Claims Data Reveal Key Clues to Why Patients May Miss Lung Cancer Screening Exams
By Marty Stempniak | March 31, 2021
Lung cancer is the deadliest form of the disease, though radiologists can help catch this concern with proper screening using low-dose CT. Only 46% of patients actually stick to their annual exam schedule, however, with a few factors proving predictive, experts detailed on Tuesday.
In particular, being between the ages of 55-64 or 75-79, living in a rural area, and using Medicaid or fee-for-service Medicare were all associated with lower adherence. University of Colorado Anschutz Medical Campus researchers analyzed data from more than 9,000 patient encounters for the analysis and believe the findings could help practices boost compliance.
“Quantifying population-based adherence rates and understanding factors associated with annual adherence is a critical first step in improving screening adherence and ultimately reducing lung cancer death,” corresponding author Stephen Malkoski, MD, PhD, with the Division of Pulmonary Sciences and Critical Care Medicine at CU Anschutz, and co-authors wrote March 30 in JACR.
For the study, scientists looked to the Colorado All Payer Claims Dataset, targeting those who received a low-dose CT lung cancer screening between 2012-2018. They defined adherence as cases where there was a second claim for such imaging 10-18 months after the initial exam. Those parameters produced a set of more than 9,000 records, including nearly 3,100 patients who stuck to their screening schedule and 3,600 who did not. Another 2,400 were “unclassifiable,” since an insufficient amount of time had passed from the baseline exam.
Malkoski and colleagues found that about 46% of patients returned for another LDCT screening within 18 months. The adherence rate leapt to 53% if any return for screening was considered compliant (even if it was within less than 10 months), they noted. Higher healthcare usage and increased comorbidity burden were both associated with greater adherence, though the two factors were interdependent.
To read more, go to Radiology Business.
Medical Liability Premium Increase Draws Practice Viability Concern
By Hannah Nelson | March 31, 2021
Medical liability insurance premiums have begun an upwards trend after remaining relatively steady over the past ten years, according to a new American Medical Association (AMA) analysis that raises concern for practice viability and care access.
The report shows that there had been increasing stability in medical liability insurance premiums up to 2018, when 80.8 percent premiums stayed the same as the previous year. However, data from the past two years show that premium stability is slowing.
“Increases in medical liability premiums compound the economic stress on medical practices as the COVID-19 pandemic resulted in significant reductions to patient volume and revenue, and higher expenses for scarce medical supplies,” AMA President Susan R. Bailey, MD, said in a press release.
“Practice revenue has not fully recovered as the pandemic has stretched on and a protracted upward trend in medical liability premiums will threaten the viability of many practices that already face a difficult road to recovery,” Bailey continued.
In 2019 and 2020, the number of premiums that stayed the same as the previous year dropped to 68.4 percent and 60.8 percent, respectively. Additionally, there was an overall downward trend in the proportion of premiums that decreased year-to-year from 2011 to 2020. In 2020, 8.1 percent of premiums dropped from the previous year, compared to 30.3 percent of premiums that fell in 2011.
More medical liability insurance premiums increased in 2020 than in any year since 2005. In 2018, the proportion of premiums that went up was 13.7 percent. Then, the proportion jumped to 26.5 percent in 2019. The share grew once again in 2020, with 31.1 percent of premiums increasing from the previous year.
The report authors noted that this appears to be the beginning of an upward trend in premium increases that has not been observed in more than two decades.
To read more, go to Revcycle Intelligence.
Physician Practices Want More from Provider Relief Fund
By Jacqueline LaPointe | March 30, 2021
Future Provider Relief Fund distributions should prioritize allocation to physician practices struggling with the financial consequences of the COVID-19 pandemic, not just hospitals, physician groups are telling lawmakers.
Physicians who practice outside of hospital systems have invested thousands of dollars in infrastructure to support telehealth and COVID-19 testing and vaccination during the pandemic, America’s Physician Groups (APG) told Senator Chuck Schumer (D-NY) in a March 25th letter.
However, independent physicians “were not the focus of previous distributions of dollars” through the Provider Relief Fund, which instead went largely to hospitals, the group added.
“It is imperative that additional funding uses a more targeted approach to ensure that those providers that are most affected by the ongoing pandemic receive the funds needed to continue their efforts in serving their patient populations and assisting them with the resulting financial challenges that have affected areas of care,” APG wrote in the letter.
The group representing over 340 physician groups that employ or contract with approximately 195,000 physicians also asked for forgiveness of the loans provided by the accelerated and advanced payment programs and to delay the Medicare sequestration.
Signed into law in March 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act established the Provider Relief Fund. The Fund includes $178 billion, which HHS is to distribute directly to healthcare providers experiencing lost revenues and added costs because of the pandemic.
HHS has distributed approximately $148.4 billion to providers so far through general and targeted allocations, according to an analysis released last month by the American Hospital Association (AHA).
More of the funds went to hospitals with more private payer revenue and larger operating margins, a Kaiser Family Foundation (KFF) analysis from the start of the pandemic showed.
But independent physician practices have also suffered financially throughout the pandemic, APG stated.
According to APG’s numbers, total number of visits for all specialties has declined by as much as 7 percent compared to a baseline from the beginning of the pandemic in March 2020. Specialty care providers, such as pediatricians, physical therapists, and surgical specialists, saw the most impact.
Additionally, chronic Medicare patient visits in both fee-for-service and Medicare Advantage are down by 17 percent compared to the baseline among some APG members.
To read more, go to Revcycle Intelligence.
10 Survival Tips for New Radiologists
By Matt O’Connor | March 30, 2021
Transitioning from a resident or fellow to an independent radiologist isn’t easy, particularly given that current training programs don’t spend much time on the topic.
To prep new graduates for the clinical imaging world, a team of experts recently composed 10 tips based on firsthand experience and observations of other junior rads.
Robert M. Kwee, MD, PhD, with Johns Hopkins Hospital’s radiology department, and colleagues shared them Tuesday in the Journal of the American College of Radiology.
‘Skyrocketing Healthcare Costs’ Push Academic Workers to Organize, Ask for Transparency
By Nona Tepper | March 26, 2021
A faculty petition at The New School in New York denouncing “skyrocketing healthcare costs” during the pandemic has attracted the support of more than 600 signatories, reflecting the growing calls among workers, particularly academics, to increase transparency of the price self-insured employers pay for healthcare.
“Did self-insured employers make money? The short answer is yes, in the same way that health plans made a ton of money because of all the deferred care,” said Adam Block, a New York-based health economist and former CMS regulator.
More than half of all Americans receive healthcare from their employer, and the majority of businesses are self-insured, meaning that companies pay for their employees’ medical expenses. Over the past decade, the average annual premium employers paid for a family of four’s health benefits rose nearly 62% to $25,574 in 2020, according to the Kaiser Family Foundation. Employee health benefits consume more than $15 million annually per 1,000 workers. But in 2020, something historic happened: employers’ healthcare costs went down, as patients avoided the doctor’s office during the pandemic. One actuarial firm estimated that self-insured employers experienced a 4% year-over-year reduction in worker healthcare costs.
“There’s going to be some pent-up demand, but it does not make up for the amount that [insurers] earned in Q2, when basically nobody was going to the doctor, except to be
hospitalized for COVID,” Block said. “Health plans had net profitability in 2020 that was better than in most other years and self-insured employers would be the same.”
To read more, go to Modern Healthcare.