Radiology Digest – April 18, 2023

April 17, 2023

Radiology Digest: News from the week of April 18, 2023.

29 Radiology Societies Met to Discuss the Specialty’s Most Pressing Problems: 8 Takeaways

By Marty Stempniak | April 13, 2023 | Included in Radiology Digest – April 18, 2023

Twenty-nine radiology societies met recently to discuss some of the specialty’s most pressing problems, sharing several key takeaways Wednesday in JACR.

The group included representatives from all subspecialties of radiology, radiation oncology, academia and private practice. Meeting in Park City, Utah, last August, the discussions centered around the theme of “Recovering from the Great Resignation, Moral Injury and Other Stressors: Rebuilding Radiology for a Robust Future.”

Among all topics, one bubbled to the surface as requiring urgent attention, Bettina Siewert, MD, a professor of radiology at Harvard Medical School, and co-authors shared April 12.

“Of these, the mismatch between the clinical workload and the available radiologist workforce was foremost—as many other identifiable problems flowed downstream from this, including high job turnover, lack of time for teaching and research, radiologist burnout, and moral injury,” Siewert et al. reported.

The American College of Radiology Intersociety Committee offered up eight action items following their three-day meeting. While aspirational, the editorialists believe they’re achievable.

Here they are in brief:Establishing a robust and sustainable workforce pipeline and retaining existing radiology professionalsImplementing appropriateness criteria to reduce wastePositioning radiology as a consult specialtyIncreasing the visibility of radiologyImproving communication with referrers and patientsDeveloping the hybrid workforceImproving staff well-being and facilitating mentorship/sponsorshipProviding strong and visionary leadership“Radiology has just weathered a perfect storm: a toxic brew of pandemic, reimbursement cuts, devastating inflation, increased work demands, social and healthcare disparities, supply chain disruptions, and now both a ‘great resignation’ and ‘quiet quitting’ from work,” the authors wrote. “Leaders must recognize the currently unique and challenging situation and prepare to think and act differently.”

To read more, go to Radiology Business.


Justice Department Seeks Pause of Texas Judge’s ACA Preventative Care Ruling

By Andrew Cass | April 12, 2023 | Included in Radiology Digest – April 18, 2023

The Justice Department will seek an injunction to halt a Texas federal judge’s ruling that struck down an ACA provision requiring insurance companies to provide coverage for preventive services, CNN reported April 11. 

U.S. District Judge Reed O’Connor said in his March 30 ruling that preventive care recommendations made by the U.S. Preventive Services Task Force do not need to be complied with and blocked the federal government from enforcing its recommendations. The Biden administration appealed the ruling to the 5th Circuit Court of Appeals.

The Justice Department has not yet filed the motion requesting the stay and it is unclear whether it will first ask Mr. O’Connor — the typical route — or send the request to the appellate court, according to the report.
Mr. O’Connor’s ruling only applies to task force recommendations made by the panel on or after March 23, 2010 (when the ACA became law), such as statins; lung and skin cancer screenings; and preexposure prophylaxis, or PrEP, drugs, which prevent HIV infection. STI screenings and cancer screenings such as mammograms and cervical screenings would still be included for preventive coverage.

Most insurers will still cover preventive services, but they may raise cost-sharing for members for certain services, according to the Kaiser Family Foundation. An increase in costs will not happen immediately because of current contracts, but that could change in the next calendar year. For PrEP specifically, there could be substantial cost-sharing. Generic PrEP costs around $360 a year, while branded prescriptions can reach upward of $20,000 annually.

To read more, go to Becker’s Payer Issues.


ACR Updates Influential Imaging Appropriateness Criteria With 4 New Topics

By Marty Stempniak | April 12, 2023 | Included in Radiology Digest – April 18, 2023

The American College of Radiology issued the latest update to its influential imaging appropriateness criteria on Tuesday, aiming to aid providers in properly ordering exams.

