October, 2020

Miami Advice/Under Cover of Covid

By Michael J. Katin, MD

Expectation, n. The state or condition of mind which in the procession of human emotions is preceded by hope and followed by despair. Ambrose Bierce, The Devil's Dictionary

The Miami area had been anticipating a continuing wave of spectacular events in 2020, with Super Bowl LIV having been held at Hard Rock Stadium in Miami Gardens, followed by, among others, Miami Carnaval 2020 in March, the Ultra Music Festival later that month, Miami Fashion Week in May, Miami SwimShow as well as the International Mango Festival in July, and the crowning jewel, the ASTRO Annual Meeting in October

Then the cancelling culture took over. Concern for contagion with SARS-CoV-2 became...well, contagious, and the remainder of 2020 essentially ceased to happen.

Ordinarily, this month would have been a time for excited preparation for the Annual Meeting of ASTRO, the inappropriately-acronymed American Society for Radiation Oncology -- this year for the 62nd Annual Meeting to be held in the Sun and Fun Capital of the World, Miami Beach, Florida. Come Participants would have been getting ready to experience the cultural attractions of the Miami Beach area, to be able to interact with vendors in legally-acceptable venues, to hook up with friends, and to be totally immersed in the fascinating science of Radiation Oncology. Instead, the 62nd Annual Meeting will be held in a sterile, virtual version, taking away 90% of the reason to attend and leaving only the educational benefits. Is it still possible to salvage some of the glamour that has been wrenched away?

In order to get at least a portion of the proper Annual Meeting experience, it would be recommended for participants to have a virtual reality experience starting with getting up at 5 am and sit in their automobiles for a simulated ride to the airport, followed by sitting in the smallest chair in the house surrounded by overstuffed pillows (optimally some whose pillowcases have not been washed in five years), and then turn the thermostat up to 95 degrees and stand for 45 minutes holding your luggage, waiting for the simulated shuttle to go from virtual Miami International Airport to the hotel in virtual downtown Miami. Oh, the room's not ready yet? Turn the heat back up to 95 degrees and walk around for another two hours. Once you're checked in, change clothes, turn the heat down to 85, and enjoy simulated Miami night life by putting on a CD of Pitbull 's Greatest Hits while drinking a daiquiri, a rum runner, and two Cuba libre's. At this point it would be worth looking over the meeting schedule, to determine how best to arrange best being able to log in and demonstrate your identity before heading off to do the things you really want to do. Next, determine what apparel

URGENT----it is appropriate to stop this meaningless drivel to address breaking news. Is it extraordinarily ironic that September 18 represents the date that the eye of the Miami Hurricane of 1926 reached the city, the storm producing 326 deaths and destruction estimated at $105 million (a LOT in 1926). September 18, 2020, was the 50th anniversary of the death of Jimi Hendrix and, sadly, the day that another icon, Supreme Court Justice Ruth Bader Ginsburg, succumbed to pancreatic cancer. On that very same tragic day, CMS, the inappropriately-acronymed Centers for Medicare and Medicaid Services, released its (their?) decision to implement the Radiation Oncology Model.

This came as a major surprise considering that so many government services have been severely curtailed during the SARS-CoV-2 pandemic, yet somehow this highly-disruptive policy somehow was able to be generated, even more remarkably coming after the proposed rule to drop the Medicare Conversion Factor by 11%.

For the readers who consider this column their primary source of information on socioeconomic oncology issues---my condolences. But for the few people who have not already been inundated by texts and e-mails and tweets from their associates regarding this development, here's a summary: in the 2015 Patient Access and Medicare Protection Act, there was a provision for the Secretary of Health and Human Services to develop an "episodic alternative payment model" for radiation therapy services. Unlike many other government projects, this one actually happened. It was then indicated for CMS to contract with an organization to monitor the Radiation Oncology Model (for 8 years, $79 million). A Webinar is scheduled for October 15 to explain the workings of this system, which, of course, would not be necessary if it were straightforward.

Suffice it to say, the Secretary of Health and Human Services must have had an incredible sense of humor or else was extraordinarily passive-aggressive. Or is it just that this was produced by the same government that provides us with the IRS tax code? It would be presumptuous to comment on all the details in this (previously) brief essay, before participating in the Webinar. One factor, however, seems particularly distressing. Determination as to which practices (a "demonstration project" with 30% of practices????) will be required to participate in the Radiation Oncology Model is made by ZIP Code. Ironically, the ZIP Code was a government development that actually worked. Beyond question, selection of these ZIP Codes was made totally randomly without input by any special interests whatever. Unfortunately, most radiation oncology practices involve too much hardware and heavy shielded facilities to allow them to be transported over the border to the nearest non-designated ZIP Code area. But some may try

Further explanation of this new system will be forthcoming, but it appears that after all the percentage calculations, holdbacks, missed potential bonuses, assessment of quality measures, etc., etc., that at the end of the day, if you're in a designated ZIP Code, we already know what you're going to get paid.


Get Off of My Dot (to the tune of "Get Off of My Cloud")

I'm tired all the time since my apartment's on the 99th floor
Don't take the elevator cause I don't know who was on it before
I get down to the store and take my place in line while waiting to pay
And then some jerk starts hanging in my zone way less than six feet away.

I say, hey, you, get off of my dot
Hey, you're too close to my spot
I'd like to think you forgot
I'm not immune and I'm sure that you're not.

I go to get some coffee and the barista's doing everything wrong
He's reaching past the plexiglass and doesn't even have his gloves on
His nose is sticking out over his mask just like a periscope
I'm sure he's gonna get me sick and now I'm at the end of my rope.

I say hey, you, you'd better respect
COVID and make it correct
How many will you infect?
Using your brain is too much to expect.

I try to get back home before the virus catches up to me
But there's people milling everywhere pretending like it's 2019
If they keep closing in on me I'm going to have a panic attack
I'm gonna be on YouTube and go viral when I blow my stack

And I'll say
Hey, get me out of this crowd
Break up this rabble somehow
They'll hear me screaming out loud
You know congregating just isn't allowed!!

Thanks for Keith Miller and Mark Sobczak for their brilliant contributions to this month's episode.

Asteroid JF1 Countdown: Asteroid JF1 will be impacting with or passing by Earth May 6, 2022, which, counting May 6, is 583 days from now. Plenty of time left to stock up on batteries, plywood, hand sanitizer, bubble wrap, Tang, and duct tape.