Radiology Digest – April 4, 2023

March 30, 2023

Radiology Digest: News from the week of April 4, 2023.
Federal Judge Strikes Major, National Blow to Cancer Screening Coverages
By Tom Greeson | March 30, 2023 | Included in Radiology Digest – April 4, 2023

A federal judge for the U.S. District Court for the Northern District of Texas vacated nationally the Patient Protection and Affordable Care Act’s (ACA’s) preventive service insurance mandate for services recommended by the U.S Preventive Services Task Force.

Section 2713 of the Patient Protection Affordable Care Act has mandated that group health plans and health insurers cover a long list of preventive health services like cancer screenings, immunizations, and contraceptives without out-of-pocket, co-insurance and deductible costs to patients.

In a ruling this week in Braidwood Management, Inc., et al. v. Xavier Becerra, et al. (formerly Kelley et al, v. Becerra, et al.) U.S. Judge Reed O’Connor enjoined requiring employers to provide coverage for these preventive health services, as well as for the HIV prevention drug PrEP. 

Judge O’Connor ruled last September that because the members of the U.S. Preventive Services Task Force are not Senate confirmed, the task force is not constitutionally permitted to wield such authority to determine coverages subject to the ACA’s mandate.

But in his September ruling, O’Connor requested supplemental briefings from the parties as to whether the government should be entirely blocked from requiring health plans to cover services identified by the task force, or whether his decision should apply solely to the plaintiff, Braidwood. Despite briefs from organizations like the American Cancer Society and the American Medical Association, he is imposing his injunction broadly.

As we wrote earlier here and here, Section 2713 of the ACA mandates that group health plans and health insurers cover a long list of preventive health services like cancer screenings, immunizations and contraceptives without out-of-pocket, co-insurance and deductible costs to patients.

The ACA’s list of preventive services recommended by the USPSTF include many offered by diagnostic imaging suppliers, like breast and lung cancer screenings that have received a rating of ‘A’ or ‘B’ from that task force. 

The impact of this decision could be catastrophic to the efforts to detect cancer early for millions of patients unless employers and health plans decide voluntarily to continue offering such preventive health services without out-of-pocket costs.

To read more, go to Viewpoints.

UnitedHealthcare Cutting 20% of Prior Authorizations
By Andrew Cass | March 30, 2023 | Included in Radiology Digest – April 4, 2023

UnitedHealthcare is moving forward with a plan to eliminate 20 percent of its current prior authorizations and implement a national gold-card program. 

Code reductions will begin this summer and continue through the rest of the year for most commercial, Medicare Advantage and Medicaid plans, according to a March 29 UnitedHealthcare news release. 

The national gold-card program will be implemented in early 2024, according to the release. The program will apply to most UnitedHealthcare members across commercial Medicare Advantage and Medicaid plans. Qualifying provider groups will follow a simple notification process for most procedure codes rather than the prior authorization process. 

“Prior authorizations help ensure member safety and lower the total cost of care, but we understand they can be a pain point for providers and members,” Anne Docimo, MD, chief medical officer of UnitedHealthcare, said in the release.

“We need to continue to make sure the system works better for everyone, and we will continue to evaluate prior authorization codes and look for opportunities to limit or remove them while improving our systems and infrastructure. We hope other health plans will make similar changes.”

American Medical Association President Jack Resneck Jr., MD, told The Wall Street Journal March 29 that he is cautiously optimistic about UnitedHealthcare’s changes but wants to see the details to be sure they will bring meaningful improvements. 

Molly Smith, the American Hospital Association’s group vice president for policy, told Becker’s that while AHA has not yet seen the specifics, “cutting back on unnecessary prior authorization is a much-needed step forward.” She added that AHA will work with its members to monitor the implementation of the policies to “ensure they do indeed remove unnecessary barriers to care for patients and wasteful administrative burden on providers.”

Two lawmakers who sponsored a Medicare Advantage prior authorization reform bill that passed the House last year applauded UnitedHealthcare’s announcement.
To read more, go to Becker’s Payer Issues.

