Radiology Digest – August 15, 2023

August 15, 2023

Radiology Digest: News from the week of August 15, 2023.

Rising Patient Volumes and Staffing Challenges: 7 Takeaways From a New Salary Survey of Radiologists, Techs and Administrators

By Marty Stempniak | August 9, 2023 | Included in Radiology Digest – August 15, 2023

Hiring challenges, swelling patient volumes and burnout continue to impact individuals at all levels of the imaging team, according to new survey data gathered by Radiology Business.

Across all titles surveyed—including radiologists, administrators and technologists—the top three biggest challenges in the specialty remained unchanged from our 2022 report. “Increased workload due to organizational changes” was the concern cited by most imaging professionals (rising from No. 2 in 2022). “Overall staffing levels” clocked in at second (it was No. 1 previously), while “patient volumes increased” remained at No. 3 year over year.

Amid frenzied competition for hiring, hospitals and practices are trying anything to attract radiologists: six-figure sign-on bonuses, flexible hours, months of vacation time and even immediate partnership tracks.

“We work with companies that source physicians to us for recruitment, and they’ve told us, in 20 years, they’ve never seen the market as competitive as it is right now for radiologists,” said Maegan Moore, director of physician recruitment and onboarding at Essential Radiology in Charlotte, North Carolina. “It’s incredible what the competition is right now.”

We gathered data for the 2023 Radiology Business Salary and Job Satisfaction Report earlier this year, reaching members of the imaging team via email.

To read about the 7 takeaways from the survey, go to Radiology Business.


What One Lending Company’s Hospital Contracts Reveal About Financing Patient Debt

By Noam N. Levey | August 8, 2023 | Included in Radiology Digest – August 15, 2023

With tens of millions of Americans burdened by medical debt, hospitals and other medical providers are increasingly shuttling their patients into loans serviced by banks, credit cards, and other financial services companies.

The arrangements have proven very profitable for lenders. But, as KFF Health News reported in November, the rise of the patient financing industry is often less welcome for patients, who can end up in loans that pile interest on top of what they owe for their medical care.

UNC Health in North Carolina, for example, historically did not charge interest on payment plans patients enrolled in to pay off their debts. But KFF Health News found that within two years of the public university health system signing a contract with AccessOne, a private equity-backed lender, to finance the plans, nearly half of its patients were in loans that charged interest.

The financial risks faced by patients and their families have sparked interest from federal regulators, including the Consumer Financial Protection Bureau. Last month, the Biden administration announced a new investigation into companies that finance medical care.
As federal scrutiny mounts, KFF Health News is posting contracts and other documents obtained through public records requests that illustrate AccessOne’s arrangements with three public systems: UNC Health, Atrium Health, and AU Health.

Both UNC Health and Atrium Health redacted significant portions of their contracts, including key terms. AU Health provided its contract without redactions.

The documents can be found at Kaiser Health News.


UnitedHealthcare Eliminating Prior Authorization for More than 60 Radiology Services

By Marty Stempniak | August 8, 2023 | Included in Radiology Digest – August 15, 2023

The nation’s largest commercial insurer is eliminating prior authorization requirements for more than 60 radiology services beginning next month.

UnitedHealthcare announced on Aug. 1 that the total reductions across all specialties represent nearly 20% of overall procedural volumes. The Minnetonka, Minnesota-based insurer said it will begin making the changes in its Medicare Advantage, commercial, Oxford and individual exchange plans on Sept. 1.

UHC first announced plans to make these modifications in March amid pressure from politicians and providers, urging insurers to stop blocking seniors from receiving essential healthcare services.

“This is part of our comprehensive effort to simplify the healthcare experience for our members and network healthcare professionals,” UnitedHealthcare said in this month’s announcement. “While prior authorization remains an important tool to address clinical quality and safety, as well as fraud, waste and abuse, we also know that fewer prior authorizations can help streamline care delivery.”

Impacted radiology services under commercial plans will include breast MRI with contrast, bone marrow imaging, gastroesophageal reflux studies and cardiac shunt detection, according to a list posted on UHC’s website.

Meanwhile, the list of eliminated codes for Medicare Advantage also includes myocardial perfusion SPECT (single photon emission computed tomography), also known as a cardiac stress test, used to assess the heart’s blood supply.

The American Society of Nuclear Cardiology highlighted the SPECT change in a news update emailed to members on Tuesday. ASNC said it has “strongly advocated” for streamlining prior authorization requirements, supporting the Improving Seniors’ Timely Access to Care Act.

“ASNC commends UnitedHealthcare for recognizing the burden prior authorization can place on patients and providers,” Friederike Keating, MD, chair of the society’s Health Policy Committee, said in an Aug. 6 announcement. “We are pleased efforts are underway to minimize this burden.”

