Radiology Digest – August 23, 2022

August 19, 2022

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Radiology Digest: News from the week of August 23, 2022.
Enrolling With Medicare as an IDTF? Dot I’s and Cross T’s Around Physician Supervision, Advises Healthcare Attorney
By Dave Pearson | August 18, 2022 | Included in Radiology Digest – August 23, 2022

Federal regulations force independent diagnostic testing facilities (IDTFs) to ensure radiologist supervision of certain imaging procedures. So why do they allow the supervising radiologists to provide direct oversight at an unlimited number of sites?

Because direct supervision, by definition, means the radiologist has to be there in person. Medicare’s thinking seems to be: “If you can get around to five different locations and provide direct imaging supervision at every one of them, knock yourself out.”

So explained healthcare law specialist W. Kenneth Davis Jr., JD, in an online IDTF primer hosted by the Radiology Business Management Association (RBMA) Aug. 16.

Davis focused largely on regulatory compliance issues that can affect whether or not a site enrolled with Medicare as an IDTF will get paid for its services. Operational supervision was one of these, and it emerged as one of the topics to which he paid special attention.

After noting that IDTFs are important enough to U.S. healthcare that they have their own section in the Code of Federal Regulations (CFR), he pointed attendees concerned about supervision rules and related matters to CFR Title 42, sections 410.32 and 410.33.

“If you’re going to consider enrolling with Medicare as an IDTF, you need to become pretty familiar with these sections,” he said.

To read more, go to Radiology Business.  
High Out-of-Pocket Costs Led to Low Patient Collection Rates
By Victoria Bailey | August 17, 2022 | Included in Radiology Digest – August 23, 2022

Self-pay after insurance patient collection rates dropped from 76 percent in 2020 to 55 percent in 2021 as the share of out-of-pocket balances over $7,500 grew.

Patient collection rates at hospitals declined and bad debt increased when out-of-pocket bills reached $7,500, according to a report from Crowe Revenue Cycle Analytics (Crowe RCA).

The report reflects data from more than 1,400 hospitals across 47 states through 2021.

The firm found that self-pay after insurance accounts were responsible for nearly 60 percent of patient bad debt in 2021, compared to 11 percent in 2018.

The increasing number of high deductible health plans (HDHPs) has led to lower premiums but higher out-of-pocket costs when care is needed. “In the past, insured patients may have had a $75 to $200 copay and many were able to pay the total amount at the point of service,” Brian Sanderson, a principal in the Crowe healthcare consulting group, said in a press release. “These days medical bills could be thousands of dollars, even after the insurance balance has been resolved, which is more than a lot of patients can afford, and hospitals are struggling to collect this revenue.”

The share of patient statements with balances of more than $7,500 grew from 5.2 percent in 2018 to 17.7 percent in 2021. The percentage of balances higher than $14,000 increased from 4.4 percent in 2018 to 16.8 percent in 2021.

As these high balances are more difficult for patients to pay, hospitals and providers face challenges when collecting payments before services or during the 120-day collection window after the insurance balance is resolved. Self-pay after insurance collection rates dropped over 20 percentage points between 2020 and 2021, going from 76 percent to 55 percent.

The report found that patients with insurance were less likely to pay their out-of-pocket bills when the balance surpassed $7,500. The collection rate in 2021 for claims between $5,000 and $7,500 was 32 percent, while the collection rate for claims between $7,501 and $10,000 was 17 percent.

According to Sanderson, ongoing labor shortages and rising patient out-of-pocket costs have led hospitals to struggle to collect these high balances from patients.

To read more, go to Revcycle Intelligence.  
Hospitals Squeezed, Insurers Boosted as Utilization Lags
By Nona Tepper, Caroline Hudson | August 17, 2022 | Included in Radiology Digest – August 23, 2022

The balanced relationship between COVID-19 and non-coronavirus utilization tipped during the second quarter, leading some of the largest health insurance companies to raise profit forecasts while health systems bemoaned the negative impact on their finances.

