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ASTRO Blog

ASTRO Blog

ASTRO Set to Lose Seat at AMA Table; Action Needed

By Thomas Eichler MD, FASTRO, Immediate Past Chair; Shane Hopkins MD; Ankit Agarwal MD, MBA; Shilpen Patel MD, FASTRO

For the first time in two years, ASTRO members converged on Chicago for five days in October to celebrate the specialty, partake in educational and scientific sessions and advocate on behalf of our patients at the 63rd Annual Meeting. In the immediate aftermath, however, the Radiation Oncology Alternative Payment Model (RO Model) final rule was released, in addition to final rules for the MPFS and the HOPPS. Although cosmetic changes were made with a few modest tweaks, all three rules remain flawed, in particular the RO Model, despite relentless ASTRO advocacy and engagement with CMMI to achieve fair and predictable reimbursement. Radiation oncology stakeholders, including the American Medical Association (AMA), have weighed in and made their opposition to the rules known. ASTRO is pleased to partner with the AMA to advocate for the specialty regarding reimbursement changes associated with the RO Model.

As the AMA prepared to meet in November, ASTRO was disheartened to learn that we may lose our representation at the AMA’s House of Delegates. The “federation of medicine” includes delegations representing states and specialties, but membership in the House of Delegates requires a certain percentage of each society’s membership to also be members of the AMA. Unfortunately, ASTRO has fallen short in that measure. We are currently in a one-year probation period after which ASTRO’s voice will be silenced in the House of Delegates.

My friends, it is absolutely critical that we continue to have ASTRO delegates at the table to advocate and testify at the AMA in support of radiation oncology interests. 

As we interact with other physicians on social media, skepticism is occasionally heard regarding AMA representation for radiation oncology. More often than not, however, the person with these concerns is unaware of the advocacy routinely done by the AMA benefiting radiation oncologists without fanfare. The AMA is one of the largest lobbying groups in the country, and the value of having them go to bat for us simply can't be replaced. For example, the AMA sent a detailed letter to CMS regarding the RO Model reflecting ASTRO’s concerns, albeit with the weight of the whole of organized medicine behind it. Recall that the AMA was instrumental in combatting SGR cuts for two decades until its repeal in 2015. In addition, the AMA has successfully fought insurance mergers, such as the Anthem-Cigna merger that would have cost physicians $500 million dollars in payments annually. The AMA has been a leading voice on reforming prior authorization burdens and will be representing physician interests on the upcoming S.3018 bill. In short, the Association has fought against perennial challenges to our autonomy as physicians, including scope of practice issues, with major successes benefiting every one of us, even if many of us are unaware. To the benefit of all, the AMA has also been a trusted voice in communicating scientific information about COVID-19 to the public.

In order for ASTRO to maintain their seat at the AMA table with the ability to testify and vote on the sundry concerns that affect our specialty and all of medicine, we need you to join the AMA. Please consider joining right now to keep the largest physician voice in Washington in close sync with ASTRO on radiation oncology issues. Consider your AMA dues a sound investment with a proven track record. Threats to reimbursement and physician autonomy are, and will remain, ongoing, and although the AMA is just one stakeholder, they remain the single most powerful voice advocating on behalf of all physicians. Act now: join or renew your membership today. It is imperative that ASTRO maintain their voice within the AMA House of Delegates! Please help us meet this challenge!

 
Thomas Eichler MD, FASTRO
Immediate Past Chair, ASTRO Board of Directors
 
Shane Hopkins MD,
ASTRO Delegate to AMA
 
Ankit Agarwal MD, MBA
ASTRO Alternate Delegate to AMA
 
Shilpen Patel MD, FASTRO
ASTRO Delegate to AMA
 
 
Posted: November 16, 2021 | 0 comments


Get the Scoop on Radiation Oncology Coding

By Jan Dragotta, Radiation Oncology Services Director, Princeton Radiation Oncology, Astera Cancer Care

ASTRO’s annual Coding and Coverage Seminar is an excellent opportunity for those involved in the field of radiation oncology to gain more insight into CPT® coding guidance, billing practices and the evolving challenges medical professionals face in the radiation oncology field today. As an attendee of the Coding and Coverage Seminar, I was surrounded by professional coders and billers, practice administrators and radiation oncologists who experience these same challenges every day. The ASTRO virtual Coding and Coverage Seminar allows for engagement and discussion among participants, which is invaluable, particularly as practices find themselves spread thin and unable to travel due to COVID-19. Attendees have direct access to ASTRO faculty and staff, and I was impressed with the ease with which questions were answered and dialogues transitioned to group discussions throughout the program and after.

