Radiology Digest – April 23, 2021

April 23, 2021

Radiology Digest: News from the week of April 23, 2021.

Radiologists Demand Greater Transparency from CMS in Merit-Based Incentive Payment System

By Marty Stempniak | April 21, 2021 | Included in Radiology Digest – April 23, 2021

Radiologists are among dozens of physician groups demanding greater transparency from the federal government in its administration of the Merit-Based Incentive Payment System.
The Centers for Medicare & Medicaid Services recently granted hardship relief for clinicians in the quality payment program, due to the COVID-19 pandemic. Groups including the American College of Radiology and Society of Interventional Radiology thanked CMS for that lifesaver but are urging the agency to go further in helping docs navigate MIPS.

In an April 13 letter to the acting head of CMS, physicians asked the feds to “immediately” release benchmark data from 2018-2020, and provide real-time, rolling updates from the current measurement year.

“We are very concerned that CMS has never published MIPS cost measure benchmarks, despite using these metrics to evaluate physician and group performance in the MIPS Cost Performance Category,” ACR, the American Medical Association and numerous others wrote to Administrator Elizabeth Richter. “Because the benchmarks have not been published, physicians cannot compare their spending to the target in the current performance period or prior periods, nor can they determine whether the benchmarks are fair and valid, accounting for variations in resource use that are within a physician’s control.”

The physician groups are “particularly concerned” that the dearth of data could be concealing issues with cost measures or benchmarks. They worry that measures might be capturing “little variation in spending” among the quality program, leading to rads and other docs being penalized for “merely one outlier case.”

“We would also like to understand the impact of the COVID-19 [public health emergency] on the cost measures, including the benchmarks, and cannot make this assessment without this vital information,” they added.

Finally, the groups also want CMS to release quality measure benchmarks at least 30 days prior to the start of the performance period. They’re asking the agency to “hold harmless” physicians by moving to pay-for-reporting when significant updates to benchmarks are made during the performance period.

You can read the entire letter from the 45 physician groups here. The American College of Radiology alerted its members about the request in a new update published Wednesday, April 21.

To read more, go to Radiology Business.

Only 30% of Radiologists Currently Using Artificial Intelligence as Part of Their Practice

By Marty Stempniak | April 21, 2021 | Included in Radiology Digest – April 23, 2021

Despite growing excitement around artificial intelligence in imaging, only about 30% of radiologists are currently using the technology as part of regular clinical work, according to survey results released Tuesday.

Larger practices are more likely to deploy AI than their smaller counterparts, with most tapping it for aid in interpretation. Intracranial hemorrhage, pulmonary emboli and mammographic abnormalities are some of the most common targets, the American College of Radiology’s Data Science Institute found in its recent poll of the field.

“Concerns over inconsistent performance, potential decrease in productivity, and lack of reimbursement have made the actual use of AI in clinical practice modest,” first author Bibb Allen Jr., MD, chief medical officer of the institute, and colleagues wrote April 20 in JACR. “And perhaps not unexpectedly, larger practices, many of which may be academic centers with dedicated data science research activity, are more likely to use AI than smaller ones,” they added.

For the Data Science Institute’s inaugural annual survey, Allen et al. sent a brief electronic survey to ACR members via email, with info gathered between April and May of 2020. All told, 1,427 radiologists responded to the initial survey, while 366 who said they used AI in practice filled out a follow-up survey.

Along with larger entities, about 20% of practices with fewer than five members said they use AI. Out of those not deploying the technology, 80% said they “see no benefit.” One-third of respondents said they cannot justify the expense, or that the purchasing decision was beyond their control. Some expressed concerns about decreased productivity. More than 70% of respondents hold no plans to pay for AI, while 20% see themselves doing so within the next five years.

“Radiologists using AI believe AI adds value to their clinical practice, but due to inconsistent performance, they would not trust AI for autonomous clinical use,” the authors noted. “As barriers to implementation are mitigated, there is opportunity for future growth of AI in clinical practice,” they added.

You can read much more about the survey in the Journal of the American College of Radiology here.

Patients Still Waiting for Clearer Radiology Reports, Particularly When It Comes to MRI Exams

By Matt O’Connor | April 19, 2021

Patients are still having a hard time understanding their radiology reports and are particularly confused about those pertaining to MRI exams, according to findings published Monday.

More healthcare organizations are giving patients access to their imaging results online via patient portals. And newly enacted federal interoperability regulations mandate providers proactively release such personal health information or face financial penalties.

But according to radiology report questions posted online to sites such as Reddit and Wiki Answers, the gap between current practice and what patients want is still a problem. In fact, more than one-quarter of the questions wanted help understanding reports, with a number of others requesting presentation changes.

Providing access to clear reports can enhance patient-radiologist interactions, decrease anxiety and facilitate care. The authors indicated creating newly designed documents must be a top priority and include a few specific features.

“From our data, patients want to improve their understanding of the report by enhancing image visualization, report representation, resources, and preference,” Mohammad Alarifi, PhD, with the University of Wisconsin Milwaukee College of Health Sciences and colleagues wrote April 19 in Insights into Imaging.

