose to accept it, is to communicate peace and hope and even to suggest that you can thrive in the these proposed models.

Dr. Robert Nagourney had a great piece this week in the Wall Street Journal titled, Every Cancer Patient is One in a Billion . I think he summarized the industry’s macro view on APM well. “Modern oncologists are being asked by insurers, hospital systems and regulatory agencies to reduce therapy options to an ever shrinking number of guideline-based treatments. This one-size-fits-all approach – attempting to apply population statistics to individual patients – is rapidly proving to be one-size-fits-almost-none.” However, what I found interesting as a non-clinician, is the paradigm shift about cancer itself. Dr Nagourney states, “Cancer is a disease of altered cell survival, not excessive proliferation. Cancer doesn’t grow too much, it dies too little.”

Metaphorically – stay with me on this – our industry should adopt more of the “refusal to die DNA” of the cells we call cancer. We need to find ways to “die too little” regardless of payers and government agencies. The radiation oncology industry should respond with an ever so slight mutation that ensures another generation of physicians will thrive. Just as each patient is one in a billion, so is your practice and unique environment. No single program can minimize your patient impact. What if you embraced outside changes with an eye toward creating an equal or greater opportunity? For example – 60-70% of our partners nationally have a year over year increase in their patient census (and financial performance) in spite of proposed declines/penalties from PQRS, MIPS, mergers and now APMS. We will just refuse to die. Market dynamics are not mandating our choices – but individualistic patient centered care is increasing our sphere of influence!  We refuse to submit because we, like our patients, won’t give up. We emulate the same sense of purpose, tenacity and hope. So when physicians say to me, “You mean I’m not going to die?  I respond, “No, your practice is just learning how to live within the new financial dynamics. You will be great!”