As someone who has attended the Coding and Coverage Seminar, I can speak to how highly interactive and informative the sessions are. The ASTRO faculty involved in the seminar included subject matter experts who write ASTRO’s Coding Resource, which serves as a textbook for the seminar and benchmark for best practice. It is a wonderful opportunity to engage in conversations and interact on coding issues, with a heavy emphasis on the clinical process of care. Case studies are presented on intensity-modulated radiation therapy, brachytherapy, proton beam therapy and stereotactic radiosurgery/stereotactic body radiation therapy for a variety of disease sites. These studies are a great tool for discussion and help attendees learn how to apply their newfound coding knowledge and provide specific coding guidance related to each scenario.

The seminar is a wonderful way to not only understand how to correctly use the CPT codes for radiation oncology, but to also understand some background information on the process of code development and valuation. Specific coding changes that are set to occur in the new year are discussed, and attendees can ask questions and gain clarity on this complex subject, helping practices avoid coding and billing errors. Faculty of the Coding and Coverage Seminar genuinely enjoy the opportunity to engage with attendees and help them navigate some of the more complex nuances of radiation oncology coding.

Additional topics covered during the seminar include sessions on the RO Model and Merit-based Incentive Payment System (MIPS), payer policy changes and other hot topics impacting the field of radiation oncology.  It’s a day well worth spending with ASTRO! I would encourage anyone with a responsibility for coding and those who want to learn more in order to grow within their profession to register for the upcoming December 11 event. An added bonus is that the electronic and hard copy versions of the ASTRO Radiation Oncology Coding Resource is included with your registration, an invaluable reference both during and after the program.

Posted: November 9, 2021 | 0 comments


Gender Equity in Radiation Oncology

By Yun Rose Li, MD, PhD, Parul Barry, MD, and Adrianna Masters, MD, PhD

While many women scientists and physicians made critical contributions that paved the path to modern day advances in radiation oncology, few were recognized for their work. Perhaps one of the most well-known pioneers in the field of radiation oncology is a woman: Marie Curie, recipient of two Nobel Prizes for her extensive work on radioactivity and the discovery of radium.

But aside from Marie Curie, most of her contemporaries received little acknowledgment. For example, Lise Meitner, an Austrian-Swedish physicist, helped discover the element protactinium-231 and described the process of nuclear fission (Sime, 1996). Her work demonstrating that uranium atoms split when bombarded with neutrons allowed for the later development of nuclear energy and nuclear bombs. For her contributions, she was nominated for the Nobel Prize in chemistry and physics 48 times, though she never received the award.

Another example is Margaret Cleaves, who in the early 1900s was one of an estimated 20 physicians (the only female) to have access to radium for clinical purposes and ultimately became the first to use radium in gynecology to treat cervical cancer (Aronowitz, Aronowitz, & Robison, 2007). She was heavily criticized and was largely dismissed by other physician colleagues. At that time, not only were educational opportunities and access to postgraduate training for women extremely limited, but society placed strict limitations on the role of women as physicians and leaders in medicine.

It was not until the demands created by WWI and WWII that broader access to medical/graduate education and career opportunities, aside from those that were traditionally seen as “feminine” roles, were made available to women. Often considered to be a founder of nuclear medicine, Edith Quimby studied the medical effects of radiation and dose limiting side effects with the application of radioactive isotopes in the treatment of thyroid disease, brain tumors and other cancers during her time at Memorial Hospital for Cancer and Allied Disease in New York (Linton, 2012). In 1954, she became the first female president of the American Radium Society and was the recipient of the Janeway Medal of the American Radium Society, the Gold Medal of the Radiological Society of North America and the Gold Medal from the American College of Radiology.

