Radiology Digest – August 16, 2022

August 11, 2022

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Radiology Digest: News from the week of August 16, 2022.
As the US Population Ages, Medicare Radiologists are Bunching Up in Some Areas and Thinning Out in Others
By Dave Pearson | August 11, 2022 | Included in Radiology Digest – August 16, 2022

There are plenty of radiologists serving Medicare patients in the U.S., but the headcounts are so unevenly distributed that patient populations in some vicinities can count on quick exam results while those in many other places get used to anxiously awaiting the doctor’s word.

Mayo Clinic radiology researchers confirmed the suspected state and regional disparities when they analyzed claims data in publicly available CMS databases alongside state-by-state Medicare enrollment figures as compiled by the Kaiser Family Foundation.

Aditya Khurana, MD, Bhavika Patel, MD, and Richard Sharpe Jr., MD, MBA, had their work published Aug. 10 in JACR [1].

Focusing on a seven-year period ending in 2019, the team tabulated changes in growth rates of radiologists per 100,000 Medicare enrollees and of Medicare enrollees themselves.

Khurana and colleagues found the overall number of radiologists per 100,000 Medicare enrollees grew—albeit slowly enough to signify stability—from 79.7 in 2012 to 79.9 in 2019.

In 2012, the number of radiologists per 100,000 enrollees was lower than the national average in the South and Midwest but higher than average in the Northeast and West, the authors report.

By 2019, only the South was lower than the national average—some 12% so, with 69.8 rads per 100,000 enrollees.

The ratios were up in every other region—1.9% over average in the Midwest (81.4 rads per 100K enrollees), +24% in the Northeast (99.3 per 100K) and +0.4% in the West (80.2 per 100K).

Meanwhile, at the state level, the gaps were vast in 2019. For example, Minnesota had 161.4 radiologists for every 100,000 Medicare enrollees (102% over national average) while Wyoming had only 38.8 (-51.5%).

The most radiologist-saturated area was Washington, D.C., with 200.5 rads per 100,000 Medicare patients. That was 151% over the national average.

Rounding out the top three in 2019 was Connecticut (50.9% above national average). Keeping Wyoming company at the bottom were Mississippi (-50.8% and South Carolina (-42.3%).

The disparities are increasingly concerning, the authors suggest, as the U.S. population continues to both age and grow.

To read more, go to Radiology Business.  
Only 16% of Hospitals Complying with Price Transparency Rules
By Amy Baxter | August 10, 2022 | Included in Radiology Digest – August 16, 2022

Few hospitals are actually complying with price transparency rules nearly two years after being implemented. 

In fact, only 16% of 2,000 hospitals are posting prices of their most common procedures for the public, according to a new report released by The Hospital Price Transparency Rule, which went into effect Jan. 1, 2021, requires hospitals to post some 300 procedures, with the intent to create a more competitive marketplace and enable consumers to price shop for procedures. 

Since the rule went into effect, hospitals have been slow to comply, even after they were granted extensions to meet the rule. The noncompliance has forced federal agencies to consider increasing monetary penalties.

“Unfortunately, after nearly 20 months of the Hospital Price Transparency Rule being in effect, the compliance rate has stalled, with only marginal improvement to 16% compliance up from 14.3% in our previous report,” Cynthia Fisher, founder and chairman of, said in a statement. “The quickest way to substantially improve compliance is through monetary fines which work, as our report shows.

“Out of 2,000 hospitals, just 319 were complying with the rule, according to’s report. Another 101, or 5%, did not post any standard charges file and were in total noncompliance. In addition, none of the hospitals owned by HCA Healthcare and Ascension Health, two of the largest hospital systems in the country, were found to be compliant. CommonSpirit Health Systems, the second-largest hospital system in the U.S., was much more compliant, with 45 out of 111 hospitals meeting the requirements. That’s compared to just 8 out of 111 hospitals in the system in February 2022. 