UHC said it also plans to implement a national gold card program next year for provider groups that meet certain requirements. Those who qualify would follow a “simple administrative notification process” for most procedure codes, instead of the typical prior authorization steps.

The move mirrors a recent proposal from House lawmakers to implement a national gold card program.

To read more, go to Radiology Business.


6 Takeaways From the Latest ACR/RBMA Workforce Survey

By Marty Stempniak | August 8, 2023 | Included in Radiology Digest – August 15, 2023

Experts recently shared six takeaways from the latest American College of Radiology/Radiology Business Management Association Workforce Survey, covering topics including practice ownership, part-time physician duties and diversity gains.

The survey was conducted in fall of 2021, receiving more than 1,700 responses from individuals in the two associations’ member databases. Respondents included more than 400 decision-makers, nearly 1,000 “rank and file” radiologists and 300-plus retired ACR members, altogether representing 376 practices.

Members of the specialty believe the results, published in JACR [1], reveal promising gains in diversity and inclusion, along with other areas for potential improvement.

“This study demonstrates changes in the landscape of the radiology workforce, with increasing women and members of [underrepresented] racial and ethnic groups in the younger cohort and changing preferences for practice ownership, preferred work environments, and differences in subspecialties within radiology,” lead author Dr. Sherry S. Wang, an abdominal radiologist with the Mayo Clinic, and co-authors wrote Aug. 3. “Results suggest opportunities and future directions for improving diversity, equity and inclusion.”

The authors offered six takeaways from the survey:
 Small gains in female representationUpward trends in diversity among younger radsYounger women prefer academiaWomen dominate two subspecialtiesOwnership concentrated among menMost radiologists work full time
To read more, go to Radiology Business.


Use of Advanced Imaging Skyrockets in ED, and Radiologists Should be Ready for More

By Marty Stempniak | August 7, 2023 | Included in Radiology Digest – August 15, 2023

The use of advanced imaging has skyrocketed in the emergency department, a trend that may continue in the coming years, researchers wrote Thursday in the Journal of the American College of Radiology [1].

In a single level 1 trauma center, imaging volumes per ED encounter leapt 5.5% for X-ray, 35.5% for CT and 56.3% among MRI during the eight years ending in 2021. Even at a lower acuity, level 3 trauma center, the numbers are striking: Imaging use climbed 10.4% for ultrasound, 74.6% across CT and 2% for MRI.

“There is a disproportionate increased utilization of advanced imaging, such as CT, over time,” lead author Neo Poyiadji, MD, with Henry Ford Hospital in Detroit, and co-authors concluded. “ED utilization trends suggest that there will be a continued increase in demand for advanced imaging interpretation, including at lower acuity hospitals; thus, radiology departments should prepare for this increased work demand.”

For the study, researchers retrospectively gathered data from two emergency departments within a major health system in southeast Michigan, spanning 2014 to 2021.

They excluded any fluoroscopic exams, nuclear medicine, or imaging from interventional procedures. The study counted exams that imaged multiple body sections under one accession as a single service.

While many categories saw gains, ultrasound use in the level 1 trauma center dropped 5.9% during the study period, and radiography dipped 4.4% at the level 3 center.

Total work relative value units, or wRVUs, increased both at the level 1 (34.9%) and level 3 (76.6%) trauma centers over the course of eight years.

Digging deeper into the numbers, computed tomography angiography use leapt 536.4% per ED encounter on the level 1 side and 1,669.1% in the level 3 trauma center.

That’s because the institution implemented a “CTA for all” policy in July 2017 to improve large vessel occlusion detection across patients with acute stroke symptoms who presented within 24 hours of symptom onset.

Meanwhile, MR angiography head and neck imaging volumes dropped at both locations, likely due to the CTA shift.

The much larger uptick in magnetic resonance imaging at the level 1 center (56% vs. 2%) may have, in part, been due to different ordering practices between the two locations. Neuroimaging is a big driver of MRI in the ED, with brain and spine volumes showing a marked increase during the study period.

The surge in imaging utilization is independent of increased patient volumes, “suggesting that other extrinsic drivers” contributed. Over the course of the study period, the percent of encounters resulting in admission did not change measurably, and it did not appear that increasing patient complexity was the culprit.

To read more, go to Radiology Business.


CMS Again Pauses Out-of-Network Billing Arbitration After Judge Sides with Providers

By Dave Muoio | August 7, 2023 | Included in Radiology Digest – August 15, 2023

The Centers for Medicare & Medicaid Services (CMS) has again suspended arbitration of out-of-network payment disputes between providers and payers due to a court order that the agency’s implementation of the No Surprises Act had run afoul of proper notice-and-comment procedure.

