Ep 18 Supercut: Medicare Proposed Rules' Impact on Radiation Oncology: ASTRO & ACRO Presidents' Analysis

The presidents of ASTRO and ACRO provide focused analysis of CMS's 2026 proposed rules and their specific implications for radiation oncology practice. This executive briefing examines key policy changes without background context, concentrating on immediate implementation concerns and the September 12 comment period.

Key Topics Covered:

• Critical APC "crosswalk" methodology issues affecting new treatment delivery codes

• CMS's new "efficiency adjustment" reducing procedural service payments by 2.5%

• Transition from survey-based valuations to hospital cost data methodology

• Image guidance and port film bundling into treatment delivery codes

• Surface radiation therapy coding updates and valuation changes

• RUC committee dynamics and specialty representation challenges

• Strategic considerations for the comment period ending September 12, 2025

Technical Analysis: Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) and Drs Paravati and Rewari explain how CMS may have assigned new radiation therapy codes to incorrect ambulatory payment classifications. The analysis suggests CMS deleted separate IMRT codes but may not have recognized that IMRT services are now bundled into new level 2 and level 3 treatment codes, potentially resulting in significant undervaluation.

Policy Context: The discussion examines how radiation oncology's 21% decline in relative value over 20 years, combined with these proposed changes, affects practice sustainability. Freestanding centers face particular challenges with a 32% reimbursement reduction since 2015.

About Our Guests: Dr. Sameer Keole serves as President of ASTRO and practices radiation oncology in Arizona. Dr. Brian Lally is President of ACRO and practices at an academic center in South Carolina. Both provide extensive expertise in healthcare policy and specialty society leadership.

This focused analysis provides healthcare leaders with essential technical information for participating in the rulemaking process.

Note: This is a condensed version of our full Episode 18 analysis, focusing specifically on radiation oncology implications.

Overview of New Coding Rules and Society Involvement

Now I'm gonna dive deep. And a lot of this may be specific to radiation oncologists, but I think it's important, since we have the Society presidents on, to hear their perspective on this. In this rule, there are new codes for treatment delivery and image guidance and surface radiation therapy, which we'll talk about a little later. But how they came to be is very important to understand. So as Sameer Keole mentioned, yes, I am a RUC advisor for ASTRO, but I also worked together with ACRO on creating these codes as part of our code development and valuation team that we formed between ASTRO and ACRO.

We were tasked with creating these codes not because it's something we wanted to do; it's something we were asked to do by AMA and the RUC. These codes had not been revalued—our G codes and our current existing treatment delivery codes—for about a decade because of stuff Sameer Keole mentioned with PAMPA and the RO APM and all these other things that kicked the can down the road. But ultimately, we had to create new codes to accurately describe the work we currently do as radiation oncologists.

Explanation of Level 1, 2, and 3 Treatment Delivery Codes

Brian, you know this. It doesn't matter what energy we're using, 6x photons versus 15x photons. Why should the payment differential be different? These are outdated concepts. So we created three new delivery codes: a Level 1, a Level 2, and a Level 3.

A Level 1 is pretty much the most basic thing. So it's for electron therapy and for 2D therapy. Then you have a Level 2, which is pretty much your bread and butter code. What we did is we took 3D but also combined it with IMRT. And then Level 3 is a much more complex code.

When we looked at how we were going to create these codes, we asked: do we create codes based on sites we're doing? Like radiologists have codes for different sites. Do we look at how many sites we treat? Do we look at this concept of isocenters? After a lot of thoughtful discussion between the two societies, we agreed on this concept of using isocenters and taking out the technology of 3D and IMRT.

So Level 2 is for anybody with a single isocenter you're treating. Whether you're doing 3D or IMRT doesn't matter. Level 3 is for anything that takes a lot more time, because things that take more time—both for our staff who are giving the radiation and for physicists who may be coming in to observe—should be paid higher. So that got moved to a Level 3. That was anything we're doing with multiple isocenters, whether it's through 3D or IMRT, doesn't matter. Or if we're treating things like total skin electron therapy, or if we're doing something with active motion management where you're actually looking in real time at organs or targets moving either through breathing or through surface guidance, because that takes time to observe. So that all got pushed to Level 3.

Challenges in Explaining Radiation Oncology to Non-Specialists

So I did want to just lay that out there. When you were arguing this stuff, explain to the audience listening here the level of knowledge of the people who you were trying to explain these codes to.

