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The Accelerators (Drs. Matt Spraker and Simul Parikh) host new Associate Executive Director for Radiation Oncology at The American Board of Radiology (ABR), Dr. Michael Yunes! 

Mike is a community radiation oncologist in Springfield, MA and long time volunteer for the ABR. The transition to his leadership comes after a turbulent period for the Rad Onc board. Communication around the 2018 score anomalies dragged trainee confidence in the ABR to new lows and, soon after, COVID forced the board to complete a rapid redesign of testing. 

More than 5 years later, there are exciting signals of change. The "Orals 2.0" platform seems very well received by examiners and examinees and the board has voted to ramp up the clinical relevance of the qualifying exams in Rad Onc.

Most importantly, Mike is all about transparency and communication. His door is always open, so we invited ourselves in and recorded a podcast. 

We discuss all things Initial Cert: the successful move to virtual oral boards, the written boards and clinical relevance, Angoff'ing, and "crisis management" and communication. 

We close the episode with Simul's lightning round.  Lobster, wine, informatics, 3D printing for benign radiotherapy, Mike's got hobbies!

We hope you enjoy what we hope is the first of many fruitful conversations. 

Physician training and evaluation is a topic near and dear to our hearts; here are some prior episodes from our group related to the ABR.

• TAP, Beckta interviews Matt about boards
• Out.Of.The.Basement, Beckta covers the contentious 2018 ABR initial certification results

Here are some other resources discussed in the episode:

• Beriwal et al., Interdisciplinary debate on the physics test content
• Golden, United States Radiation Oncology Curriculum Development: The Tail is Wagging the Dog
• Warwzuta et al., The rise of negative portrayals of radiation oncology: A textual analysis of media news
• Chimney Rock Winery, a Yunes' family favorite
• See Mike's blog in ABR The Beam

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Welcome to MattPAC*, a new Accelerators pilot concept!

Radiation Oncologist Dr. Matt Spraker aims to introduce important healthcare policy concepts rooted in current events. Each show is designed to be efficient with your time and inspire you to get engaged with advocacy in around 30 minutes. 

In MattPAC #1, Matt covers quality payment programs (QPP). QPPs aim to incentivize "High Quality Care" by adjusting a portion of physician's pay according to performance on quality indicators, measures of healthcare quality. 

We'll discuss the rich history of care quality improvement in radiation medicine and examine how Medicare has approached the QPP with Merit-based Incentive Payment System (MIPS). After, we examine practice accreditation, the QPP approach proposed in ASTRO's ROCR and close with a brainstorm of a better QPP. 

Here are some good resources for further reading on these topics:

• Albert and Das reviews, Quality Assessment in Oncology and Quality Indicators in Radiation Oncology
• MedPAC report, Examining MACRA implementation and the road ahead
• MedPAC report, Moving beyond the MIPs
• GAO Report, Provider Performance and Experiences under the Merit-based Incentive Payment System
• Patel et al., Oncologist Participation and Performance in the Merit-Based Incentive Payment System
• Luh, Radiation Oncology Alternative Payment Model's Impact on Small and Rural Practices
• Jones et al., Merit-Based Incentive Payment System (MIPS) Participation in Radiation Oncology Practices — A Simple Survey
• Chera et al., Improving Quality of Patient Care by Improving Daily Practice of Radiation Oncology
• Coia and Hanks, Quality Assessment in the USA: How the Patterns of Care Study Has Made a Difference 
• Hanks et al., Patters of Care Studies: Past, Present, and Future
• Visit the CMS QPP page for a lot of info: check your participation status, MIPs guides, APMs, and more
• ASTRO ROCR FAQ page

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

*MattPAC is not a political action committee, it's just a cute name. If you'd like to support our efforts, please visit the Cold

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host the lung cancer legend, Brendon Stiles, MD. He is a Professor of Oncology, Medicine, and Thoracic Surgery at Montfiore and Albert Einstein College of Medicine.

We discuss all things lung cancer: early stage, locally advanced, staging, quality, and more.