Breast Density Notification Laws: How will the FDA’s Updates Affect Radiologists and Referring Providers?
By Hannah Murphy | March 30, 2023 | Included in Radiology Digest – April 4, 2023

Earlier in March, the U.S. Food and Drug Administration released updated regulations pertaining to breast density notifications, which now require that facilities notify women of their breast density category following a mammogram. 

Updates to the Mammography Quality Standards Act (MQSA) of 1992 were applauded by advocates who have been pushing for such changes in breast density reporting for years, but the changes also left some wondering what comes next. 

To get a better idea of how these latest updates will affect patients, referring providers and radiologists, and what each group can do to prepare for the day the changes take hold, Health Imaging spoke with two individuals who are deeply rooted in the women’s imaging community—JoAnn Pushkin, executive director of and Stamatia Destounis, MD, managing partner of Elizabeth Wende Breast Care and chair of the ACR Breast Imaging Commission.

What do the updates mean for breast density notification requirements? 

To understand how the updates might impact providers and patients, it’s important to first understand exactly what has changed. 

Starting in September 2024, the FDA will require that facilities notify patients of their breast density status—whether they are dense or not dense—following a mammogram. What this means for the patient must be explained in lay language that is easy to understand (the FDA has provided specific language for this).

The new amendments also require that radiologists classify patients’ breast density using one of the four BI-RADS categories on imaging reports. 

Facilities that do not comply could be subject to a citation from the FDA. 

While most states have some form of density notification laws in place, these requirements vary widely, and some populous states—Connecticut, Louisiana, Maryland, Missouri, New Jersey, Texas—do not require that women be notified at all if they have dense breast tissue.

Given the lack of continuity to date, the FDA’s updated density notification requirements could spur an onslaught of questions not only from patients but also from referrers.

To read more, go to Health Imaging.

Paltry Use of CT for Lung Cancer Screening Persists Across All Payer Types
By Marty Stempniak | March 29, 2023 | Included in Radiology Digest – April 4, 2023

Uptake of CT-based lung cancer screening is miniscule, regardless of a patient’s health plan, according to a new analysis published Wednesday in the Journal of the American College of Radiology [1].

Among more than 1 million enrollees eligible for such exams, only about 3.2% were actually imaged for lung cancer in 2017.

That included 1.7% of patients covered by commercial insurers, 3.4% of those in traditional fee-for-service Medicare and 4.6% of individuals holding advantage plans.

Those residing in remote geographies, along with Black patients covered by traditional Medicare, also were much less likely to undergo low-dose CT, the data show.

“Although screening rates were low across all subgroups examined, there appear to be substantial disparities in LDCT usage among rural nonwhite populations,” Danny R. Hughes, PhD, with the College of Health Solutions at Arizona State University, and co-authors concluded. “Although LCS rates are increasing, albeit slowly, now is the time to identify disparities and underutilization across states and within the population groups eligible for screening. Efforts specifically targeting historically vulnerable populations could present opportunities for outsized gains to public health.”

Investigators utilized smoking-rate data from the County Health Rankings to help estimate eligibility numbers. They tied that together with information from two large databases, representing 5% of nationwide Medicare fee-for-service enrollees and 100% of those covered by large commercial and Medicare Advantage carriers.

The criteria turned up a total of 1,077,142 individuals eligible for lung cancer screening. Uptake was lower among females (1.5% to 4%), patients aged 75 to 77 (0.6% to 2.9%), rural residents (1.9% to 3.6%) and in western parts of the U.S. (1.2% to 3.6%). Screening also was higher for white patients covered by FFS Medicare (3.7%) when compared to their Black (2.2%) and other nonwhite counterparts (1.7%). Race-related data was not available from commercial plans.

Regardless of payer, those residing in northeastern parts of the country saw much higher rates of uptake compared to other geographies, possibly attributable to greater availability of accredited facilities.

To read more, go to Radiology Business.