To read more, go to Health Imaging.

FDA Adjusts Policy for Radiology Software—Ditching PACS for MIMPS

By Matt O’Connor | April 19, 2021 | Included in Radiology Digest – April 23, 2021

The U.S. Food & Drug Administration has adjusted the descriptions for three radiology software functions to more accurately align with recent regulatory changes, the organization announced Monday.

The final rule, published April 19 in the Federal Register, outlines software functions that were previously classified as medical devices under the 21st Century Cures Act. Overall, it includes changes to eight software functions.

“In other words, in this action, FDA is amending eight classification regulations so that the regulations conform to the medical software provisions of the Cures Act and reflect FDA’s current statutory authority,” the federal oversight group explained.

Radiologists should take note of three specific modifications:
• Medical Image Storage Devices
• Picture Archiving and Communication Systems
• Medical Image Communications Devices

All changes are effective immediately. Read the entire final rule here.

To read more, go to Health Imaging.

Radiologist Salaries Slide to $413,000 as Specialty Among Those Hit Hardest by Pandemic

By Marty Stempniak | April 19, 2021 | Included in Radiology Digest – April 23, 2021

Radiologist salaries slid about 3% in 2020, knocking the specialty out of the top 5 highest paid, according to the results of a new salary survey released Friday.

Physicians in imaging earned roughly $413,000 in full-time pay last year, down from $427,000 in the previous survey, Medscape reported. Plastic surgeons led the way at $526,000, followed by orthopedists ($511,000) and cardiologists ($459,000).

Radiology wasn’t alone in suffering salary setbacks during the pandemic as physicians grappled with job losses, fewer hours and reduced patient volumes. Otolaryngologists and allergists/immunologists saw the biggest pay drop at 9%, Medscape found, while pulmonologists, physical medicine specialists and gastroenterologists all matched radiologists’ 3% drop.

“Physicians experienced a challenging year on numerous fronts, including weathering the volatile financial impact of lockdowns,” Leslie Kane, senior director, Medscape Business of Medicine, said April 16. “COVID took a terrible emotional toll on physicians and healthcare workers, and many are still struggling financially. But our findings showed that physicians will innovate and change quickly to meet the needs of patients through extremely difficult times,” she added later.

Among radiologists and other physicians who saw pay decreases, 92% blamed the pandemic. The other 17% cited factors unrelated to COVID-19 including maternity leave or voluntarily decreasing hours to gain more free time. Among respondents, 22% said they suffered a reduction in hours, 15% received no annual raise, and 13% worked reduced hours. About 65% of specialists said their original hours and pay had been restored at the time of the survey.

More than half of specialists surveyed said they were eligible for an incentive bonus in 2020. Radiologists scored roughly $69,000 in extra pay on average, good for sixth place among physician types, with orthopedists topping the list at $116,000.

To read more, go to Radiology Business.

Payers, Providers Clash Over Telehealth Reimbursement as Congress Mulls Changes

By Jessie Hellmann | April 16, 2021 | Included in Radiology Digest – April 23, 2021

As members of Congress decide how to expand access to telehealth after the pandemic, one of the biggest questions has centered around how much Medicare providers should be paid for virtual care.

While the rates Medicare pays for telehealth and in-person services are currently the same, that arrangement—along with several other CMS telehealth waivers—expires at the end of the public health emergency absent Congressional action.

Now providers are pressuring Congress and CMS to keep payment parity—or something close to it—after the pandemic ends, but some government officials and insurers worry the fee-for-service structure of the traditional Medicare program will incentivize overutilization of telehealth visits. Payers view changing Medicare’s payment model around telehealth as an opportunity to push value-based care forward in the healthcare industry, which they say will result in lower overall healthcare costs and better health outcomes.

“A doctor’s time is a doctor’s time whether it is virtual or if it’s in-person,” said Kyle Zebley, director of public policy for the American Telehealth Association, which supports a “fair rate” that accounts for the costs of maintaining and continuing to improve a telehealth program.

A 2020 article in the Journal of American Medical Association pegged Medicare reimbursement for audio and video calls at just $15 before COVID-19, a rate that researchers said did not even cover the cost of submitting the insurance claim.

“We recognize that not having brick and mortar costs should be a factor in terms of telehealth reimbursement, but we also think that there’s a level of investment required to get this technology off the ground and continue to innovate,” Zebley said.

The American Medical Association, Federation of American Hospitals and other groups are also pushing for increases in pay for telehealth services, compared to what Medicare paid pre-pandemic.

Of course, none of that matters unless Congress moves to expand access to telehealth in Medicare post-pandemic.

To read more, go to Modern Healthcare.

Renewal of Determination That A Public Health Emergency Exists

April 15, 2021 | Included in Radiology Digest – April 23, 2021

As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective April 21, 2021, the January 31, 2020, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, that a public health emergency exists and has existed since January 27, 2020, nationwide.

To read more, go to the PHE website.

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