Health systems attributed the slump in inpatient services to staff shortages that limited procedures, telemedicine alternatives and fewer acute COVID-19 patients. Insurers credited the decline to patients deferring care due to rising inflation, the availability of more cost-efficient value-based care payment arrangements and care shifting from hospitals to less expensive outpatient sites.

This condition may be short-lived. Volume is down compared with before COVID-19 arrived, but that appears to be gradually changing. “It’s not at 2019 levels, but it’s trending towards that,” said Glenn Melnick, a health economics and policy professor at the University of Southern California. “Volume is going from minus 10 to minus five to minus three-something. It’s still below, but the trend suggests that it’s going to return to normal, certainly at some point this year.”

Changes in volume
Fewer patients are being admitted to hospitals, but those who are, tend to be sicker, said Erik Swanson, senior vice president of data and analytics at the consulting firm Kaufman Hall. Higher inpatient acuity and longer stays at Mass General Brigham led to a 5% decrease in discharges during the quarter that ended June 30, which denied the Boston-based not-for-profit hospital of revenue it would have gained from new intakes.

Inpatient surgeries, in particular, are lagging. Those volumes are about 18% below the pre-pandemic level, according to a Kaufman Hall analysis of 900 hospitals. Inpatient surgery volume fell 4% in the second quarter at Nashville, Tennessee-based HCA Healthcare’s facilities. Inpatient surgeries at Boulder Community Hospital in Colorado were down 3.4% in the first half of 2022.

To read more, go to Modern Healthcare.  
Radiologists the 7th Best-paid Medical Workers, Biz Mag Finds
By Dave Pearson | August 16, 2022 | Included in Radiology Digest – August 23, 2022

Cardiologists are the highest paid professionals in medicine, averaging $170 per hour for an annual average salary of $353,970, according to a new Forbes report.

Radiologists’ $145 an hour, or $301,720 annually, lands their specialty in seventh place.

The popular business magazine presents average paychecks of some 50 jobs under the category of “healthcare practitioners and technical occupations” in the Bureau of Labor Statistics’ (BLS) Occupational Employment Statistics (OES) database. Bringing up the rear at No. 50 are therapists other than radiation therapists (No. 33 at $94K per year) and therapists providing physical, occupational and respiratory care.

The article’s author, Forbes contributing writer Andrew DePietro, notes several interesting trends he came upon. For example, the most common setting in which cardiologists practice is physician offices. Similarly, DePietro found anesthesiologists earning the highest pay in their specialty when working in outpatient care centers.

Here are the top 25 healthcare jobs with average annual earnings, according to Forbes:
1. Cardiologists—$353,970
2. Anesthesiologists—$331,190
3. Oral and Maxillofacial Surgeons—$311,460
4. Emergency Medicine Physicians—$310,640
5. Orthopedic Surgeons, Except Pediatric—$306,220
6. Dermatologists—$302,740
7. Radiologists—$301,720
8. Surgeons, All Other—$297,800
9. Obstetricians and Gynecologists—$296,210
10. Pediatric Surgeons—$290,310
To see the rest of the list, click here.  
Screening Recommendations Are Disputed, So When Are women Actually Starting Their Annual Mammograms?
By Hannah Murphy | August 15, 2022 | Included in Radiology Digest – August 23, 2022

There are varying age recommendations for when women should begin mammographic screenings, but at what age do most women actually begin undergoing yearly mammograms and why? 

That’s exactly what researchers sought to understand recently when they analyzed thousands of survey responses from a 2018 National Health Interview Survey. The responses of 1,948 women aged 40 to 49 were detailed recently in Academic Radiology, where the researchers offered detailed insight into what factors influence women at average risk of breast cancer to seek screening at certain ages. 

“Over the past 40 years, a 10-37% decline in breast cancer specific mortality has been observed in the United States due to screening mammography utilization and advances in breast cancer treatment,” corresponding author of the paper Randy C. Miles, MD, MPH, Chief of Breast Imaging at Denver Health Medical Center in Colorado, and co-authors wrote. “While there is consensus among national health organizations that mammographic screening in average-risk women is overall beneficial, key differences exist related to recommended age to initiate screening and frequency of routine screening.” 