That's a great point, Brian. Sameer Keole is laughing at me when I asked that one. There's the CPT committee, which are CPT advisors from ASTRO and ACRO—Kate Yashar and Tarita Thomas representing us—and then the RUC advisors, which was me and Chris Jahraus. And when we talk to these people, they're not radiation oncologists. They're not radiation oncologists who sit on the committee.

So you have to explain things that are very complicated concepts in radiation oncology to people who don't understand our field, which is why sometimes it's hard to get them to understand the valuation. And as we will see in this rule, it was probably confusing for CMS and others to understand maybe some of the nuances between 3D and IMRT that are the building blocks for these codes, which is why they got assigned payments not associated with the correct building blocks.

The Rulemaking Process and Shift to APCs

Yes, and we should say that this process, this yearly process of a proposed rule being released, there is a 60-day period for stakeholders to comment and correct CMS's errors and potentially convince them of going down a different path. Only later in November is the rule finalized. So that's really the task now.

What Amar Rewari is speaking about specifically, and we alluded to it earlier, is that in the process that the RUC follows, they have to estimate physician work and they have to estimate practice expense, and they do that through survey methods. What CMS made very clear in this proposed rule is that they believe that is an outdated approach or an ineffective approach for certain specialties. And as we together with CMS agreed on these new three treatment delivery codes, not the physician work, but the expense component of it is being arrived at through something called an ambulatory payment classification. So in order to explain where we stand with this proposed rule, we need to go into that.

Historical Context of Code Revaluations

It may be useful for the casual listener to know that, number one, we never go and ask for revaluation of codes ever. This is why sometimes as the code sets grow and grow, I use the analogy of imagine you have a two-bedroom, one-bath house built in the '50s, and now you built onto it and built onto it and it's now 10,000 square feet with a bunch of bedrooms and a bunch of bathrooms. Then to get from the kitchen to the dining room, you may have to go through someone's bedroom. It doesn't make sense. But we don't ever reconstruct. We don't actually ask for revaluations until we're really asked to do it. And that's because it's tough to maintain valuations as you go back through the process.

This is kind of a rule of thumb. When we started, IMRT I believe was first a code in 2003. Prior to that, there was nothing. So it went from zero to being a $1.1 billion code, the number four code in all of Medicare by the year 2011. That obviously got on the radar. And that prompted the last big code set revaluation, which I believe was 2014 going into effect 2015 or 2016. IMRT was billed under a number called 77418. Then as a result of the US restructuring the code set at that time—and I was very involved in that one—we split it into simple and complex, 77385 and 386.

But we needed to fix some stuff after the fact. So these G codes got created. As you probably realized, for about 10 years we've been billing one set of codes in the freestanding or non-facility setting and a different set of codes in the hospital or facility setting. Internally, we called it the "G Code cliff." G codes are only supposed to be around for a few years, but we knew it was coming up. In fact, it was due largely to Amar Rewari's work as well as our advisor that we did probably extend it maybe longer than intended. But we knew at some point in time we were going to have to get revalued, and that just happened. Amar Rewari was called to the table along with Tricia and a few other folks I believe in September 2023 and instructed that they wanted us to take another look at this. Really the take-home point is we never voluntarily go and ask for a revaluation.

Understanding Ambulatory Payment Classifications (APCs)

That is helpful context. And so as it relates to our reevaluation of codes and reassortment as Amar detailed into these three treatment delivery codes, a key component of that is the practice expense component. We spoke previously about the traditional way that that is done and how CMS takes the advice of the RUC to arrive at what they pay for that. But it's important to state that in the Medicare hospital outpatient environment, hospital reimbursement—so now I'm not talking about anything to do with professional services, but technical or facility reimbursement—is based on this concept of ambulatory payment classification, otherwise known as APCs.

What CMS does is they assign the CPT codes—Common Procedural Technical codes—to a given APC based on clinical and resource use similarity, and that is how the payment to the hospital is derived. All services in a given APC are reimbursed at the same rate. The process for this basically involves cost data that are collected from hospitals, including from their chargemasters. And then in this HOPS rule which was just released, there's a conversion factor also there that's used to turn that into what CMS pays in terms of a dollar amount for a given APC.

