Latest / Medsolve Dynamics / A Guideline Says It Is Appropriate. The Next Question Is Whether Your Program Can Deliver It.
Transcript
- Yoel Bakas: The American Radium Society just published appropriate use criteria in low dose radiotherapy for osteoarthritis. This is a real milestone for the field in the moment the benign disease can enter the mainstream conversation. I'm not going to add anything to the clinical case. People who wrote the criteria know that side way better than I do. And a shout out to Bobby Koneru What I can tell you is what decides whether a program runs well, which is different from whether a treatment works. Start with the math because it's reassuring. A regular IMRT slot and a benign disease slot are not competing for the same slot on your LINAC The economics are not close So this really isn't about protecting capacity from benign disease cases. In fact, it's the opposite. Benign disease lets you treat indications that you could otherwise not treat before on a LINAC that has available capacity on an afternoon slot. That is incremental. The catch is not clinical. It's two pathways. First is a referral pathway because low dose radiation volume does not show up on its own. And the second is the coverage and prior auth pathway. It bills in the same radiation delivery codes that you're already used to. And coverage varies by payor With several treating benign disease as still investigational, Despite its long history. So you can deliver it cleanly and still not get paid if you haven't sorted out the billing pathway first. Both pathways, the referral and ensuring that you're gonna get paid is the work that we do at Medsolve. Confirm the pathways, build a referral engine. And set the program up to get paid before the first patient shows up. A guideline establishes that treatment is appropriate. Whether your program can deliver it and get paid is the next question.