Radiology Digest: News from the week of April 22, 2022.
Links to 20 New and Revised American College of Radiology Appropriate Use Criteria
By Dave Fornell | April 20, 2022 | Included in Radiology Digest – April 22, 2022
The American College of Radiology (ACR) recently released 5 new topic areas and 15 revisions to existing topics in the ACR Appropriateness Criteria. The appropriate use criteria guidance provides support for referring physicians and other providers to enhance radiologic care by outlining the best imaging modality to answer specific clinical questions. This can help reduce the need for additional testing.
This latest update includes five new and 15 revised topics. The new areas include ataxia-child, fibroids, hernia, staging and follow-up of esophageal cancer, and imaging after breast surgery.
Each topic has a narrative, an evidence table and a literature search summary. Many of the topics also have patient-friendly summaries. Links to all the new and revised radiology imaging appropriate use sections can be found below.
“Referring physicians and other healthcare providers depend on the ACR Appropriateness Criteria for consistency and standards in providing quality patient radiologic care,” said Mark E. Lockhart, MD, MPH, chair of the ACR Committee on Appropriateness Criteria. “This tool is valuable for patients as well, providing them with easy-to-understand summaries that help explain which tests are appropriate for their situation.”
Lockhart is the chief of genitourinary (GU) radiology and a professor in the abdominal imaging section at the University of Alabama at Birmingham.
The ACR Appropriateness Criteria includes 221 diagnostic imaging and interventional radiology topics. It also offers more than 1,050 clinical variants, covering 2,900 clinical scenarios.
To read more and access links, go to Radiology Business.
AI-based Mammo Screening Protocol Reduces Radiologist Workload By 62%
By Hannah Murphy | April 19, 2022 | Included in Radiology Digest – April 22, 2022
Experts are once again highlighting the benefits of artificial intelligence (AI) in the field of radiology, citing that an AI-based mammogram screening protocol has similar sensitivity to radiologists for cancer detection.
Screening mammograms account for a substantial amount of a radiologists’ workload. Although screening mammograms are known to reduce breast cancer mortality, the majority of exams are negative. In these low prevalence conditions radiologists are more likely to miss subtle signs of malignancy, resulting in increased rates of false-negative reads. Artificial intelligence systems have proven their benefit as a complimentary decision support tool in these scenarios when radiologists are overburdened with mounting workloads.
This was the case in a new retrospective simulation study published recently in Radiology.[1] In it, researchers reported that an artificial intelligence system was able to interpret more than 114,000 screening mammograms using a reading protocol with high sensitivity and specificity, which resulted in a 62.6% workload reduction for radiologists.
“Such systems may also improve the performance and productivity of radiologists when used to support decisions,” corresponding author Martin Lillholm, from the Department of Computer Science at the University of Copenhagen in Denmark, and co-authors explained. “These circumstances motivate investigations into making population-based screening programs more effective using AI and potentially improving screening outcomes, while maintaining an equally high safety level for screened women.”
The AI system detected normal, moderate-risk, and suspicious mammograms consistent with two radiologists. Using the system, the mammograms were scored from 0 to 10 for risk of malignancy, with the higher scores correlating to increased risk. During the simulation, mammograms with scores less than 5 (considered normal) were excluded from radiologist reads. Suspicious mammograms were recalled, and the protocol was also applied to each BIRADS density.
To read more, go to Health Imaging.
Neiman Health Policy Institute Finds 18% Increase in Radiology Employed Non-physician Providers
April 19, 2022 | Included in Radiology Digest – April 22, 2022
A new Harvey L. Neiman Health Policy Institute study found that between 2017 and 2019 the number of non-physician providers (NPPs, which includes nurse practitioners and physician assistants) employed by radiology-only practices increased 18%. This increase was associated with more NPPs employed per practice, as well as an 11% increase in the number of practices employing them.
This Journal of the American College of Radiology study was based on Centers for Medicare and Medicaid Services (CMS) databases of doctors and clinicians who participated in Medicare.[1] Radiology practices were defined as practices in which all affiliated physicians were radiologists. Two-thirds of U.S. radiologists currently practice in radiology-only practices.
The study found that radiology practices were more likely to employ NPPs when they employed more than 50 radiologists, were urban located, had above average interventional radiology specialization, and employed more earlier-career radiologists.
“As radiology practice and professional society leaders seek to better understand and react to apparent trends in NPPs, our findings about their evolving use within the specialty could inform these efforts,” explained senior author Richard Duszak, Jr., MD, professor and vice chair for health policy and practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Neiman HPI affiliate senior research fellow.
“Given how NPP scope of practice is largely defined by state laws and regulations, our observation of substantial variation in radiology practices’ use of NPPs across state lines was not surprising,” said first author Stefan Santavicca, senior data analyst in the Department of Radiology and Imaging Sciences at Emory University School of Medicine. Specifically, he said the share of practices with NPPs in 2019 was 15% overall but was 17% for urban practices and 7% for rural practices.
The increase in the share of urban practices with NPPs increased from 10% to 17% between 2017 and 2019, but over the same period Santavicca said it increased from 5% to 7% for rural practices. “Given reduced local access to both diagnostic and interventional radiologists in rural counties across the U.S., we found it interesting that urban, rather than rural, radiology practices were much more likely to employ NPPs to meet their clinical service needs,” he explained.
To read more, go to Radiology Business.
How Hospitals Are Navigating Doctor, Patient Interoperability Challenges
By Jessica Kim Cohen | April 19, 2022 | Included in Radiology Digest – April 22, 2022
One year ago, a tranche of new healthcare regulations designed to get data moving freely from providers to patients took hold.