The episode is capped with Simul's Lighting Round. Good luck Brendon!

We hope you enjoy this #MedEd instant classic!

Here are (almost?) all the studies and materials we mentioned during the show:

• Brendon's "Old Slide" on patient selection and operability
• Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer (CALGB 140503)
• Stereotactic ablative radiotherapy with or without immunotherapy for early-stage or isolated lung parenchymal recurrent node-negative non-small-cell lung cancer (I-SABR)
• Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials (STARS-ROSEL)
• Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non–Small Cell Lung Cancer (MISSILE)
• Stereotactic ABlative Radiotherapy Before Resection to AvoId Delay for Early-Stage LunG Cancer or OligomEts During the COVID-19 Pandemic (SABR-BRIDGE)
• Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer
• Phase II Study of Accelerated High-Dose Radiation Therapy with Concurrent Chemotherapy for Patients With Limited Small-Cell Lung Cancer (RTOG 0239)
• Randomized Phase II Study of Preoperative Chemoradiotherapy ± Panitumumab Followed by Consolidation Chemotherapy in Potentially Operable Locally Advanced (Stage IIIa, N2+) Non-Small Cell Lung Cancer (RTOG 0839)
• Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer (CheckMate 816)
• Pacific-2 Press Release, AstraZeneca
• Study of Durvalumab Given With Chemoradiation Therapy in Patients With Unresectable Non-small Cell Lung Cancer (MDT-BRIDGE, in progress)
• Society of Thoracic Surgeons quality initiatives

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host Radiation Oncologist and prolific X'er Dr. Dave Chang for a discussion of Small Market Radiation Oncology.

We wax philosophical about the work and life of docs formerly known as #LittleRadOnc: radiation oncologists often under resourced and practicing solo, working miles away from large US cities. 

Dave's personal stories emphasize that the reality of radiation oncology "maldistribution" is a lot more complicated than is often described by city slicker researchers.

Simul and Dave close the episode by discussing practical problems faced by Small Market Radiation Oncology and potential solutions, including... of course... supervision policy!

The only link for this show is the X announcement of Dr. Glaucomflecken's medical school.

The Accelerators Podcast is a Photon Media production. 

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host radiation oncologists Dr. Jona Hattangadi-Gluth and PGY-5 resident Dr. Austin Hopper. Jona is a central nervous system malignancies expert, co-lead of the Central Nervous System Disease Team and Associate Professor of Radiation Oncology at UC San Diego.

In this episode, we discuss Jona's lab's work in understanding the link between brain tumors, radiation (and other) treatments, and neurocognitive toxicity.

We start by discussing Austin's recently presented work that developed an normal tissue complication probability (NTCP) model for radiation dose and attention/processing speed. 

Later, we discuss specific methods used in the NTCP work. How can this work be translated to clinical counseling and practice? 

Also, Matt argues that building NTCP models based on neurocognitive outcomes, such as attention or fine motor control, can be more difficult to model than more simple clinical outcomes such as pneumonitis.

Here are some links to things we discussed during the show:

• Connor et al., 2023. Fine Motor Skill Decline After Brain Radiation Therapy—A Multivariate Normal Tissue Complication Probability Study of a Prospective Trial
• Unnikrishnan et al., 2021. Phase II Clinical Trial of Image-Guided Cognitive-Sparing SRS in Patients With Brain Metastases
• Oscar's Mexican Seafood, Oncology Twitter's favorite fish tacos in San Diego.

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Welcome to MattPAC*, a new Accelerators pilot concept!

Radiation Oncologist Dr. Matt Spraker aims to introduce important healthcare policy concepts rooted in current events. Each show is designed to be efficient with your time and inspire you to get engaged with #RadOnc advocacy in 30 minutes or less.  

In MattPAC #1, Matt covers two current congressional bills that are currently being considered for inclusion into next year's Medicare legislation: HR 2474 and HR3674. These bills seek to link Medicare physician pay to inflation and boost practice expense reimbursement for freestanding practices. The history of Medicare, administration processes, the payment formula, and sites of service are covered for context. 