So critical in our new codes, and Amar made reference to this, is that each of our new codes is assigned a given APC for the technical reimbursement. And so what we're going to do now is talk about what's been done in the proposed rule with regard to APCs and likely what at least we hope would come out of this 60-day comment period in terms of dialing those APCs in to the right level to make sure that we don't have cuts that were not even necessarily CMS's intent, but potentially just a knowledge gap more than anything else.

Flaws in CMS Execution and Crosswalking Errors

Exactly. I think one of the things to realize is this is actually a good thing, what they're thinking of doing. It's thinking outside the box. It's what we've been advocating through both these professional societies for years, which is payment stability. We know that radiation oncology, as Sameer Keole pointed out, has had these huge cuts—20-something percent over the last decade on the Medicare physician fee schedule. But on the hospital side, it's been relatively stable. And the reason for that is this cost-to-charge data that the hospitals provide. It's a more stable form of payment.

So CMS is looking to figure out ways to stabilize payments for us because they understand that it's not sustainable to have these huge cuts in radiation oncology. They're also worried that the data that goes into what people submit in surveys can be flawed. You may only have three to five surveys submitted on data. You have to submit invoices for these high-cost equipment to get priced through the RUC process. A lot of people have non-disclosure agreements. They don't feel comfortable sharing that kind of information. Their institutions don't let them. And so they have very limited data to calculate this practice expense.

So this allows for a site-neutral kind of payment methodology with payment stability. The intent, personally speaking as myself, is a good thing. It's just the execution that kind of failed on this one. And that is because the building blocks they used to build the codes were incorrect. They deleted, as we knew they would, the two IMRT codes because the IMRT services were bundled into the new Level 2 and Level 3 treatment delivery codes. But the numbers of those codes are the same numbers as was already used in our legacy 3D codes.

So when they deleted the IMRT codes, I'm not sure—speculatively—that they understood that IMRT was now being bundled into those new codes so that our Level 2 had IMRT in it and our Level 3 had IMRT in it. So when they assigned payment, they looked at the hospital outpatient payment, the APC for 3D radiation therapy, which is a Level 2 payment of 622. They assigned both our new Level 2 and Level 3 codes to that payment because they thought it was 3D only.

So what we want them to do is to reassign those valuations to IMRT and IMRT-plus. So instead of assigning it to a Level 2, we would like them to assign it to a Level 3 and a Level 4, which more accurately accounts for those bundling services. They have these Excel spreadsheets they put out there for the public that show all the cost data about what goes into all these codes. And when you summate and look at the geometric mean of the costs for IMRT and the cost for 3D, you can see that it's drastically undervalued the new valuations they did. And so we're hoping that the whole radiation oncology field, ACRO, ASTRO, everybody gets together and advocates CMS to correct these linkages to the APC payments.

Impact on Hospitals and the Need for Advocacy

Well said. We call this crosswalking and we think that the crosswalk was done incorrectly. Within 24 hours, after a lot of us had looked at this, we said, "Sure looks like this crosswalk's wrong." But again, we're going to have to do some work here. You're not going to find anybody in the radiation oncology stakeholder community on the other side here. It's just a question of getting the word out, making sure people understand this and making sure that CMS hears it from a plurality of radiation oncology stakeholders to get this sorted out.

And not just radiation oncologists. Because this, like I said in the beginning of the podcast, impacts the money that flows through radiation oncology programs in the hospital setting impacts all those other services that we talked about. And so the hospitals have an incentive here. So I think this should be something that the American Hospital Association (AHA), and some of these other large professional societies also need to understand—the ramifications of this for their cancer programs and access to patient care. And they should be advocating also for changes in this to CMS.

Yeah, that's a great point. I see that in all the things that are charged to us for other services—I'm talking about my department—and it's because the revenue is generated and it goes to cover those areas that are important services for our patients that unfortunately don't generate enough sustainable revenue on their own. Brian, do you have anything to add to that?

No, I mean, I'm 100% in agreement with you guys. I think the main thing is that the word of this and how there was what appears to be some type of misconstruction needs to be explained to our membership of both societies. And then we need to ask them to try and make sure that we have those little grassroots sites so that people can let their Congressmen and other people know, and that we mobilize our voices to explain how this is really going to impact patient care in the wrong way.

You mentioned the AHA. But it's also our therapists, our dosimetrists, our physicists, and our societies. We tried as a society. We have been one of the best at policing ourselves as a profession. We have been one of the best at policing ourselves, moving towards hypofractionation, doing studies, trying to find ways to do cost-effective care. And it seems like we have been mostly penalized for it. We've been looking for ways to become efficient and you guys are going to talk about that shortly.

