SROA 2009: Change, Challenges and Trusty Trousers
It's always a bit refreshing to hit the smaller meeting of SROA after time at ASTRO. With fewer people (about 450 this year compared to ASTRO's approximate 11,000), the networking is more intimate and the feel, more relaxed. It's kind of like a favorite pair of jeans after a day in a suit.
Big topics at both shows centered on the economy, health care reform, the specialty's future and new technologies that are continuing to gain momentum---nanotechnologies, molecular imaging, IMRT, IGRT, VMAT, proton therapy, new advances in brachytherapy and more. In the main exhibit hall and within sessions, there was also a steady hum about comparative effectiveness (i.e., outcomes) and appropriate use of treatment options, especially IMRT, whose utilization has skyrocketed since its inception, so much so that it's now on the radar of the House Ways and Means Committee.
But despite concerns and uncertainties plaguing the field (which made for an aptly titled "Winds of Change" SROA conference theme), SROA attendees found a lighter side for winding down. Among events were the Halloween party the first night, a dinner and Spirit of Chicago cruise/president's party on Tuesday night, several networking receptions and private get-togethers among attendees, and a mentalist to entertain and boggle the mind at the Quality Luncheon on Tuesday. How he knew that Darrin Kistler, SROA president from 2006-07, read the word "pasted" from a random book is beyond me.
Moving from downtime to down on the times (humor me and roll with that transition) is the growing fear and loathing of health care reform among Americans. One take-home message on the topic is that health care is going to cost us regardless of where we're headed. "Some say [the future] will be more expensive with reform," says David S. Hefner, MPA, senior advisor for Healthcare Innovation, Association of American Medical Colleges and Council of Teaching Hospitals, "but it will be more expensive no matter what."
While last year's message among the general public was "Yes we can!" now it's "Don't euthanize grandma!" he joked during his reform talk. Fear is a powerful deterrent indeed. He also added that dialog needs to shift to payment and utilization reform, which so far has remained in the margins.
According to Paul Wallner, DO, senior vice president of 21st Century Oncology, another take-home message is that reform probably won't affect radiation oncology on a day-to-day basis ... but that also remains to be seen.
Dr. Wallner, who gave the SROA talk, "Changes in the Economics of Radiation Oncology over the Next Five Years," shared several additional concerns facing the field:
- Radiation oncology has not been able to show significant differences in treatment with IMRT and IGRT. "We need to prove these thing work," he says, "or we're not going to get paid for them."
- The field is losing sight of the new conversion factor--$28 down from $36, which is a real hit for facilities. While some say it won't happen, Dr. Wallner says it could.
- There's a "stealth attack" in rad onc by surgeons involving the 62 modifier. This modifier raises reimbursement to 120 percent of the Medicare allowable and allows surgeons to get half. Rad onc, however says no thanks to this intrusion.
- Also a concern: Who owns your rad onc facility? Those owned by docs outside of the field can pose serious turf incursions ... and cause Dr. Wallner to define chutzpah in colorful new ways, he admitted.
- More rad onc benefits managers (ROBMs) are entering the scene, requiring modality precertifications, time/dose precertifications, technology limits and bundled payments, which could compromise care.
With these and other challenges, the call for leadership remains strong in radiation oncology. Of course, riding the winds of change isn't easy--even with your best pair of Levis on.