The long-awaited regulations, requirements of 2016’s landmark 21st Century Cures Act, have been expected to force a “culture change” in healthcare, according to Micky Tripathi, who leads the Health and Human Services Department agency tasked with implementing many of the Cures Act’s data-sharing requirements.
“That is starting to slowly happen,” said Tripathi, chief of HHS’ Office of the National Coordinator for Health Information Technology. “Just like with anything, culture change takes a lot. It doesn’t happen overnight.”
ONC received 274 complaints about healthcare entities allegedly blocking access to patient data from April 5, 2021—when the agency’s data-sharing rule went into effect—through January 2022, averaging roughly one complaint per day. Most complaints came from patients, which Tripathi said suggests that consumers are becoming aware of the requirements.
To read more, go to Modern Healthcare.
American Society of Nuclear Cardiology Urges Congress to Speed Prior Authorizations, Repeal AUC Mandate
By Dave Fornell | April 18, 2022 | Included in Radiology Digest – April 22, 2022
The American Society of Nuclear Cardiology (ASNC) is lobbying Congressional leaders to take action on prior authorization and call for the repeal of the Medicare Appropriate Use Criteria (AUC) mandate.
Over the past few weeks, members of ASNC’s Health Policy Committee have held meetings with their members of Congress. One of the key messages to Congress has focused on requesting co-sponsorship of the Improving Seniors’ Timely Access to Care Act (S. 3018 and H.R. 3173). The bill is aimed at protecting seniors citizens from delays and interruptions in care that result from the prior authorization process in the Medicare Advantage (MA) program.
The legislation would require electronic prior authorization, improve transparency for beneficiaries and providers, and increase oversight from the Centers for Medicare and Medicaid Services (CMS) on how MA plans use prior authorization. The ASNC said the act recognizes that physicians should be focused on patient care, not on navigating the prior authorization process to get patients their recommended tests, procedures and treatments.
The ASNC said this legislation has strong bipartisan support, including more than half of the House of Representatives. ASNC is encouraging lawmakers who are already cosponsors to ask for committee action on the legislation this year, which would create a path for final passage.
“It’s not the appropriate use criteria we have an issue with, it’s the decision support mandate, because it is overly prescriptive and there is a hassle factor and a time factor involved,” explained Randall Thompson, MD, immediate past ASNC president, attending cardiologist at St Luke’s Mid-American Heart Institute, and professor of medicine, University of Missouri, Kansas City School of Medicine.
Thompson said the mandate would take away resources from efforts in quality improvement by requiring additional administrative burden. “This is at a time when most of us are struggling with staffing just like the rest of the economy is,” he said.
To read more, go to Radiology Business.
Experts Highlight ‘Suboptimal’ Rates of CMS-required Shared Decision Making Encounters Prior to LDCT
By Hannah Murphy | April 18, 2022 | Included in Radiology Digest – April 22, 2022
Despite the U.S. Centers for Medicare and Medicaid Services requiring counseling encounters prior to lung cancer screening, shared decision-making remains under documented.
A study recently published in the Journal of the American College of Radiology disclosed that less than half of individuals who underwent CT lung cancer screening (LCS) in their cohort had the required shared decision-making encounter documented in their electronic health record (EHR).[1] Additionally, only 21.8% of the records included all Medicare-designated components. Experts involved in the research suggested these findings underscore the need for better implementation of shared decision-making (SDM) models, as well as more thorough counseling documentation, as coverage for LDCT is dependent on these factors.
“SDM is a fundamental tenet of LCS, intended to ensure that an individual’s preferences are incorporated into the LCS decision through a balanced discussion of an individual’s risk versus benefits,” corresponding author Louise M. Henderson, PhD, from the Department of Radiology at the University of North Carolina, and co-authors explained. “The SDM visit is a multicomponent patient-clinician encounter, which per Medicare coverage requirements includes the use of an LCS decision-making aid, discussion of benefits and potential harms of LCS, counseling on the importance of LCS adherence, discussion of comorbidities, including an individual’s ability or willingness to undergo treatment for lung cancer, and counseling on smoking cessation and maintenance.”
This study analyzed the electronic health records of 580 individuals who underwent lung cancer screenings at 4 LCS centers between February 2015 and June 2020. Through these records, experts examined the frequency of EHR-documented SDM, as well as adherence to all Medicare-designated SDM components.
Out of the 580 screened individuals, 243 (41.9%) had EHR-documented SDM. Self-reported SDM was higher, occurring in 295 (71.1%) of those who completed the cancer screening. However, only 53 (21.8%) of the records included all Medicare-designated components.
Specialists, such as pulmonologists, were more likely to document SDM, the researchers noted. Similar trends were observed in referring clinicians treating patients with greater body mass and in current or former smokers.
To read more, go to Health Imaging.
Medscape Physician Compensation Report: 2022 Incomes Gain, Pay Gaps Remain
By Leslie Kane | April 15, 2022 | Included in Radiology Digest – April 22, 2022
Last year was a welcome reprieve for many physicians; practices reopened, patients ventured out, and elective procedures ramped up. Still may physicians struggled with a tougher workload, having to see more patients, taking pay cuts, and having less staff to work with.
Over 13,000 physicians in more than 29 specialties told us how their compensation fared, how they now feel about being physicians, how they’ve been supplementing their income, and how they’ve been paying for their own healthcare.
To view the report, go to Medscape.
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