Other important women who made contributions to radiation oncology include Chien-Shiung Wu, also known as the First Lady of Physics. Wu, a Chinese American particle and experimental physicist, worked on the Manhattan Project and played an important role in the advancement of nuclear and particle physics. Despite their successes, very few women obtained faculty positions and even fewer chaired departments during the mid-1900s. One example was Ruth Guttman, who became the director of the Department of Radiotherapy at Columbia University from 1955 to 1976. Other notable examples include Florence Chu, who was the chair of Radiotherapy at Memorial hospital 1976-1984, and Anna Hamann, who at the end of a long career, became the director of radiation therapy at Evanston Hospital, although she never attained a full professorship. These women and many other women physicians and scientists overcame tremendous challenges and faced persecution and hostility in order to pursue their dreams to advance the field of radiation oncology and radiation physics.

Though many would like to believe that efforts made to address challenges faced by women in science and medicine have allowed women to break the glass ceiling in radiation oncology, there is still a lot left to do. In fact, the lack of gender diversity among radiation oncologists begins with medical school applicants and continues to widen throughout career development. Currently, women represent at least half of all medical school students but make up only 30% of applicants to radiation oncology training programs. The gender disparity widens as women progress in their careers, with leadership positions and chair positions further widening the gap: academic positions 17.4% and female chairs 11.7% (Gharzai and Jagsi 2020).

Leadership roles on editorial boards of oncology journals are another area of noticeable disparities in representation of underrepresented minorities and women. A recent abstract presented by Patel et al. reviewed 54 oncology journals and 793 board members, and there was not a single editor-in-chief position held by a minority female. At a time when COVID-19 has disproportionately affected the career development of women, who often serve as primary caretakers at home, how do we create an even ground for achieving career success? This is a pivotal time to reevaluate our measures of productivity and the metrics we use to decide on tenure or promotion. Recognizing that women in STEM in general have shown much larger interruptions in submissions to journals during this time than their male counterparts, even those with young children, the charge is with institutions and national organizations within our field to make a change to do better for women in radiation oncology.

We would argue that we need to promote diversity of not just representation and service on committees, but chairing committees, successfully applying for FASTRO status and even the Gold medalists. We reviewed the listed ASTRO Gold medalists on the website and found that since 1977 only 12% of honorees were female. The majority of the current ASTRO executive committee is female. In reviewing the chair and vice-chair positions of the councils, two of five council vice-chairs are women. Because portions of the application process for FASTRO focus on recommendations of existing recipients, leadership roles and other metrics of academic success, is this placing an undue burden on persons from underrepresented groups? We are curious to know what the success rates are for applications and if there is a way to blind applications to reduce bias.

It is important to recognize that, even though much remains to be done to level the playing ground for women in radiation oncology, our field has seen enormous contributions made by women, and more and more women are being recognized for their work. The 2021 ASTRO Gold medalists were notably both women (Colleen Lawton, MD, FASTRO, and Lori Pierce, MD, FASTRO). Moreover, Sue Yom, MD, PhD, FASTRO, who has made tremendous contributions to major societies in our field including ASTRO and American Radium Society where she is the immediate past chair, is the incoming editor-in-chief of the Red Journal.

What are some of our thoughts on increasing representation of diverse groups of people in leadership?

  • Recognize the accomplishments of others and go out of your way to highlight those who may not be in a position to do it for themselves.  
  • Do not assume that someone doesn’t want to serve in a leadership role, is too busy or wouldn’t want to take time away from a specific activity (raising young children, for example). Why not simply ask? 
  • Offer support in a positive way that sponsors the success of others and specifically think about multiple candidates for a task or role in leadership. 
  • Be thoughtful with your word choices and their impact on those around you. 
  • Acknowledge the additional burden of unpaid domestic work, specifically during global pandemics, and think about ways to provide resources: Adapt to a changing environment to allow diversity of experience to enrich our culture as radiation oncologists!
  • Be aware of biases, speak up when you recognize them and acknowledge when you recognize your own. Positive change cannot happen unless we do. 

Join us on the ROhub to share your thoughts and discuss: What other ways can we support diversity of leadership and diversity of thought?

And be sure to acknowledge Marie Curie on Sunday, November 7 with #WeWhoCurie day!

References: 

Aronowitz JN, Aronowitz SV, Robison RF. Classics in brachytherapy; 2007.

