Mark Sittig, MD

@DrDiGiorgio I would argue that having to charge patients more (premiums, co-pays, co-insurance, deductibles..) with a profit motive where insurers like UHC make BILLIONS/yr in *profit* is not “market efficiency” — it’s wealth transfer from Americans to the investor class. Happy to disagree!

@DrDiGiorgio Sure, of course. But your initial contention was that private insurance is more efficient with lower overhead as compared with government plans, and then you listed a bunch of tasks MDs/DOs have to do for every patient regardless of insurance, like enter CPT codes.

I love when smug healthcare policy wonks throw out that old “Medicare and Medicaid only have 2–5% administrative costs” line, as if it’s gospel truth and not a completely misleading stat from a 2011 Health Affairs article. Let’s unpack this nonsense because it violates basic economic logic. In what world does a centrally planned, government-run bureaucracy more efficient than a private competitive market? True efficiency requires price signals, profit/loss, and competition. This is econ 101. Medicare/Medicaid lack all of these things. So lets think more about that 2-5% figure that keeps getting thrown about. You know what it's based on? CMS's administrative budget. That's it. It leaves out the following: - Physician time on documentation for CPT compliance, ICD coding, and submitting claims. -Physician compliance with MIPS quality metrics -Hospital staff requirements for submitting claims, auditing charts for maximum DRG capture, coding queries, quality metrics, star ratings, bundled payment compliance, readmission tracking, etc - The entire RUC/CPT process which involves four annual meetings a year with hundreds of doctors. - Licensing fees for CPT - EMR and meaningful use mandates - CMMI demo projects And, last, but most importantly, most of Medicare and Medicaid are now administered by private insurance. So to claim that Medicare/Medicaid has lower administrative cost than private insurance assumes that these private insurers somehow operate MORE efficiently when taking capitated payments from the government. Not only is this a ridiculous notion, the insurance companies also need to comply with the various regulations, such as quality metric reporting, star-ratings, MLR reporting and the hundreds of other compliance regulations needed to get capitated government payments. So when people keep saying popping up and saying "well AKSHUALLY it's way more efficient to just have the government run the program." Remind them it only appears efficient because CMS makes everyone else do the work.

@DrDiGiorgio But that wasn’t your argument, right? It was about cost to administer? I’m not here to cheerlead CMS or ongoing payment cuts (I do advocacy for payment stabilization every year). I’m just saying private payors have inefficiencies and bureaucracies that govt run plans do not.

@MarkSittigMD Fee for service Medicare has had a conversion factor reduced 50% over 20 years, quality metrics, CMMI projects, bundled payments, and, now, it has its own prior auth coming with WISER. Tough to defend either version of Medicare.

@AaronGoodman33 @olsonplanner Hope the change isn’t because of overdue modules!

New low for @OptumRx — requiring #priorauth for TWO (2) tablets of Ativan for procedural anxiety for an upcoming brain MRI, in a patient who had radiation for a brain tumor. TWO TABLETS.

We are pleased to announce that The Surgical Clinic has joined the Tennessee Oncology family! To read more information, please click the link below: loom.ly/VFVFcqU #TennesseeOncology #Community #TheSurgicalClnic

@bananaP08 @JordanJ65544091 @j_luh @sindhu_kunal @tjroycemd @ARRO_org @ArsRocket @ACROresident Another way to make docs into interchangeable widgets. Not good for patients, not good for doctors. Just my 2 cents after hearing the Bridge pitch.

@JordanJ65544091 @j_luh @sindhu_kunal @tjroycemd @ARRO_org @ArsRocket @ACROresident Ok I’m going to call a spade a spade…but Bridge Oncology is just another employment model. It’s a company, probably with the goal of making a profit because I have yet to find the 501(c)3 designation on your website.

Paradigm shift needed in #radonc training if we are going to address the #communityhealth and #rural workforce shortage This may very well have been a med student interviewing for a #radiationoncology spot @bananaP08 @sindhu_kunal @tjroycemd @ARRO_org @ArsRocket @ACROresident @d__beyer @DGlaucomflecken youtu.be/k2BEA8mNXPg?si…

@JoshuaSchiffMD Congrats! Where are you headed?

12/10 recommend for your rad onc training! Fantastic department with great people and endless opportunities in the clinic and research. Joanna Yang and @AllisonLehman14 are the best and will get you where you want to go 😁

It’s that time of year…back in DC for another great #ASTROAdvocacy Day! #radoncs from all over the US are here to tell Congress: 🤝 Support the #ROCR Act ⏰It's time to #FixPriorAuth ⬆️ $$ for #cancer research @ASTRO_org @NIH @theNCI @ARPA_H #CancerSurvivorship

2ndCA/Dediff week 4/7 2003 IMRT will double the rate of 2nd Malignancies 2023 No diff btwn 3D and IMRT pubmed.ncbi.nlm.nih.gov/37289449/

@StephanieEWeis1 Also, I’m not sure this is the same Dr. Weiss, but are you the program director at Fox Chase? I’m especially interested in hearing the views of those in charge of training our next generation of rad oncs. These are important questions and I sincerely appreciate your thoughts!

@StephanieEWeis1 How would you suggest we do better? What is the right way to discuss job market and residency over-expansion concerns shared by many of our colleagues? If there isn’t data to discuss, how should we approach this important issue?

Respectfully, this is a bad take. Machines above capacity? Where? Again, show the data. Asking students to match into RO, train 5y, then ‘make their own luck’ is a tough pitch without data. We all need to do better for the future of RO.

Dear @ASTRO_org and @ASTRO_Chair: any thoughts on today’s FTC ruling regarding non-competes? This would be a great time for ASTRO to stand up and voice support for physicians and department staff. Please let your members know where you stand on this important issue. Thanks!

And for the record, I’m an @ASTRO_org (and @ACRORadOnc) volunteer. I just wish ASTRO would take a stronger stance. The workforce study was a start, but woefully inadequate.

This is the only question. I’m not anti-expansion. I’m pro-data-driven decisions. And there isn’t any macro data to support the extent of expansion. OA/Oligomets/skin(?) may help the trends but we can & should ask ‘leadership’ to be accountable for the problems they created.

@JordanJ65544091 But saying “PE won’t be an issue” is kind of premature, right? FTC comments or not, the model your business proposes would allow for good things (rural coverage) as well as not-so-good things (consolidation, APP-managed clinics, decreased MD presence)

@MarkSittigMD It is a component, and hybrid is a portion. We have already established the parameters and guardrails to ensure consistency, quality and safety.

Isn’t virtual direct supervision the crux of the Bridge Oncology business model?

"Reality is, formularies should not exist. Doctors should decide what patients need access to, not the PBMs." - @mcuban