The decision stems from a Texas Medical Association (TMA) complaint filed in the U.S. District Court for the Eastern District of Texas back in January. The provider group argued that an increase in administrative fees from $50 to $350 that was implemented earlier that month was “arbitrary and capricious” and would curtail certain physician organizations’ ability to contest a health plan’s reimbursement offer.

The No Surprises Act gives payers and providers 30 days to settle any disputes on an out-of-network charge. If an agreement can’t be reached, both parties submit a preferred amount to a third-party arbitrator, which then chooses one—a process referred to as Independent Dispute Resolution (IDR).

CMS said its fee increase was necessary to cover expenses related to the arbitration process.

Additionally, TMA took issue with CMS’ updated requirement that joint consideration of multiple disputed items and services, a process referred to as “batching,” must be billed under the same or comparable code. The change, which CMS said was made to enable greater efficiency, would force providers to submit for multiple IDR processes, which, combined with the price hike would be prohibitive for certain providers, TMA argued.

In an order signed Aug. 3, Judge Jeremy Kernodle granted-in-part TMA’s motion for summary judgment.

The court struck the higher fee and vacated and remanded three portions of the rule outlining the IDR process.

“In sum, the Court holds that the Departments improperly bypassed the [Administrative Procedure Act]’s notice-and-comment requirement in issuing the Fee Guidance and the September Rule’s batching regulations,” Kernodle wrote in the order. “The Court finds that vacatur of these rules is the proper remedy.”

TMA had also sought a refund of previously paid fees and an extension of the IDR deadline, though the judge ruled that the plaintiffs had not done enough to demonstrate that these were warranted under his court’s jurisdiction.

“While the court declined to provide deadline extensions and certain other requested relief, we remain pleased with the overall outcome,” TMA President Rick Snyder, M.D., said in a Friday release. “Yesterday’s decisions on batching rule provisions and administrative fees will aid in reducing barriers to physician access to the law’s arbitration process, which is vital to both patient access to care and practice viability.”

As a result of the decision, CMS wrote in an online notice that it has “temporarily suspended the Federal IDR process, including the ability to initiate new disputes until the Departments can provide additional instructions,” effective immediately.

To read more, go to Fierce Healthcare.


ACR Shares Concerns About Specialty’s ‘Struggle’ to Participate in Alternative Payment Models

By Marty Stempniak | August 4, 2023 | Included in Radiology Digest – August 15, 2023

The American College of Radiology is sharing concern around the specialty’s “struggle” to participate in alternative payment models.

ACR voiced its views in a Tuesday, Aug. 1, letter to the Physician-Focused Payment Model Technical Advisory Committee, which makes recommendations to Health and Human Services. Barriers to radiologists’ ability to excel in the Merit-based Incentive Payment System include their ineligibility to earn maximum incentive adjustments, despite perfect performance in the program.

That’s because there are a limited number of MIPS clinical quality measures equating to 10 points, along with a lack of attribution to episode-based cost and promoting interoperability measures, the college wrote.

“The ACR recognizes the importance of ensuring that radiologists participate in [alternative payment models], due to the major role imaging plays in achieving better quality and cost savings through the rendering of an early diagnosis,” the letter stated. “However, such opportunity is clearly lacking in the current state, based on an insufficient number of disease-based or episode-based APMs. Participation in many APMs, such as [accountable care organizations] and patient-centered medical homes, is only available to primary care providers. Relevant advanced APMs are particularly limited for radiologists.”

The feedback comes in response to a recent request for information from the Physician-Focused Payment Model Technical Advisory Committee, or PTAC, exploring the integration of more specialty care into population-based models. PTAC has held a series of discussions this year about the topic, hoping to better advise politicians, payers, and ACOs about ways to bring value-based care to specialties such as radiology. ACR said such an effort “provides a compelling opportunity for radiologists to demonstrate and earn rewards for their unique contributions toward patient care.”

The college suggested that possible physician-focused payment models in radiology could focus on breast, lung and colorectal cancer screening, along with cancer staging and follow-up, either as standalones or integrated into multispecialty models.

“Diagnostic radiologists are critical to the patient care path,” the letter concluded. “The value they provide is evident to patients whose screening exams or AIF follow-up recommendations result in early disease detection, their treating clinicians who use the imaging results and radiologists’ recommendations to inform on treatment next steps, and healthcare payers responsible for the costs associated with the downstream effects of cancer treatments. Additionally, diagnostic radiologists’ identification of non-pertinent imaging findings is crucial for establishing cost savings as these results inform on unnecessary therapies frequently associated with the presenting health problem.”

PTAC said it will use responses to its request to help further inform its review of recommendations the committee may provide to the HHS secretary on this topic.

You can find the full RFI here, along with ACR’s response letter and a related newsupdate posted Aug. 3.

To read more, go to Radiology Business.

Learn more about what Zotec Partners can do for your radiology practice here.