Gharzai LA, Jagsi R. Ongoing Gender Inequity in Leadership Positions of Academic Oncology Programs: The Broken Pipeline. JAMA Network Open 3 (3): e200691–e200691. 2020. doi:10.1001/jamanetworkopen.2020.0691

Linton O. Edith H. Quimby. Journal of the American College of Radiology, 9(6), 449. 2012. https://doi.org/10.1016/j.jacr.2011.11.020

Sime RL. Lise Meitner: A Life in Physics. University of California Press. 1996.

 

 

Posted: November 3, 2021 | 0 comments


#ASTRO21 Social Champions share excitement for the Annual Meeting

For this year’s Annual Meeting, we have 11 attendees who will serve as Social Champions. Two #ASTRO21 Social Champions, Amishi Bajaj, MD, and Laura Dover, MD, share what they look forward to at the Annual Meeting in Chicago, October 24-27.

Amishi Bajaj, MD

Dr. Bajaj: This year’s Annual Meeting promises to be particularly special because it’s the first time we’ll all be gathering in one place since the onset of the pandemic. There is no better time and place to satiate one’s hunger for self-improvement and continued excellence in radiation oncology than the ASTRO Annual Meeting. It’s a five-day buffet featuring the most delectable bites of information, carefully curated for indulgence by all. Being a PGY-4 resident, and having such vast interests, I plan to cover general radiation oncology because it means I get to sample a bit of everything!

I will be sitting at the edge of my seat anxiously awaiting novel, practice-altering data, so I can’t wait for the Plenary session on October 25 with insights into the management of prostate cancer, HPV-positive oropharyngeal cancer and node-positive breast cancer. I am also extremely excited for the ASTRO/NCI Diversity Symposium on October 24 (and the Diversity, Equity and Inclusion in Health Care session on October 25 — there’s a DEIH track now!) as well as the disease-site specific, case-based sessions addressing nuances underlying treatment considerations throughout the conference, the biology session on genomic and molecular biomarkers (October 24), the ASTRO/RSS session on heterogeneous tumor dosing and spatial fractionated radiotherapy (October 25) and both Keynotes. As the Junior Chair of Communications for ARRO, I look forward to the ARRO programming on October 23, and as the proud presenter of two posters on early-stage breast cancer and glioblastoma (October 25 and October 27), I can’t wait to also check out the wonderful work done by others, both within breast and CNS radiation oncology, as well as within other areas of study.

I look forward to the practice-changing data, the cutting-edge technology presented by industry exhibitors and the cool Zen Den sessions happening daily in Room W180 as well as the camaraderie with my colleagues. I’m sure the other attendees share our sincerest hopes to optimize therapeutic ratios, feel the same consternation when faced with rock-and-a-hard-place re-irradiation cases and experience the same electrifying jolt evaluating the hotspot on a heterogeneous, ablative SBRT plan for an oligometastasis.

What makes the conference experience so deeply enriching is the ability to discuss presentations with people in real time, so I’m enthusiastically awaiting the opportunity to re-experience that this year for the first time in 19 months.

Laura Dover, MD

Dr. Dover: As editor and co-founder of QuadShot News, I use social media to keep a finger on the pulse of what radiation oncologists are curious about, struggling with or celebrating. QuadShot News was created to help keep busy radiation oncologists informed of recent literature and policy updates relevant to their clinical practices. Social media is particularly helpful in broadening familiarity with a variety of strategies of treatment for those who are only exposed to a single practice pattern. Perhaps most importantly, it provides camaraderie among a small field that is often widely dispersed in small pockets throughout the country.

We (co-founder Caleb Dulaney and I) were surprised when a reader nominated us as an ASTRO 2021 Social Champion and are excited to share our ASTRO experience with everyone on social media throughout the meeting. As the largest annual conference for radiation oncology, ASTRO attendees — virtual or in person — can easily be overwhelmed in their attempts to digest the most practice-changing highlights of the conference. We’re here to help. We will be sharing our take-aways in real time across as many disciplines as possible so you can feel like you’re right there with us. Please reach out to us directly if there is a particular trial or concept you’d like us to cover!

Follow the Social Champions and @ASTRO_org with our official hashtag #ASTRO21.