‘Quite Impressive’: ChatGPT Generates a Nuclear Medicine Report
By Hannah Murphy | March 27, 2023 | Included in Radiology Digest – April 4, 2023

ChatGPT recently produced a radiology report that experts described as “quite impressive,” prompting them to suggest that the artificial intelligence chatbot could have a promising future as an assistive tool for radiologists. 

In a new paper in the Journal of Nuclear Medicine, Irène Buvat, PhD, of the Inserm Laboratory of Translational Imaging and Oncology in France, and Wolfgang Weber, MD, PhD, from the Technical University of Munich in Germany, described their experience of working with ChatGPT to generate a radiology report based on specified metrics [1].
Buvat and Weber presented the chatbot with several questions related to nuclear medicine, eventually tasking it with generating a PET/CT report on a patient with suspected lung cancer to demonstrate how it could potentially be utilized in radiology in the future. 

“The bot can be asked to adopt a specific style, such as Shakespearean or journalistic language,” the experts explained. “Its knowledge is impressively broad, including aspects of medicine and medical imaging.” 

In January 2023, the experts asked ChatGPT to write a PET/CT report for a patient with suspected lung cancer. They informed ChatGPT that the patient’s scan showed a hypermetabolic mass in the right upper lobe of the lung and hypermetabolic lymph nodes in the right hilar and left lower paratracheal region; they also specified that TNM stage should be included in the report. 

The generated report included indication, findings laid out numerically, TNM stage, impression and follow-up recommendations. This was all generated within just a few seconds and without prior preparation outside of its own extensive dataset, the authors wrote.

The experts noted that although the chatbot stops short of being “the perfect assistant,” its skills and knowledge are impressive. 

Based on their experience with ChatGPT, Buvat and Weber suggested that chatbots and AI could be beneficial to radiologists by helping to “cope with ever-increasing workloads, freeing up time to devote to patients and colleagues and to expend more energy on tasks that require unique and advanced expertise.” 

Learn more about the writers’ discussion with ChatGPT here. 

To read more, go to Health Imaging.

Settlement with DOJ Offers Compliance Reminder to Radiology Teaching Programs
By Tom Greeson | March 27, 2023 | Included in Radiology Digest – April 4, 2023

Last week, U.S. Attorney’s Office for the Northern District of Iowa and the University of Iowa (UI) entered into a settlement agreement to resolve allegations that UI’s academic medical center in Iowa City, Iowa, had submitted certain improper claims for payment to the Medicare program.

The allegations related to claims for diagnostic radiology interpretations performed by resident physicians which were submitted under an attending teaching physician’s billing number.

The government alleged that the review of the residents’ interpretations by the teaching physicians did not satisfy government payment requirements for such teaching physician services. Under the terms of the settlement agreement, UI increased compliance training and the payment of $16,444 to the United States.

Quoting the press release: “Specifically, the government alleged that it had certain civil claims against UI arising from its submission of claims for payment for resident x-ray interpretations, where review by an attending physician did not satisfy the requirements of 42 C.F.R. § 415.180, between the period July 2018 to May 2020.

Under 42 C.F.R. § 415.180, a Medicare payment regulation identifying requirements for the interpretation of diagnostic radiology in a teaching setting, physician fee schedule payment may be made for x-ray interpretations if the interpretation is reviewed or performed by a physician other than a resident.”

Medicare rules expect that diagnostic imaging interpretations performed by resident be billed as physician services only when the attending teaching radiologist also personally reviews images and the resident’s interpretation and either “agrees with it or edits” the findings.

It is not permissible for teaching physicians to only sign off on resident’s interpretations without documenting their own physician work. See Medicare Claims Processing Manual, Chapter 12, § 100.1.2 (A)(6).

Despite the relatively small amount of the UI settlement agreement, it provides an important compliance reminder to all radiology teaching programs. Attending radiologists must personally review imaging examinations and their resident’s radiology reports, and they must document their agreement with the report, or document that they edited the report, in order to be eligible to bill for these professional services. 

