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Perspectives from Council of Affiliated Regional Radiation Oncology Societies

Representing Radiation Oncologists across the country to the American College of Radiology (ACR), the Council of Affiliated Regional Radiation Oncology Societies (CARROS), a chapter within the ACR, held its annual meeting in conjunction with the ACR 2019 Annual Meeting in Washington D.C., May 18-22, 2019.

One highlight was the the 2019 symposium, organized by Drs. Arthur Hung and William Small, which explored economic issues specifically relevant to Radiation Oncology. Anne Hubbard, Director of Health Policy at the American Society for Radiation Oncology (ASTRO) along with Dr. Najeeb Mohideen, Chair of the ACR's Committee on Radiation Oncology Economics, gave an update of the Merit Based Incentive Payment System (MIPS) and covered the hot topic of Radiation Oncology alternative payment models (APM). Dr. Amar Rewari discussed the Relative Value Utilization Committee (RUC) process of developing a common procedural terminology (CPT) code, and Dr. Steven Frank detailed a novel payment program developed in the University of Texas System designed to cover proton therapy, one that resulted in overall cost savings for the insurance plan as well as enhanced access for patients. Also, Jordan Johnson of Crux Quality Solutions gave an industry perspective on the effects of changes in Radiation Oncology practice on revenue (i.e. increased use of hypo-fractionation), as well as the practice costs associated with negotiations with private 3rd party payers.

All ACR members had the opportunity to attend the CARROS Caucus Sunday morning, where CARROS welcomed six Radiation Oncology residents who were recipients of the ACR/CARROS Travel Grant, supported in large part by donations made by CARROS members Basel Altoos, MD (Loyola), Eric Anderson, MD (Cedars-Sinai), Anna Laucis, MD (U. of Michigan), Deborah Marshall, MD (Mount Sinai), Kyle Stang, MD (Loyola), and Anupriya Dayal, MD (Temple).

 Dr. Simon Lo (president), Dr. Join Luh (president-elect), Dr. Nancy Ellerbroek (immediate past president), Dr. Alan Hartford (secretary), and Dr. Ray Wynn (past president and CARROS nominating committee chair), gave updates on membership, outreach, fellowship recipients, practice parameters, and potential future nominees. Dr. Seth Rosenthal, Chair of the ACR Commission on Radiation Oncology, and Brian Monzon, director of the Radiation Oncology Practice Accreditation (ROPA) program, presented the ACR ROPA surveyor award to Tariq Mian, Ph.D., for his dedicated engagement in the ROPA program over many years. Dr. Lo was pleased to announce that Dr. Anne Lee from Hong Kong was successfully nominated by CARROS to be awarded Honorary ACR Fellowship based on her tremendous contributions to Radiation Oncology and the management of nasopharyngeal cancer.  

The CARROS caucus meeting was followed by the Commission on Radiation Oncology meeting, with Dr. Seth Rosenthal presiding as its outgoing Chair. The Commission coordinates RO activities within the ACR. Updates were given on the ROPA program, NRG Oncology and IROC research operations, practice parameters, and economics. Dr. Chelsea Miller, resident and fellow section (RFS) representative and Dr. Zach Morris, young physician section (YPS) representative, gave updates on issues affecting their groups. Dr. Rosenthal was presented with a plaque and gifts in recognition of his many years of dedicated service as Chair of the Commission.

 At the celebratory ACR Convocation Sunday evening, several Radiation Oncologists were inducted into ACR Fellowship: Drs. John Holland, Steven Frank, Alex Frank, Shalom Kalnicki, Neha Vapiwala, Mark L Sobczak, William Bodner, and Prajnan Das, in addition to Dr. Anne Lee’s honorary Fellowship. Numerous national leaders of Radiation Oncology attended the events, including Dr. Albert Blumberg, Past-President of ACR, Dr. David Beyer, Past-President of ASTRO, and Dr. Sarah Donaldson, Past-President of ASTRO and also of RSNA, to name but a few. The new fellows were honored at the CARROS New Fellows dinner that night.

As councilor and alternate councilor, respectively, Drs. William Small and Abhishek Solanki represented CARROS to the ACR's Council sessions on May 20-21, attended by all the ACR’s state and specialty chapters. The Council’s Keynote Address was delivered by Dr. Liselotte Dyrbye, internist at the Mayo Clinic, on issues related to physician wellness.

Radiation oncologists were active at the ACR Council meeting. Dr. Join Luh, Chair of the College Nominating Committee, gave its report to the entire Council. Dr. William Small was elected the new Chair of the Commission on Radiation Oncology and appointed ASTRO’s representative to the ACR’s Board of Chancellors. Dr. David Beyer was appointed to the Council Steering Committee as its designated Radiation Oncology representative. Dr. Nancy Ellerbroek chaired a reference committee and facilitated discussion of its resolutions on the council floor. Dr. Alan Hartford, Chair of the ACR’s RO Practice Parameters Committee and also ASTRO’s representative to the Council, shepherded adoption of several new and revised Radiation Oncology Practice Parameters through the ACR Reference Committees and the Council approval process.  

In other notable developments for Radiation Oncology, CARROS was honored with ACR's Chapter Recognition Award in the category of membership outreach, a first in the history of CARROS. Dr. Candice Johnstone won a contested seat on the College Nominating Committee. Ms. Anne Hubbard, ASTRO’s health policy director, returned on Monday afternoon to debate and discuss APM's further in the scheme of health care payment reform. The Carrier Advisory Committee met and discussed issues related to Radiation Oncology Reimbursement. Significantly, Dr. Reshma Jagsi, Deputy Chair of Radiation Oncology at University of Michigan, was invited as guest speaker by the ACR for an outstanding presentation to the ACR Council members and guests on issues related to gender equity in leadership roles across organized medicine and academia.

There was also an active Resident and Fellow (RFS) Section program throughout the meeting, allowing opportunities for emerging leaders in our specialty to be exposed to the breadth of Radiation Oncology activities within the ACR.

A highlight of every ACR meeting, Capitol Hill Day is when Radiologists (both diagnostic and therapeutic) have an opportunity to meet with our elected members of Congress in the House of Representatives and in the Senate. Many Radiation Oncologists, including members of CARROS and its Executive Council, attended Capitol Hill Day, working hand-in-hand with our brothers and sisters in diagnostic Radiology, nuclear medicine, and Interventional Radiology to discuss important issues for Radiology and the entire House of Medicine. Most notably, ACR prioritized four issues for 2019: forgiveness of interest on medical school student loan debt during residency, continued access for women ages 40–49 to mammographic breast cancer screening without fear of co-payments, development of financial support for “radiology assistants” to serve as extenders of physician clinical services, and better transparency and management of insurance companies’ surprise denials of coverage of out-of-network services. CARROS members who attended the Hill activities came away with very positive experiences, yielding a heightened appreciation of the fantastic contribution that Radiation Oncologists may provide to the broad, multi-dimensional activities of the ACR, including its strong leverage of the important coverage, payment, and legislative issues that face all of us in Washington D.C.

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