The Efficiency Adjustment and CMS Cuts

Yeah, that's well said. So speaking of efficiency, I alluded to it earlier as one of the mechanisms that CMS has considered and there's some history to this. It dates back to at least 2018. It could date back even further. But using the efficiency factor as a means of redistributing funds that the Medicare program pays from specialty, primarily procedural-based specialties to primary care. And the reason why I mentioned 2018 is that MedPAC—and we've had the previous chair of MedPAC on this show, Michael Chernew—MedPAC has advocated and spoken in their testimony to Congress since even before 2018 that there should be across-the-board cuts to procedural services.

Basically, the time and survey data that feeds into these services are inflated and there's all sorts of terms that people use to discuss that inflation as it relates to the RUC. But that's really not the key issue here. This is basically CMS saying that methodology does not accurately represent what it costs to deliver these services. They are overinflated. So we're going to come up with another mechanism to do that and that's what they're calling this efficiency adjustment.

If you look into the details, I'm going to call bullshit because my cases have gotten a hell of a lot more complicated. As you become more senior, you get all the stuff nobody else wants. And that's the world that I live in these days. I remember it used to be like five minutes to do those little circles around the prostate. We ain't doing that anymore. With all the re-radiation you do, you live in that space. You gotta be very careful and not take anything for granted. So I'm gonna say it one more time.

So let's discuss a little bit sort of exactly what this is. CMS is proposing a 2.5% cut, what they're calling an efficiency adjustment to non-time-based work RVU codes. And that's the tell right there. Because for those who are non-proceduralists, for those who are in the clinic doing evaluation and management only and submitting the associated codes for that, those codes are exempted from this. And as I said, and CMS wrote this—this is in quotes—that this adjustment stems from CMS's view that time valuations for services, procedural services in particular, are quote "very likely overinflated." And that experience, improved workflows, and technology gains have made the delivery of these services basically faster and more efficient.

There's a whole preamble in the text about the work RVUs and the system dating back to 1992, which Sameer Keole already discussed at length. It talks about the budget neutrality pressure and talks about all kinds of misvaluation concerns related to MACRA, etc. But what this does is it affects the entire house of medicine. Not just radiation oncology, or I should say it affects the entire procedural house of medicine. So again, a 2.5% reduction to non-time-based work RVUs. This would start in 2026. This is CMS saying that we're going to take a corrective step beyond moving beyond the RUC survey-based updates to reflect what CMS believes are operational improvements and to essentially because of cost containment pressures is more or less what they're doing here.

I agree with Brian. I think it is bullshit. I think there's a way to redistribute toward primary care, which I think is an intent here. But it's not by robbing Peter to pay Paul. I do agree that there is obviously concerns about overinflation in the surveys. But I will say as someone who goes to the RUC, what they look at is not the median time responses that survey respondents get. We never get valued based on median levels. We get valued based on the 25th percentile. That's because they assume people are overinflating their times and so we're already kind of having an efficiency factor already done through the survey data. But this is something CMS has been doing for years. And Sameer Keole, I'd love to hear you talk about this a little bit because with the RO APM they introduced an efficiency discount factor for us. If you remember when they were trying to create a bundled payment for us, they did.

The RO APM and PAMPA

Boy, you're going to send me into PTSD talking about RO APM. For those of you who don't know, part of the provision of PAMPA was not mandating an alternative payment model, but studying a payment model. And as you may remember, under the Obama White House CMMI was created, the Center for Medicare and Medicaid Innovation. So they were very much looking at different ways to pay people. Hence how all this happened. I think the feeling from the societies was we're better off designing it ourselves than having it designed for us. So it was designed. To be in full disclosure, I wasn't wild about what was designed initially but then when it went off to the agency and off to the government, it really took a bad turn to the point that really no one could support it and was withdrawn. So that's why it's not there anymore.

The efficiency factor... there was a lot of issues with the RO APM version 1. One big issue was efficient practices were punished for their past good behavior. And that was something that was a little bit tough to swallow if you were at a place that was doing things correctly because 70% of the weight was based on your own practice pattern. So if you had been doing a lot of hypofractionation during the look-back period, it came out that you would be paid less than somebody in the same geographic area who had not been. And that just didn't sit well.