To read more, go to Health Exec.  
Fanning the Flames—How Burnout Initiatives are Failing Radiologists, According to New Survey Data
Hannah Murphy | August 10, 2022 | Included in Radiology Digest – August 16, 2022

Burnout is a phenomenon that is plaguing radiology and although initiatives intended to blunt its impact are well-intentioned, new survey results suggest that employers are missing the mark when it comes to combating employee frustrations. 

In recent years, there has been no shortage of data highlighting the impact of physician burnout. Likewise, initiatives aiming to blunt the effects of burnout are plentiful. However, few efforts have been made to understand whether these initiatives have conjured any positive changes on employee well-being. 

To get a better idea of how their own departmental initiatives focusing on culture, team building, work-life balance and personal well-being fared, experts at a tertiary academic medical center surveyed their colleagues on their experiences before and after the interventions were made. Their results are published in Academic Radiology

The results revealed that not only did the burnout initiatives fail to improve morale, in some cases radiologists reported feeling lower professional fulfillment than they did before efforts were made to improve it. Additionally, the responses indicated that some employees experienced increased emotional exhaustion and sleep disturbances during the timeframe when the interventions were taking place. 

“Despite numerous departmental initiatives intended to improve culture, workplace efficiency, work-life balance, and personal wellness, across eight domains assessed, radiologist self-reported burnout showed no change over the study period,” corresponding author of the paper Ivan K. Ip, MD, from the Department of Radiology at Brigham and Women’s Hospital, and colleagues shared. 

To read more, go to Health Imaging.  
Insurers to Crack Down on Providers Performing Unscheduled Procedures
By Nona Tepper | August 9, 2022 | Included in Radiology Digest – August 16, 2022

Health insurance companies are increasingly pressing doctors for more information when they perform unscheduled, minor procedures such as drawing blood, performing skin biopsies or conducting electrocardiograms on patients the same day as visits for other reasons. 

Insurers are zeroing in on providers evaluation and management claims that include modifier 25. Providers use evaluation and management codes on claims for assessing or controlling patient health, such as when they have office visits or perform surgical procedures. They add a modifier 25 when they provide significant and separately identifiable services during the same patient visits, such as removing a mole. 

Insurers have previously paid out massive settlements because they denied payments for modifier 25, and their new policies set them up for more lawsuits, said Ed Gaines, vice president of regulatory affairs and industry liaison at Zotec Partners, a revenue cycle management company. 

“This is history repeating itself,” said Gaines, who sits on the American College of Emergency Physicians’ reimbursement committee and participated in legal challenges to similar practices in the past.

Horizon Blue Cross Blue Shield of New Jersey is mulling a plan to halve pay for all claims that include modifier 25 starting Nov. 1, according to a notice sent to providers. The not-for-profit insurer was originally set to enact the policy at the start of August. The company credited the reimbursement cut to revisions made by Change Healthcare in its ClaimsXten claims editing software, according to the notice. 

Change Healthcare and Horizon, the largest carrier in New Jersey with more than 3.8 million members, didn’t respond to interview requests. 

“These modifiers just take into account real life,” said Larry Downs, CEO and general counsel at the Medical Society of New Jersey. “This is what happens. Patients come in, and they need additional services.”  The physician group sent a letter to Horizon asking the insurer to reconsider the policy last month. Standard coding practices operate under a theory of “multiple procedure logic,” which reduces payment for additional care provided during a patient encounter to avoid double paying for services such as anesthesia and facility fees, Downs said. Under this theory, modifier 25 claims are already discounted, he said. Cutting payment for these modifiers will increase healthcare costs by forcing patients to schedule separate appointments and delay needed care, he said. 

To read more, go to Modern Healthcare.  
What Works—and What Doesn’t—for Chipping Away at CT Overutilization in the ED
By Dave Pearson | August 9, 2022 | Included in Radiology Digest – August 16, 2022

The presence of any or all of four factors can help ensure appropriate CT utilization in emergency settings: established diagnostic pathways, alternative test availability, involvement of specialists and feedback from referrers.