ACR outlined revisions to 11 of its existing criteria, along with four new topics that it did not previously address. The latter included guidance related to abnormal liver function tests, congenital or acquired heart disease, dialysis fistula malfunction, and both staging and assessment of head and neck cancer.

First introduced in 1993, the appropriateness criteria now cover a total of 227 topics, 1,080 clinical variants, and 3,000 different scenarios. A panel of experts in both diagnostic imaging and interventional radiology compiled the recommendations, hoping to help referrers and other providers to appropriately select services.

The criteria meet the requirements spelled out in the Protecting Access to Medicare Act, which stipulates that providers must use such a decision aid before ordering radiology services for Medicare patients, ACR noted.

Find more details on the update here.
To read more, go to Radiology Business.


Major Credit Bureaus Remove Medical Debt Collections Under $500

By Jacqueline LaPointe | April 12, 2023 | Included in Radiology Digest – April 18, 2023

Three major credit bureaus are giving consumers a break when it comes to medical debt. Equifax, Experian, and TransUnion jointly announced yesterday that any medical debt collection with an initial reported balance of under $500 has been removed from US consumer credit reports.

The credit bureaus wiped nearly 70 percent of the total medical debt collection tradelines reported to the Nationwide Credit Reporting Agencies (NCRAs) in light of the change, according to the joint announcement.

“Our industry plays an important role in the financial lives of consumers. We understand that medical debt is generally not taken on voluntarily and we are committed to continuously evolving credit reporting to support greater and responsible access to credit and mainstream financial services,” said Mark W. Begor, CEO Equifax; Brian Cassin, CEO Experian; and Chris Cartwright, CEO TransUnion.

“We believe that the removal of medical collection debt with an initial reported balance of under $500 from [US] consumer credit reports will have a positive impact on people’s personal and financial well-being,” the CEOs said.

Past-due medical debt impacts over one in seven adults, according to an Urban Institute report released last month. Additionally, nearly two-thirds of adults affected by past-due medical debt have incomes below 250 percent of the federal poverty line.

Regardless of insurance coverage, most adults under the age of 65 have experienced medical debt, reports Kaiser Family Foundation. This debt can lead to serious health consequences, including denied services and forgone care, as well as financial challenges, such as depletion of savings, going without household essentials, and damage to credit scores.

study published in the American Journal of Public Health in 2019 found the majority of bankruptcy filers said medical expenses contributed to their seeking relief. Since then, consumers have had to manage the health and financial repercussions of the COVID-19 pandemic, as well as recent inflation and economic uncertainty.

Last year, the NCRAs committed to supporting consumers with medical debt collection reporting changes. The group said the changes would “help people to focus on their personal wellbeing and recovery.”

Equifax, Experian, and TransUnion have already eliminated all medical debt collection that had been paid by the consumer from US consumer credit reports. The time period before unpaid medical debt collection appears on a consumer’s credit report also increased from six months to one year in an effort to give consumers more time to address the debt before it was reported on their credit file. These changes went into effect in July 2022.

To read more, go to Revcycle Intelligence.


Biden Ends COVID National Emergency After Congress Acts

By Associated Press | April 11, 2023 | Included in Radiology Digest – April 18, 2023

The U.S. national emergency to respond to the COVID-19 pandemic ended Monday as President Joe Biden signed a bipartisan congressional resolution to bring it to a close after three years — weeks before it was set to expire alongside a separate public health emergency.
The national emergency allowed the government to take sweeping steps to respond to the virus and support the country’s economic, health and welfare systems. Some of the emergency measures have already been successfully wound down, while others are still being phased out. The public health emergency — it underpins tough immigration restrictions at the U.S.-Mexico border — is set to expire on May 11.

The White House issued a one-line statement Monday saying Biden had signed the measure behind closed doors, after having publicly opposed the resolution though not to the point of issuing a veto. More than 197 Democrats in the House voted against it when the GOP-controlled chamber passed it in February. Last month, as the measure passed the Senate by a 68-23 vote, Biden let lawmakers know he would sign it.

