November 2009

Second City, Last Chance

By Michael J. Katin, MD

A high wind warning coming from Chicago was in fact the mistaken interpretation of the huge collective sigh of relief coming from radiation oncologists gathering for the 51st Annual Meeting, after the pronouncement came from CMS that proposed slashes in reimbursement were to be nearly totally reversed in the final version. A second reason for the high winds was the turbulence created from the parties rushing to take credit for this accomplishment. Undoubtedly celebration for this minimal decrease (while all our expenses go up) will continue for the full week. It may as well, since we didn't just dodge a bullet, we dodged a MOAB. We should not be complacent, since there's moabout to happen.

This struggle will certainly resume again and we still face the possibility of a 21% cut in professional charges from the SGR, if that is not corrected, and the probability that our practice patterns will be affected by the Affordable Health Care for America Act of 2009. Somewhere in the nearly 2000 pages of H.R. 3962 could be a reference to our specialty, but possibly disguised in a manner that only Leonardo da Vinci would be able to find.

It seems like serendipity that this year's ASTRO session is in the most recent home town of our 44th President. This is a golden opportunity, literally, to get his attention and make sure we're on his good side when it all comes down.

The first goal is to get his attention We have no idea if he knows that we're a specialty separate from radiology or medical oncology or podiatry, for that matter. Considering that Rahm Emanuel's brother is a medical oncologist , we may already be working against negative p.r. I would propose that the current schedule for the ASTRO meeting be adjusted to make sure we make the most of this time.

It would probably be best to plan to revise the presidential address and the keynote speeches in order to get our points across. The current keynote speakers are outstanding, with presentations by Drs. Langer and Coffey of the science that will change the way we deal with cancer. Gail Wilensky would be discussing the history of cancer care economics and possiblities for the future.Unfortunately, if we don't change this schedule, we won't be able to buy a used orthovoltage machine five years from now. I would encourage that the three keynote slots be used to best advantage. It would be somewhat too obvious to invite Oprah Winfrey, but we could get the same networking by having Dr. Oz as the first keynote speaker. The second scientific speaker could be Dr. Thomas Frieden of the CDC talking about H1N1 influenza and why it's still called swine flu. It might also be worth explaining why a national emergency was declared when enough immunizations were not available. Kind of like hyping your IMRT/IGRT setup and then having it go down for two weeks. The speaker for the sociopolitical keynote address could be Nancy Pelosi or Harry Reid, but they're busy right now. Not only would Vice President Biden be a good choice, but he's always fun to have around.

The critical part will be getting President Obama to attend. He would be able to hear about how important radiation oncology is to this country. We need to show him that we're too big to fail. If we go down, there would be a disastrous domino effect involving physicists, dosimetrists, nurses, administrators, golf pros, and spa attendants. If we can make this convincing enough, we might be the next to get a two to three billion dollar handout in exchange for absolutely nothing. We would expect the ASTRO board to distribute this fairly to the members. Programs such as tax credits for first-time office builders and cash for clunkers to replace your 2007 accelerator with a newer model (What? You don't have RapidArc??? Good Lord!!!) could be proposed. Anything's possible if we do this right.

Every year ASTRO presents gold medals to two individuals who have contributed the most to the specialty over the years. The key to our success for the next decade will be granting this award to our president, Barack Obama. In fact, it would be appropriate to give him both gold medals, to distinguish us from the Nobel Prize Committee. I'm certain Drs Shipley and Lawrence would be willing to make this sacrifice. When asked about President Obama's qualifications for this award, we can fairly say that he has done as much for the field of radiation oncology as he has for the cause of world peace.

PLEASE---do not wear Chicago Olympics 2016 T-shirts to this event!!!!