By contrast, interventions that are unlikely to take a meaningful bite out of CT overutilization in the ED include family/patient education, clinical decision support tools and passive dissemination of appropriate use guidelines.

The findings are from a literature review conducted by emergency medicine researchers at the University of Calgary and published Aug. 1 in Annals of Emergency Medicine.

Lead author Cody Dunne, MD, senior author Shawn Dowling, MD, and colleagues analyzed around 150 studies with an eye on identifying ED-based strategies that effectively reduced CT imaging without compromising on diagnostic accuracy or patient safety.

After categorizing 26 documented actions into 15 single and 11 multimodal interventions, the researchers found those that engaged multiple specialties during planning and/or implementation had a greater reduction effect than ED-only interventions.

In particular, multidisciplinary-led interventions that provided an alternative to CT imaging “were the most effective at reducing usage and did so without compromising patient safety,” Dunne and co-authors report.

The study is available in full for free.

To read more, go to Radiology Business.  
Americans Are Spending Less Due to the Cost of Healthcare
By Amy Baxter | August 8, 2022 | Included in Radiology Digest – August 16, 2022

Nearly four in 10 Americans are cutting costs due to the high cost of healthcare –– and rising inflation may be making the issue worse, according to a recent West Health and Gallup poll. 

Overall, that’s roughly 98 million adults who have delayed or skipped healthcare treatments, trimmed regular household expenses or borrowed money in the past six months in order to afford healthcare in the United States. These actions were much more common among lower-income households, with over half of adults in households earning less than $48,000 per year reporting cutting some spending. 

However, the high cost of healthcare impacts wealthier adults, too –– 19% of respondents in households earning at least $180,000 have reported cutting spending to pay for healthcare. The issue also impacts women more frequently than men, and women younger than 50 are disproportionately compelled to cut back on healthcare costs due to its rising costs. Three in 10 women report economizing to pay for healthcare –– and 36% of women under 50 –– compared to 22% of men, according to the poll, which surveyed 3,001 U.S. adults June 2-16, 2022.

For those who can’t pinch pennies to afford healthcare, skipping treatments can have dire impacts. More than one-quarter of adults reported delaying or avoiding medical care or purchasing prescription drugs in the prior six months due to high healthcare prices, and 43% of adults in lower-income households making less than $24,000 per year said the same. Without regular healthcare, those with certain conditions could see their health status deteriorate and acuity rise.

Inflation is likely having a big impact on Americans’ wallets and their ability to pay for healthcare, as 21% of respondents said they delayed or avoided medical care or purchasing prescription drugs because of inflation in general. Overall, the rising cost of goods and services is driving more cost-cutting measures that are non-healthcare related, as well. A whopping 59% of adults reported driving less and 30% reported cutting back on utilities because of the higher price of goods. 

To read more, go to Health Exec.  
Should Patients—or Any of 6 Other Stakeholder Groups—Get Paid for AI in Healthcare?
Dave Pearson | August 7, 2022 | Included in Radiology Digest – August 16, 2022

The commoditization of health data raises questions about who is owed what, and in what proportion, when artificial intelligence renders the data clinically useful and thereby financially profitable.

An obvious avenue of inquiry focuses on legal ramifications. However, preceding these are fundamental moral and ethical considerations. Two radiology researchers at Mayo Clinic Florida flesh out the basics in an opinion piece published online Aug. 3 in Radiology: Artificial Intelligence [1].

“There is no consensus on who owns medical data, or for how long,” write Colin Rowell, MD, and Ronnie Sebro, MD, PhD. “There are multiple stakeholders and multiple individuals who are essential when creating an AI system.”

After tracing the typical path of a commercialized AI system from the conception of an idea through the deployment and management of a model, the authors offer numerous points to ponder. Among the most compelling are thought exercises involving potentially legitimate claims to compensation among seven groups:

1.      Patients
2.      Healthcare Professionals
3.      Healthcare Systems
4.      Health Insurance Companies
5.      U.S. Taxpayers
6.      AI Companies
7.      AI Developers

To read more, go to Radiology Business.  
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