Posted: October 18, 2021 | 0 comments


Balancing a Career with Special Needs Parenting: A Little Something Extra

By Jessica Schuster, MD

“The lows may feel lower, but the highs will be higher than you can imagine.” ―  Madison Area Down Syndrome Society board member

This was our first piece of advice given after my husband and I learned our middle son, Jacob, would have Down syndrome or trisomy 21. These words started a completely unexpected, but wonderful, journey filled with a little something extra we had not realized we were missing. It has been a hard journey with some struggles, but through it I have learned to see people ― patients, colleagues and other people’s children ― in the way I want the world to see my son. I have been taught by my experiences that it is the length of one’s journey and perseverance, not solely the final accomplishment, that are worth celebrating.

The start of this journey collided with a career scenario all radiation oncologists can relate to: Oral Boards prep. After a seemingly lifetime of preparation, I fully expected I would be encountering the “scariest” event of my life to date in May 2016 ― Oral Boards. However, in December 2015, my husband and I sat watching our second son on prenatal anatomy ultrasound. During the ultrasound, the technician spent extra time on the baby’s heart. She explained, “I am going to have the doctor come talk to you.”

Anxiously, we braced for “bad news.” The obstetrician revealed a complete atrioventricular (AV) canal heart defect. As if answering a step 1 board question, AV canal defect triggered in my mind an association with Down syndrome. Despite a desperate desire to capture and understand every word from the obstetrician and genetic counselor, I found myself sitting in silence. Swirls of words danced around me. In 30 minutes, they covered an array of different trisomies, statistics about death in utero, life expectancies, specialist visits and the need to decide about abortion. After hearing the word “abortion,” nothing more was heard as my mind started racing with a million other thoughts and hypotheticals.

Amid relentless specialist visits and further testing, my husband and I questioned our career choices. As we received confirmation of Jacob’s Down syndrome diagnosis and need for heart surgery at three months of age, I began to struggle with picturing a future as mom of a child with special needs and as a radiation oncologist. Despite knowing we needed support and help, it was challenging to share with our families, friends and colleagues. Each retelling of our baby’s diagnosis and heart defect forced us to admit our fear, vulnerability and unpreparedness to be special needs parents.

My original plans included intensifying Oral Boards prep while on maternity leave. Most parents reading that comment, including myself, will probably laugh! Caring for a newborn is wonderful, but it leaves little room for anything else. In mid-April 2016, we celebrated Jacob’s birth. But minutes later, Jacob's NICU journey would start. Within the NICU, learning respiratory and feeding supports, Down syndrome and AV canal defects, I realized I had replaced radiation oncology board preparation with “real life board preparation” by learning how to be Jacob’s parent.,/p>

Jacob made slow progress, but his oral intake was not increasing. It became clear he would not be discharged home prior to Oral Boards. The morning after my final study session, my husband and I were informed Jacob could be discharged home with a gastrostomy tube. This was our first emotional high! We were overjoyed by the possibility of our baby boy coming home. However, gastrostomy tube placement would require transfer to another facility. Outside of a few nurses, my commitments as a radiation oncologist seemed irrelevant to Jacob’s care team. We informed the NICU team that we consented to the procedure if the transfer did not happen while I was out of town for Oral Boards. Being present with Jacob on his first night in the new NICU was extremely important to me.

The day before my planned 36-hour trip to Louisville, Kentucky, a NICU team member popped in to alert me that after “some extra work,” the transfer NICU had accepted Jacob for the next day. Stunned, I stared as she left the room completely unaware of what devastating news she had delivered. This was a low moment. I was overwhelmed with feelings of being unheard and unseen. I was confronted with the fact that my two worlds seemed destined to be incompatible.

The Oral Boards paled in importance to my desire to care for my child. After wrestling with the decision, I arrived at the testing location largely due to a supportive husband gently pushing me and a gracious mother who drove me. Contrasting the devastating low of missing Jacob’s first night in the new NICU, we were able to celebrate Jacob’s homecoming and my Oral Boards results on the same day.