Since we've mentioned it a few times here, I think it would be helpful for the radiation oncology listener to have a reminder of about what PAMPA was. PAMPA is an abbreviation. It means Patient Access and Medicare Protection Act. It was unanimously passed in 2015. It froze reimbursement rates for freestanding radiation oncology centers from the year it was passed through 2018. And then I think it was actually extended another year to 2019. Basically why this mattered is that freestanding facilities were facing steep reimbursement cuts. And PAMPA basically, once it was passed, provided a buffer, allowing time to develop alternative payment strategies, which came to a head with the RO APM, which then never came into existence.

Changes to Image Guidance Codes

One other thing, because Amar said something very important about the RUC and how it relates to image-guided radiation therapy and the codes for that and the RVU that is now applied to that because that too was up for review at the RUC this year back in February or January. Amar, if you could just speak about that, because there's been some heartburn already in the radiation oncology community about this RVU level.

That's a great point. So image guidance, which is both cone beam CT, ultrasound, and KV imaging... Nobody really does ultrasound anymore in our field. It's not very common for image guidance. We'll talk about that a little later. But you had cone beam CT and KV imaging. The KV imaging was also a G code. And so we were also asked to fix image guidance. And when you do two things at the same time, you can't oftentimes report them separately. They want you to bundle it together.

So the technical portion of image guidance is bundled into these codes. For your 77407 and 77412—your Level 2 and your Level 3 treatment delivery—has the technical component of image guidance bundled in professionally. You can still bill separately for checking your films. The cone beam and the KV imaging codes were deleted and they were bundled together into a new code. And so the new code is not going to be the same value as a cone beam. It can never be the same value as a cone beam because it also has KV imaging, which had a lower valuation.

So what they look at is they take the utilization of how much cone beam is being done in the country, how much KV imaging is being done in the country, kind of created a weighted average, which is then how you get a new kind of RVU set. So just so people understand, because everyone's going to be like, "Oh my God, my cone beam CT valuation has gone down." Yes, but your KV imaging has gone up because it's a bundled code. And your port films now are also... those technical charges are also bundled into your treatment delivery. So you can't bill those separately anymore either.

And that was again, nothing on the part of ACRO or on the part of ASTRO that was generated voluntarily. That is due to the mechanisms and the screens that exist in the system. Like Amar Rewari explained, doing two things together, they're going to have you review those and then come and explain what you're doing at the table, as Amar did.

The Composition and Role of the RUC

The New York Times will take many shots at the CPT RUC process. Every few years they recycle a series of articles. But these 32 seats on the RUC, can you describe which specialties are represented and which ones are not?

Yeah. So, primarily it's surgical specialties. The American College of Radiology does have a seat at the RUC. Radiation oncologists do not have a permanent seat at the RUC. It's like the Security Council for the UN. There's some countries that have a permanent seat and then there's some that have a rotating seat. So there are some rotating seats that then people get elected to. We had Paul Wallner, who was the only radiation oncologist who sat at the RUC through a rotating seat. But otherwise, yeah, it's mainly surgical specialties.

What's the relationship between CMS and the RUC?

The RUC submits their recommendations to CMS and CMS can choose to approve them or not. And this has now happened twice to us. As Sameer Keole brought up in 2015 when we came with new IMRT codes and treatment delivery codes, we got them approved by the RUC. They went to CMS and CMS was not happy with the image guidance and treatment delivery codes and that's why they created the G codes. So they can choose to accept the RUC stuff or they cannot. This time around they chose to accept the codes that were created, but they didn't choose to accept the valuations for practice expense and decided to do this whole new payment method of assigning them values based on hospital payments.

Issues with PPI Survey Data and Successful Advocacy

And this is very important. So we were facing, based on the data that the AMA generated through their so-called PPIs, which is the acronym for their survey, radiation oncology as a field was going to face a huge cut in practice expense reimbursement due to the way that the survey was done. And our societies—ASTRO—said, "Hey, hold on here, this survey is poorly done." The respondents, the intended respondents for so-called non-facility radiation oncology practices, was actually zero. And so CMS reacted saying, "You guys are serving us up surveys that are not adequate, not satisfactory." And so that is in part to explain, if not totally to explain, why CMS went the APC route, which we already explained earlier in this podcast to value that aspect of reimbursement for radiation oncology services for treatment delivery.