Out of the nearly 2,000 respondents, 46.6% reported having undergone a screening mammogram within a year of the survey, while 61.4% had received a mammogram within a two-year timeframe. Reasons for not having completed a mammogram for the small percentage of women who didn’t were due to overlooking the exam, the lack of a presumed need for screening due to “being too young,” doctors not ordering the exam and health insurance/price constraints

The experts suggested that at the patient level, many women are under informed about their breast cancer risks. On the provider level, they indicated an increase in shared decision-making could improve screening rates for this age demographic, adding that radiologists could play a greater role in keeping both patients and providers informed on the benefits of early screening.

To read more, go to Health Imaging.  
Emergency Overreads Change Care for 92% of Patients with Discrepant Outside Reports
Dave Pearson | August 14, 2022 | Included in Radiology Digest – August 23, 2022

When emergency radiologists overread interpretations of critically ill transfer patients, they discover discrepancies in fewer than 15% of cases. However, more than 90% of these second opinions produce a change in patient care or follow-up.

So found ED radiologists at the University of Washington in Seattle when they tracked records of more than 5,800 patients transferred to their Level 1 trauma center at UW Medicine throughout a single calendar year.

In the study report, published online Aug. 13 in JACR [1], corresponding author Jeffrey Robinson, MD, MBA, and colleagues suggest their findings warrant broad attention for two key reasons.  

First, their study is the first they know of to analyze the clinical impact of ED overreads. Second, the high rate of change in care pathways they uncovered “confirms the relevance of radiology overreads by emergency medicine physicians, who act on these reports.”

The team was facilitated in the project by their department’s policy of routinely overreading advanced-imaging exams of every patient transferred to UW Medicine for emergency care. As the ED radiologists perform second reads of CT and MRI studies, software electronically flags discrepancies with radiology reports filed at sending sites.

Along with the findings on rates of discrepant interpretations (669 of 5,834 overreads [12%]) and changes in patient management (613 of 669 [92%]), the authors report that ED management was changed by discrepancies noted on the final report in 33% of cases.

Meanwhile ED stay was extended in some 81% of cases and selection of consulting services in 61%, while patient disposition was affected 13% of the time and outpatient follow-up in 8%. In their discussion, Robinson and co-authors point out that managing exams conducted and interpreted from sending care sites is a common challenge for all referral centers.

The issue is especially pressing in an emergency setting—as compared with a tumor board, for example—because a patient’s primary diagnosis “may be in doubt, and changes in interpretation significantly affect management.”

To read more, go to Radiology Business.  
Urgent Care Centers Save Hospital System Hundreds of Thousands in Imaging Costs
By Hannah Murphy | August 11, 2022 | Included in Radiology Digest – August 23, 2022

Urgent care centers save emergency rooms hundreds of thousands of dollars every year when it comes to assessing cervical trauma, a new analysis shows.

Experts with a large academic hospital system came to this conclusion after examining the records of patients who received cervical spine imaging at urgent care clinics affiliated with the institution between May 1 and August 31, 2021. Patients who self-initiated the visits after a low-acuity injury were compared to those who sought or were referred to the emergency department at the main campus for care. 

This included a total of 143 self-selected, low acuity patients who first underwent imaging at urgent care clinics. After calculating work relative value units (wRVUs) for the urgent care or emergency department imaging type, the experts concluded that the patients’ urgent care visits saved 105.94 wRVUs, or $3696.25, over the four-month study period.  

“While UCCs may not have the full capabilities of an ED, they can treat minor to moderate injuries,” corresponding author Marc D. Succi, MD, of the Department of Radiology at Massachusetts General Hospital and co-authors shared. “It is estimated that between 13.7%–27.1% of all ED visits might be conducted at either an UCC or a retail clinic with a cost savings of approximately $4.4 billion annually.” 

When the authors expanded their calculations to the yearly costs of having cervical spine radiographs completed at an urgent care rather than a cervical CT scan in the emergency department, they concluded urgent care visits save an estimated $437,928 in healthcare costs within that hospital system. 

To read more, go to Health Imaging.  
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