My husband and I learned that happiness from accomplishment is fleeting as special needs parents. We felt a pressure to push the next milestone to help Jacob be closer to a typically developing child and prove we were “good” special needs parents. Initially, we ran ourselves and him ragged, attending every possible therapy (feeding, speech, occupational therapy, physical therapy) and specialist appointments. We read about and tried alternative therapies ― diets, supplements, etc. The fatigue and guilt from constantly apologizing either to my patients or clinic staff or Jacob’s providers was (and sometimes still is) intense. The balance between work and special needs parenting proved to be difficult.

Thankfully, during this time, my husband and I met other parents through several local support organizations who related their journeys as special needs parents while balancing career decisions. They shared an openness about success, failure and regrets. Although no one used the term “sponsor” or “mentor,” this is the role these families served for us. They modeled and shared their life as a special needs parent while staying at home, part-time, or full-time work.

I decided ultimately to remain in my career full-time. I share my story not to say one choice is better ― remaining in versus leaving the workforce, but to validate how intense and complex work-life balance decisions can be for individuals. I also share, because I was helped immensely through the openness and willingness of other parents in the Down syndrome community to share experiences.

Prior to exposure to the Down syndrome community, as a physician and parent I found self-worth in accomplishments and saw failure until the next task was completed. However, the other special needs parents I met seemed to have “a little something extra.” They had the ability to celebrate progress and accomplishment. This represents one of the true highs. Some of my highs go completely unnoticed to most in society as they are not “big” accomplishments. I celebrated with uncontrollable happy tears upon Jacob’s hospital discharge after heart surgery, when Jacob learned to walk with confidence (age 3) and when he said “Mama, love you” (age 4 ½). Jacob’s accomplishments were celebrated, but Jacob himself and his journey are potentially even more positively impactful. For example, my oldest son, James, read a book called “47 Strings'' to educate his second grade class about how people with Down syndrome have a little extra in their DNA causing some milestones achievements a little slower than others. Through loving Jacob, our oldest son is often able to recognize differences in others and respond to those differences with kindness and depth of understanding well beyond his age. By opting to remain in our careers, my husband and I have been able to provide seemingly small insights to our colleagues, such as having the family present for inpatient team rounds and improved understanding of need for work hours flexibility.

From Jacob's medical experiences, I became a better radiation oncologist. My experiences remind me that, as an oncologist, I often meet people at one of their most vulnerable life moments. I remember that this uncertainty and fear makes information harder to process. I strive to emulate medical professionals that cared for Jacob, and also served as navigators through the complexities of his care. Establishing intersectionality between the patients, their families and myself starts with learning about the patient as a person first. Patients should not be reduced to only a “cancer patient.”

The Down syndrome community highlights the importance of person-first language, meaning a person is a person first, i.e., Jacob has Down syndrome versus Down syndrome kid. So, I often start visits with social history asking, “What is your career and what do you do for fun?” Rapidly over a few minutes, “cancer patient” transforms into John, avid biker and primary caregiver for his elderly mother who now has the additional stressor of prostate cancer. Without acknowledgement of a patient’s life before cancer and guidance from medical professionals like us, patients are often unsure how to rank pre-cancer life obligations and cancer care. Through my experiences as Jacob’s mom, I have learned to appreciate the “true highs” of helping patients navigate their balance ― cancer versus life.

Although I cannot travel back in time and remove the anxiety, fear and uncertainty from my 2015 self, I can share the message that from the lows there are also highs higher than I could have imagined. These highs are not because I have accomplished more; in fact, some might argue I have achieved less. These highs stem from a blessing that has allowed for unexpected personal and professional growth. Jacob has given us the opportunity to see all people in the way I desire the world to see Jacob. He is more than just a “kid with Down syndrome,” as each of us are more than just a label.

While an individual’s accomplishments deserve celebration, I find myself often admiring and celebrating people more for their journey and perseverance than the actual accomplishment. We have so much more to celebrate over a lifetime. I have such excitement for the future where my patients and children continue to help me grow as a radiation oncologist, colleague, mom, wife and advocate for parents and individuals with Down syndrome. I share our story to empower others to recognize that their own story and journey has value and is worthy of celebration and to highlight that the seemingly simple act of sharing has the power to help others.

Join the Gender Equity Community discussion on the ROhub to share: How has your journey shaped you?

Posted: September 28, 2021 | 3 comments