To read more, go to Viewpoints.

‘A Turning Point’: Inside the Federal Push to Measure Social Determinants for the First Time
By Jakob Emerson | March 27, 2023 | Included in Radiology Digest – April 4, 2023

CMS is in the process of creating a “universal foundation” of quality measures, setting the stage for the first time the federal government has tracked social determinants of health across all of its healthcare programs.

“This is a major shift and really a turning point in a number of ways for our federal approach to healthcare,” Gary Price, MD, president of the nonprofit Physicians Foundation, told Becker’s.

CMS shared in February that the universal foundation of 23 measures will function as a base for which programs can add additional aligned or program- and population-specific measures over time. The preliminary measurement categories for adults include wellness and prevention, chronic conditions, behavioral health, seamless care coordination, person-centered care and equity.

The measure set focused on SDOH was proposed by the Physicians Foundation and was first adopted by CMS last year for the Hospital Inpatient Prospective Payment System, starting voluntarily in 2023 and as a requirement in 2024.

“CMS also acknowledged the fact that current measures can lead to inefficiencies at the point of care for those of us delivering, and they gave a nod toward making sure that as they build this new system of measurements, there’s concern for the efficiency of how that data is gathered,” Dr. Price said. “That’s very important.”

The movement to standardize quality measures is 20 years in the making, according to Dr. Price. There’re currently more than 20 federally managed healthcare programs, along with different payment and care delivery systems, which makes quality measurements very inefficient and confusing.

Though many health systems and physician groups already measure SDOH, universal federal acknowledgement and data collection around the issue has been a struggle.

“Although well-intentioned, I think a lot of current measures have shifted our focus away from things that truly matter,” Dr. Price said.

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

Radiology Rises Into 10 Highest Paid Specialties with Average Compensation of $503,564
By Marty Stempniak | March 24, 2023 | Included in Radiology Digest – April 4, 2023

Radiology has risen into the 10 highest paid physician specialties, according to data released by Doximity on Thursday.

The $503,564 average annual salary puts radiologist’s 10th on the list for 2022, with surgical specialties filling out the leading six. Those include neurosurgeons at No. 1 ($788,313), followed by specialists in thoracic, orthopedic, plastic, vascular, and oral and maxillofacial surgery. Radiation oncologists, cardiologists and urologists round out the top 10.

This number represents a roughly 1.6% uptick from the radiologist salary figure recorded in the previous Doximity survey ($495,451), released in December 2021, when the specialty placed 12th among the highest paid doc types. Radiology has since surpassed gastroenterology and otolaryngology on the list, Doximity data show.

Overall physician compensation actually dipped slightly year over year, down 2.4% compared to the previous survey. A 2% pay cut in Medicare—following two decades of flat payments—was likely a factor, authors noted. However, the job market still appears robust.

“While the average compensation for U.S. physicians stalled in 2022, the demand for physicians across the U.S. remains high,” Pete Alperin, MD, VP of product at Doximity and an associate professor of internal medicine at Dell Medical School in Austin, Texas, said in a statement. “Our report underscores the considerable pressures physicians face today, as they navigate a growing physician shortage, a tough economic environment, and a looming gender pay gap.”

On average, male doctors earned about $110,000 more than their female colleagues last year. That represents a roughly 26% pay divide between the sexes, and one that persists even when controlling for specialty, location and years of experience, the report noted. Doximity speculated that this may be contributing to burnout, with 92% of women in medicine reporting feeling overworked compared to 83% of men, the survey found.

This is the sixth annual Physician Compensation Report from the San Francisco-based online networking service for professionals, which was founded in 2010. Radiology has seen its average annual pay climb more than 23% since the inaugural survey published in April 2017, when Doximity placed radiology at ninth among the highest paid ($408,000). Dermatology has since fallen behind, going from seventh in the initial survey to 13th in the latest.

The report incorporates self-shared data from more than 190,000 physicians over a six-year period, including 31,000 in the most-recent poll.

