ASRT Speakers Address Rad Onc’s Future
The Windy City was bustling with excitement early this Sunday morning. With a crisp, autumnal breath of Chicago air, feet not yet encumbered by McCormick's mean corridors, and an extra hour of sleep under our belts, conference attendees dove in with Dean. Howard Dean.
The American Society for Radiation Therapists (ASRT) Radiation Therapy Conference began with a big bang in Howard Dean, MD, former practicing internist, 2004 U.S. presidential candidate and six-term governor of the Vermont, the Green Mountain state. Dr. Dean, with his unique background in medicine and politics, shared insights on "America's Health Care."
To understand how we may, as a nation, revolutionize the health care system, Dr. Dean says we have to gain a better understanding of our past and our future. Noting that employer-based health insurance evolved long ago--during World War II, in fact--he assured attendees that change would not come quickly or easily. However, with a new generation of service-oriented and moderate young voters, there's much promise for development. The generation of today that elected President Barack Obama, believes in working "across broad [partisan] lines to get things done." With values in the right place, young [under 35] Americans want to work together to come up with solutions, Dr. Dean says with excitement. "Changes never happen from the top down. It's always from the bottom up."
So while discussion of health reform seems to be playing out in a rather political, partisan manner, the new generation of centrists will demand more from Washington. They'll demand simple choice and a need for change. Dr. Dean says this will happen when "the fear of change is exceeded by the pain of staying the same."
"If you want real reform," says Dr. Dean, "let the people choose." His "Dr. Dinosaur" public option program in Vermont insured 96 percent of all children, with 99 percent eligible to receive care if their families made less than $66,000 annually. Public option will vastly improve uninsured rates and offer a much-needed boost for small businesses, although he notes other big problems that need solving: reimbursement rates (especially for primary care physicians) and the repercussions of the fee-for-service model. He also stressed the importance of a wellness model of care, as well as grassroots efforts to spur real health care choice.
Dr. Dean conjectured that since radiotherapy is a core service, system of payment and cost control changes shouldn't have that huge of an effect on the specialty in the immediate future. Paul Wallner, DO, who followed Dr. Dean with a presentation on "Changes on the Economics of Radiation Oncology Over the Next Five Years," did not want to speculate on effects of Congress-initiated changes in the works. He simply admitted he wasn't sure that new policy would actually impact radiation oncology greatly on a day-to-day basis.
Dr. Wallner spoke about the unsustainable rising of health care expenses, and how increased utilization of many radiation oncology technologies are contributing to this problem. The penetration of new technologies such as 3-D CRT, IRMT and particle-beam RT escalate costs without substantial proof of improved patient outcomes. IMRT, in fact, is the single fasted growing code in health care, he reports, noting a 10-fold increase of utilization in the past 10 years.
"Efficacy by proclamation" is no longer flying for payers and regulators, he warns. Critical issues face us, including CPT code and RVU changes, political agendas and the state of the economy, for a start. Comparative effectiveness research and radiation oncology benefits management are on the near horizon and will play a large role.
The future of our field as it relates especially to legislative and regulatory changes is uncertain. This week in Chicago, radiation oncology's greatest minds will make predictions--and provide professionals with the information they need to seek success in this complicated climate.