The administration said once it became clear that Congress was moving to speed up the end of the national emergency it worked to expedite agency preparations for a return to normal procedures. Among the changes: The Department of Housing and Urban Development’s COVID-19 mortgage forbearance program is set to end at the end of May, and the Department of Veterans Affairs is now returning to a requirement for in-home visits to determine eligibility for caregiver assistance.

Legislators last year did extend for another two years telehealth flexibilities that were introduced as COVID-19 hit, leading healthcare systems around the country to regularly deliver care by smartphone or computer.

To read more, go to Modern Healthcare.


Bill Would Boost the Number of Residency Slots in Radiology and Other Specialties

By Marty Stempniak | April 11, 2023 | Included in Radiology Digest – April 18, 2023

House lawmakers have introduced a bipartisan bill to bolster the number of residency slots in diagnostic imaging and other specialties, garnering support from trade groups including the American College of Radiology.

U.S. Reps. Terri Sewell, D-Ala., and Brian Fitzpatrick, R-Pa., first announced the Resident Physician Shortage Reduction Act of 2023 in late March. The proposal aims to address workforce inadequacies by adding another 14,000 Medicare-supported medical residency positions over a seven-year period.

In advocating for their proposal, lawmakers highlighted recent data from the Association of American Medical Colleges, projecting that the U.S. could see a shortfall of up to 124,000 medical doctors by 2034.

“In Alabama and all across the nation, we are facing an urgent physician shortage that will only get worse as our population continues to age,” Sewell said in an announcement. “…This critical legislation will give hospitals and health centers the tools they need to improve access to care, lower wait times for patients, and create a pipeline of qualified medical professionals to serve Americans’ health needs.”

Others have since voiced their support for the legislation, including ACR, the Association of American Medical Colleges, the American Hospital Association, and the Greater New York Hospital Association. Getting the Resident Physician Shortage Reduction Act enacted has been a priority for ACR in previous years, the college noted in an April 6 news update.

“This action by Congress is a key strategy to address the growing physician shortage and improve patient access to care,” ACR said. “It also aligns with recent ACR advocacy efforts, including responding to a request for information issued by the Senate Committee on Health, Education, Labor, and Pensions (HELP) regarding healthcare workforce shortages.”

The federal government recently committed to investing $1.8 billion to create 1,000 new residency slots—the first such increase in 25 years. ACR applauded the move earlier this year but expressed concern that much of the money would go toward primary care, mental health and rural geographies.

Members of Congress also previously proposed the Resident Physician Shortage Act in 2021, but it failed to ever reach the president’s desk.

To read more, go to Radiology Business.


Lawmakers Want to Tie Physician Payment Updates to Inflation

By Jacqueline LaPointe | By April 6, 2023 | Included in Radiology Digest – April 18, 2023

Several lawmakers are seeking to tie physician payment updates in Medicare to inflation to prevent potential physician shortage issues.

Representatives Raul Ruiz, MD (D-CA-25), Larry Bucshon, MD (R-IN-08), Ami Bera, MD (D-CA-06), and Mariannette Miller-Meeks, MD (R-IA-01) introduced H.R. 2474, the Strengthening Medicare for Patients and Providers Act, today. The bill would link the Medicare Physician Fee Schedule to the Medicare Economic Index, a measure of the average annual price change for the market basket inputs, including physician compensation and practice expenses.

Just recently, the Medicare Payment Advisory Committee (MedPAC) recommended in its March report to Congress that lawmakers increase physician payments above current law next year by tying the payment update to the Medicare Economic Index.

The Medicare Economic Index has increased significantly over the past decade, exceeding the 6 percent cumulative boost in annual updates to the Medicare Physician Fee Schedule rates, MedPAC reported. Meanwhile, the American Medical Association (AMA) reports that physician payments have declined by 26 percent since 2001, even after adjusting for the inflation of practice costs.