Here are some good resources for further reading on these topics:

• A paper on how Medicare drove hospital desegregation, especially in the south.
• Power To Heal: Medicare and The Civil Rights Revolution
• How is Medicare Funded?
• Information about Medicare administration and procedures, Wikipedia
• A lot of info on the RUC, AMA
• The medicare physician fee schedule payment formula, MedicalBillersAndCoders.com
• Interesting write up of history of conversion factors, AMA
• Medicare payments are not keeping up with inflation, AMA
• Framework for Rational Medicare, AMA
• AMA letter to congress about these issues, March 2023
• AMA commends MedPAC for recognizing challenges of inflationary environment, April 2023
• HR 2474
• A Primer On Office Based Specialty Care, USPA
• USPA Letter to MedPAC about threats to free standing specialty practices, such as Rad Onc
• 2023 survey of multi-specialty practices regarding Medicare cuts
• HR 3674

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

*MattPAC is not a political action committee, it's just a cute name. If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD.

Our discussion concludes with a discussion of proton and adaptive radiotherapy, Wagyu beef, life advice, and Simul's Hot Seat.

Here are a couple of book recommendations from the show: 

• Why We Sleep by Matthew Walker, PhD
• Outlive by Peter Attia, MD

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

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Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD.

No notes.

It's Bob Timmerman, just listen.

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy.

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Accelerators co-host Dr. Matt Spraker is joined by Out Of The Basement co-host and Dr. Jason Beckta. We're talking #ASTRO23 and jobs, the theme of the conference for Matt.

This episode is, in part, a reaction to Jason's most recent OOTB episode: Chicken Little Strikes Back. Jason weaves 2023's "hot" job market and the workforce data into a master narrative to describe the changing market across recent years.  As this episode is heavily referenced here, you may want to listen first!  (But its not required)

Matt and Jason kick off by discussing interview experiences at ASTRO 2017 in San Diego. We then share thoughts about the 2023 "workforce session", what this means for medical students and graduating residents, and a plea for Rad Onc advocacy in the broadest sense.

The episode concludes with more discussion of the conference and our future.

Here are links to things mentioned in the show:

• Dr. Susannah Ellsworth Xeet on over/under supply, and her thread on the session.
• Matt Xeet on the alarming SOAP data and the "12,000 RVU Poll"
• How Much Are Resident Physicians Worth by Dr. Carmody, an excellent read on "the economy of residents"

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy.

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It's a Photon Media crossover episode! Accelerators co-hosts Drs. Matt Spraker and Simul Parikh team up with Dr. Jason Beckta, host of the Out Of The Basement podcast, to talk about billing.

We are joined by Shawna Stacey, ROCC, MBA, Coding and Billing Specialist at Radformation. The episode kicks off with a discussion about why you should care about billing and coding. Matt, Simul, and Jason discuss their (lack of training) training and experiences trying to learn on the job.

Simply learning about billing and coding doesn't make you greedy, it helps you understand how you are paid for your work. A transparent and well funded clinic offers the best chance of optimizing care for your patients!

Feeling overwhelmed by billing and wish you could just stick to patient care? Us too.

Later in the episode, we discuss resources that help you not care, especially Radformation's QuickCode. You already know how AutoContour and ClearCheck have automated your clinic, QuickCode does it for billing and coding. 

Don't believe us? We close the episode by asking Jason and Simul to "break" QuickCode with a complicated billing and coding scenario that is sure to frighten even the experts. 

Here are some things we discussed during the show:

• "What is a MAC?", from CMS
• "What's an LCD?", from Medicare.gov
• ACROInsights Newsletter from the Goverment Relations/Economics Committee (membership required)

Editor's Note: While our love for their products is genuine, The Accelerators were compensated for this episode and Radformation participated in planning the content. The discussions in this episode are the opinions of the participants and are not billing and coding advice.

Please see our website for complete information on our past and current sponsors.

The Accelerators Podcast is a Photon Media production.