To read more, go to Radiology Business.

Radiologists Outperform Commercially Available AI in PI-RAD Scoring
By Hannah Murphy | March 24, 2023 | Included in Radiology Digest – April 4, 2023

Artificial intelligence applications are often touted as tools that can improve the performance of radiologists with varying experience levels, particularly in lesser experienced readers, but new data indicate that AI does not always live up to its hype. 

Experts concluded this recently after testing a commercially available AI software said to improve Prostate Imaging-Reporting and Data System (PI-RADS) scoring consistency on bi-parametric MRI among radiologists with various levels of experience. They shared their findings in Insights into Imaging on March 20. 

“The PI-RADS provides guidelines for acquiring and interpreting prostate MRI, and the benefits of the system have been demonstrated in large-scale multi-center studies,” corresponding author of the new paper Deniz Alis, with the Department of Radiology at Acibadem Mehmet Ali Aydinlar University in Turkey, and co-authors wrote. “However, despite the PI-RADS, there are still non-negligible intra-reader and inter-reader differences in interpreting prostate MRI.” 

For the research, four different radiologists with experience levels ranging from two years to more than 20 years evaluated 153 bi-parametric prostate MRI scans both with and without the software.

Experts found that use of the software had minimal impact on readers’ initial evaluations. In fact, use of the software resulted in just six total score changes (less than 1%) across all four readers.  

Additionally, readers with more than five years of experience performed significantly better than the DL software in identifying clinically significant prostate cancer.  

The authors noted that their findings contradict prior research that utilized the same software. They suggested that this could be due to out-of-distribution data for the DL software, which could impair its performance. 

To read more, go to Health Imaging

Radiology Business Advocates Implore Congress to Remedy Worsening Physician Shortages
By Marty Stempniak | March 24, 2023 | Included in Radiology Digest – April 4, 2023

The Radiology Business Management Association and American College of Radiology are imploring Congress to take steps that would begin addressing a deepening shortage of physicians in the U.S.

Both societies spelled out concerns in a March 17 letter to leaders of the Senate Health, Education, Labor and Pensions Committee. Top executives at ACR and RBMA cited a 2021 report from the Association of American Medical Colleges. It estimated that the nation will face a shortage of radiologists and other specialists as high as 35,600 by 2024.

Other factors such as burnout and related radiologist retirements will only exacerbate these numbers, ACR’s William T. Thorwarth Jr., MD, and RBMA’s Robert T. Still contended.

“Physicians are a vital component of our nation’s healthcare infrastructure, and we have seen firsthand the worsening shortage of healthcare providers surrounding the impact of the COVID-19 pandemic,” the pair wrote to committee Chair Sen. Bernie Sanders, I-Vermont, and Ranking Member Sen. Bill Cassidy, MD, R-Louisiana. “A large portion of the physician workforce is also nearing traditional retirement age, which will soon contribute to the magnitude of national workforce shortages,” they added.

The letter comes in response to a HELP Committee request for information from the healthcare industry related to labor shortages. To begin remedying the deficit, ACR and RBMA are urging Congress to reintroduce the Resident Physician Shortage Reduction Act. Proposed in 2021, the bipartisan bill would significantly increase the number of Medicare-supported doctor training slots to help address a “growing nationwide physician shortage crisis,” lawmakers said at the time.

ACR and RBMA commended the federal government for committing to invest $1.8 billion to create 1,000 new residency slots—the first such increase in 25 years. However, the feds have placed numerous restrictions on this money, steering much of it toward primary care, mental health and rural geographies.

“While there is a definite need to focus on mental health and psychiatry, several specialties are missing out on new residency slots,” Thorwarth and Still wrote. “We recommend that Congress pass legislation to fund [graduate medical education] slots specifically designated for radiology].”

ACR highlighted the letter in a Thursday, March 23, news update. Bob Still on Friday called this a “critical issue” impacting the specialty.
To read more, go to Radiology Business.
Learn more about what Zotec Partners can do for your radiology practice here.