“I am deeply concerned about the impact the outdated Medicare physician payment rate is having on [healthcare] access for my constituents,” said Representative Ruiz said in a statement. “That is why I am announcing legislation that will move us away from a system where every year seniors’ access to care is threatened due to uncertainty over potential cuts.”

The bipartisan bill aims to bring certainty to physicians and their Medicare beneficiaries by preventing a possible physician shortage in the federal healthcare program, the coalition of doctors in Congress added in the statement.

“At a time when our [healthcare] system is already strained, instability in our Medicare payment system creates further access and workforce issues,” said Representative Bera, former Chief Medical Officer for Sacramento County.

AMA said it welcomes the bill that “could put Congress on the path to finally reforming the outdated Medicare payment system.” The Association has long backed tying physician payments to the Medicare Economic Index, it said in a statement today.

Medicare physician payments are currently subject to a six-year freeze expected to last until 2026. Additionally, Congress recently cut physician payment rates by 2 percent under the year-end omnibus bill.

As physicians deal with inflation, burnout, and the lingering effects of the COVID-19 pandemic, many healthcare stakeholders fear physician payments are not adequate to keep doctors practicing, especially those treating historically underserved and marginalized communities. Inadequate payments could also threaten the financial viability of small, independent, and rural practices.

To read more, go to Revcycle Intelligence.


What is the ROI Adoption in Radiology

By Dave Fornell | April 6, 2023 | Included in Radiology Digest – April 18, 2023

Radiology by far has the largest penetration of artificial intelligence (AI) in medicine, but with minimal or no reimbursement, hospital administrators may ask where the return on investment (ROI) is to justify AI spending. Radiology Business spoke to several key opinion leaders to find out their thoughts on the value of AI.

The U.S. Food and Drug Administration (FDA) has now cleared well over 500 market-cleared AI medical algorithms as of January 2023. The vast majority of these are related to medical imaging. This includes 396 radiology algorithms. Cardiology has the second largest number of approvals at 58, many of which also are specific to cardiac imaging. 

“We have seen from the U.S. FDA the number of cleared algorithms available for commercial use are escalating,” explained Bibb Allen, MD, FACR, chief medical officer of the American College of Radiology (ACR) Data Science Institute and a past ACR president. But, he said, the adoption rate has been very slow. This is partly due to hospitals wanting assurances that the AI will work as intended and has clear evidence it will improve workflow, reduce costs and improve patient care. There also is a lack of reimbursement to cover the cost of adopting AI.

“I think finding the right AI tools and the right value proposition for the institutions is the main thing,” Allen said. “On the payment and policy side, there are two reasonable arguments. As a radiologist, I believe it will provide us with safer and more effective care, whether that comes from decreases in turnaround times or decision support capabilities, or the identification of critical findings.

On the other hand, the payer might say ‘well wait a minute, we are already paying you, the radiologist and the expert, to make those same conclusions, so why should we on a fee for service basis provide additional payment?’ And I think that is going to be a struggle for health policy makers.”

Should AI gain reimbursement or is it just a practice expense?

The decision to adopt AI is not really up to the radiologist. Administrators or entire group practices must first figure out if AI adoption is worth the cost, explained Keith J. Dreyer, DO, PhD, chief science officer of the American College of Radiology (ACR)  Data Science Institute. Often, that decision lies with hospital or health-system executives who do not understand the day-to-day work of a radiologist. 

“There are not a lot of use cases today that have proven to a payer that AI is of value such that they are willing to reimburse the clinician who uses it. There is no reimbursement for PACS either, or for radiology information systems (RIS) or electronic health records (EHR), it’s just a practice expense,” Dreyer said. “So, thinking of AI as a full category of its own, but just as a technology, then the question is does this technology make you more efficient? Does it bring is some new action that can improve care or make it faster, so it is worth paying for it?”

Dreyer said the lack of reimbursement for AI might also dissuade health systems from spending more to purchase the technology. However, health systems need to consider if the technology can help enhance the workflow of radiologists to make them more efficient, or if AI could help improve patient outcomes. 

To read more, go to Radiology Business.
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