I do want to give a shout out here to our societies here when people question the value of membership. While we don't know exactly how the sausage was made on that, we certainly like the way it tastes now because we were looking at a 40% cut on practice expense and they held the line at zero. So when this survey came out in 2023, we at ASTRO certainly recognized that this was going to be problematic and we knew it was going to be problematic because we have a relatively small number of people who can answer this. We know because of the information they ask and the way they ask it, since it's transparent, it could violate a lot of confidentiality agreements at individual centers.

So we knew this, we knew it would be tough to get responses and we knew that because we went through this in 2009 or 2010. And so I think last year when it came out there was some panic, but we were not panicked because remember a lot of people don't know this, but we started working almost immediately in parallel on an alternate survey. So we, out of our own expenses, I think we spent over six figures to contract with another firm. And we have been in the process of doing our own PPIs practice expense survey and at the same time putting significant appropriate pressure on the agency and letting them know. I do think it... we don't know exactly how they ended up here, but certainly we made it loud and clear that this was not a fair way to do it with a 40% cut.

Updates to Surface Radiation Therapy and Orthovoltage Codes

Let's get back to just some of the codes. Yes. And as you brought up with the ultrasound, Brian, let's talk a little about the surface radiation therapy changes here. And so pretty much there's now new codes to bill both surface radiation therapy but also orthovoltage, which is important because that also applies to people who are treating benign radiation therapy. So if you're doing anything with an energy level that qualifies as surface radiation therapy—and we've now bundled in electronic brachy into that. Electronic brachy is no longer a separate code. Everything's billed with this code that's an X06 code.

And then you have your orthovoltage that's billed with an X07 code. And the simulation for either of those is no longer going to be your prior simulation codes. It's now going to be this X05 code. And then if you're doing any kind of ultrasound guidance, it's going to be an X09 code. And those were also valued with the same methodology that CMS used, where they aligned it with some level of a hospital payment. They're not the highest paying things, and so it may end up curbing some of the usage of some of these treatment modalities. But that's kind of how their new codes are created. It's a fair valuation, I think. It's certainly not what it was, but I think when you look at it for the equipment costs, because these systems don't cost as much and the maintenance costs are less, I think it's a fair valuation.

Right. And I agree. And it also allows and accounts for the real work that these people are doing. So it's the actual process of care of simulation that people are doing for surface radiation therapy and the ultrasound guidance that they're doing for surface radiation, so it's actually based on that description of work that they're doing. So it is a fair evaluation for the procedures they're performing.

Long-Term Trends, Consolidation Risks, and ROCR

All right, Anthony, first of all, thanks for doing this. I would say I think even the casual non-radiation oncology listener hopefully learned a lot because I think hopefully this demystifies some of the process. And I think for the radiation oncology listener, hopefully you're learning that hey, this process is complicated and every year I feel like we're going through this. So sometimes it's good instead of looking year to year to step back. I think we gave some of the numbers. Our cumulative radiation oncology pool has gone down about 21% over the last 19 or 20 years. The technical reimbursement in hospitals over 2015 to 2023 inclusive went down 16%.

But on the technical side, in the freestanding centers, MRT 20 years ago in 2005 was $687 with a GPCI of 1.0. Today it's roughly $345. So literally going down by half. So in the freestanding side you're dealing with hypofractionation and decreased cost per fraction. And so this is why the system isn't working, especially for our members in the freestanding setting. I am terribly worried about consolidation. I think it's going to hurt access, especially in rural areas. We really need to fight to protect the private practice segment of our society and especially those that are technical. And it's really why we're big supporters of ROCR, the Radiation Oncology Case Rate. We think there's something in there for everybody, but it really is a benefit and a lifeline to those who own their own equipment and practice in the freestanding setting.

Call to Action and Closing Remarks

So I'm very thrilled to have had you both on. And I guess my parting words would be two things for the radiation oncologists: Please advocate on behalf of the correct changes to this rule by talking to other people who do this, whether it's through your professional societies or if you're part of American College of Radiology or if you go to your advocacy days with ACRO and ASCO or ASTRO or AMA. Just be involved in your professional society and try to advocate on behalf of this.

And I will give a plug for a lot of the radiation oncology listeners who may not have heard our podcast before. We delve into other topics in healthcare policy such as Medicaid, the Big Beautiful bill, Medicare Advantage, prior authorization, employer-based insurance, politics, finance, you name it. So please give us a listen. Thanks everyone. We'll see you on the next episode of Value Health Voices podcast.