2/
I went to the CMS website and downloaded each year’s data for each specialty, starting in 2008, all the way to the most recent year’s data, 2018. I’d been wanting to do this for a long time. This is Part B only.
cms.gov/Research-Stati…
I went to the CMS website and downloaded each year’s data for each specialty, starting in 2008, all the way to the most recent year’s data, 2018. I’d been wanting to do this for a long time. This is Part B only.
cms.gov/Research-Stati…
3/
I then combined all the med onc/heme onc numbers. And combined the radiation numbers. And then cherry-picked some specialties of interest for comparison, especially any that have anything to do with rad onc. Or onc.
I then combined all the med onc/heme onc numbers. And combined the radiation numbers. And then cherry-picked some specialties of interest for comparison, especially any that have anything to do with rad onc. Or onc.
4/
Here’s Figure 1. It’s bar charts of each year for the selected specialties, with simple 2008-to-2018 slope lines for visual reference. Some things “jump out”…
i.imgur.com/VRg9lvo.png
Here’s Figure 1. It’s bar charts of each year for the selected specialties, with simple 2008-to-2018 slope lines for visual reference. Some things “jump out”…
i.imgur.com/VRg9lvo.png
5/
First, rad onc has been very steady over time. In real dollars, we’re definitely down in cost over time. Cardiology is down the most. Urology is down a bit too. Rad onc $1.5798B in 2008, and $1.5792B in 2018. Pretty good right?
First, rad onc has been very steady over time. In real dollars, we’re definitely down in cost over time. Cardiology is down the most. Urology is down a bit too. Rad onc $1.5798B in 2008, and $1.5792B in 2018. Pretty good right?
6/
There was talk in Obama era for cardiology APM. “The announcement is about-face from earlier efforts that scrapped cardiac care bundled pmt program originally developed during the Obama admin.”
ajmc.com/view/azar-anno…
There was talk in Obama era for cardiology APM. “The announcement is about-face from earlier efforts that scrapped cardiac care bundled pmt program originally developed during the Obama admin.”
ajmc.com/view/azar-anno…
7/
I think the cardiology data in Fig 1 is one reason cardiology APM was “scrapped.”
I think the cardiology data in Fig 1 is one reason cardiology APM was “scrapped.”
8/
HemeOnc has the biggest upward slope in cost in medicine from 2015-2018 (approx $580,000,000/y increase). NB: This would not include cost of cancer drugs. The cost of that is high, maybe $50B/year… maybe more in 2020. It is rising.
ashclinicalnews.org/news/u-s-spend…
HemeOnc has the biggest upward slope in cost in medicine from 2015-2018 (approx $580,000,000/y increase). NB: This would not include cost of cancer drugs. The cost of that is high, maybe $50B/year… maybe more in 2020. It is rising.
ashclinicalnews.org/news/u-s-spend…
9/
It’s cliché at this point but e.g. there is more spent per year on the single breast cancer drug Herceptin (about $2B a year) than there is for Part B rad onc.
It’s cliché at this point but e.g. there is more spent per year on the single breast cancer drug Herceptin (about $2B a year) than there is for Part B rad onc.
10/
Look at opth. Opthalmology’s **growth** from 2008-18 (about $3B) was twice the cost of rad onc per year (about $1.5B/y). Derm grew $1B over 10y. Heme/onc about $2B over 10y. All this data is interesting, therefore, that rad onc is being looked at for cost containment.
Look at opth. Opthalmology’s **growth** from 2008-18 (about $3B) was twice the cost of rad onc per year (about $1.5B/y). Derm grew $1B over 10y. Heme/onc about $2B over 10y. All this data is interesting, therefore, that rad onc is being looked at for cost containment.
11/
To look another way, I “normalized” all the specialties’ 2008 costs to the 2008 cost of cardiology (highest in 2008) to show, relatively, how costs are changing over time. Some things “jump out” here too… Fig 2…
i.imgur.com/PkXEcbM.png
To look another way, I “normalized” all the specialties’ 2008 costs to the 2008 cost of cardiology (highest in 2008) to show, relatively, how costs are changing over time. Some things “jump out” here too… Fig 2…
i.imgur.com/PkXEcbM.png
12/
Opth, derm, surg onc (didn’t look too big in absolute numbers, but does when normalized), and interventional are very “growth-y.” But still, by just a hair, the “growthiest” of all for the past few years is heme onc. And again, this is JUST Part B data.
Opth, derm, surg onc (didn’t look too big in absolute numbers, but does when normalized), and interventional are very “growth-y.” But still, by just a hair, the “growthiest” of all for the past few years is heme onc. And again, this is JUST Part B data.
13/
As Forrest Gump said “I am not a smart man.” But If you were looking at Fig 1 (4/14) and Fig 2 (11/14) and trying to exert precious energy to save money would rad onc be 1st choice?
As Forrest Gump said “I am not a smart man.” But If you were looking at Fig 1 (4/14) and Fig 2 (11/14) and trying to exert precious energy to save money would rad onc be 1st choice?
14/
RO APM proj to save $230m over 5y, or $46m/y. If we could slow opth and derm and heme onc growth just a little we could save orders of magnitude more than $46m/y. But APM doesn’t slow RO growth. It makes it negative.
medscape.com/viewarticle/93…
RO APM proj to save $230m over 5y, or $46m/y. If we could slow opth and derm and heme onc growth just a little we could save orders of magnitude more than $46m/y. But APM doesn’t slow RO growth. It makes it negative.
medscape.com/viewarticle/93…
15/
Final observation: if rad onc is contributing about ~0% to the rising cost of cancer care, why attempt to save money in that specialty by reducing its reimbursement. That is, at the end of the day, the question: penurious or wise?
Final observation: if rad onc is contributing about ~0% to the rising cost of cancer care, why attempt to save money in that specialty by reducing its reimbursement. That is, at the end of the day, the question: penurious or wise?
16/
Final final observation.
Vol of two eyes=12cc.
Vol of avg human body=60000cc.
Opth CMS=$7.1B.
Radonc CMS=$1.6B.
Opth ∴ reimburses at $600,000,000/cc.
Radonc ∴ reimburses at $27,000/cc.
Perspective!
Final final observation.
Vol of two eyes=12cc.
Vol of avg human body=60000cc.
Opth CMS=$7.1B.
Radonc CMS=$1.6B.
Opth ∴ reimburses at $600,000,000/cc.
Radonc ∴ reimburses at $27,000/cc.
Perspective!
• • •
Missing some Tweet in this thread? You can try to
force a refresh
