|Radiology Digest: News from the week of December 12, 2023.
Artificial Intelligence ROI Considerations in Radiology
By Dave Fornell | December 6, 2023
Artificial Intelligence use has surged in radiology, promising increased efficiency, accuracy and patient outcomes. However, while AI might aid medical imagers and improve care, assessing the return on investment becomes a critical consideration since there is little to no reimbursement.
“One of the most important things to think about these days with AI, if you’re going to get it deployed, is you need to have an ROI. AI costs money and if it’s going to be sustainable, you need someone to pay for that,” Nina Kottler, MD, associate chief medical officer for clinical AI at Radiology Partners, said in an interview with Radiology Business at the Radiological Society of North America 2023 meeting. “Payers aren’t really paying for this. These days a lot of hospitals are losing money, so the ROI for them is if you can bring in more dollars into their system, or if you can decrease their costs.”
Kottler also is an associate fellow of the Stanford Center for Artificial Intelligence in Medicine and Imaging, on the steering committee for RADEqual, and serves on several committees for RSNA, the American College of Radiology and the Society for Imaging Informatics in Medicine. She is a key figure in radiology AI and highlighted essential factors in understanding the ROI of AI adoption in radiology during an RSNA session.
While there are some reimbursement codes for a few new AI technologies, she explained ROI may not be monetary in the form of a direct reimbursement. Instead, ROI is often in the form or better efficiency to enable radiologists to look at more studies to provide more information to referring physicians or offering better patient outcomes by catching more disease and incidental findings. By helping to appropriately identify more patients with health issues, this can translate into more downstream services and therapies that a health system can bill for.
“You can bring in more dollars if you could get more imaging exams done, and from a procedure standpoint if you get more patient admissions,” Kottler said. “Now of course we want these to be appropriate ones, but AI can help with those things. Decreasing cost is another way to do it. For instance, moving people through the emergency department more appropriately, more quickly, then you can decrease cost to a health system.
Decreasing costs in admissions or if the length of stay is decreased, then you’re getting the same dollars. But if the cost is decreased, those things can pay for the AI system.”
Kottler emphasized that while physicians prioritize creating value for patients, deploying AI in healthcare demands sustainable financial models. Identifying stakeholders—hospitals, radiology practices, referring clinicians, payers (including Medicare and private insurers), and patients—can help delineate who bears the cost burden and who reaps the benefits. Direct patient payment for AI tools is not considered feasible, she said.
Challenges in AI reimbursementHospital system ROI using AIRadiology practice ROI for quality and efficiencyAI may help address the shortage of radiologistsTo read more, go to Radiology Business.
The Impact of Medicare Payment Cuts on Radiology and Patient Care Access
By Dave Fornell | December 5, 2023
Radiology faces unprecedented challenges due to imminent Medicare payment cuts in the 2024 Physician Fee Schedule. Cuts to reimbursements have already impacted radiologists with burnout, deciding to retire or leave clinical practice, which has increased the pace of staffing shortages. The radiologist shortage was one of the top concerns expressed across sessions, vendor booth visits and interviews during the Radiological Society of North American 2023 meeting.
Radiology Business Management Association President Kit Crancer, who is also executive director of the Rayus Quality Institute, spoke with Radiology Business on these issues at RSNA. He explained the gravity of these impending cuts and their potential ramifications for patient access.
“The Medicare Physician Fee Schedule has significant cuts to diagnostic and interventional radiology,” Crancer said.
“We’ve had this chronic cycle that we’ve been in where we’ve looked at these reimbursement cuts for the better part of the decade. We’re looking at, at least, a 4% cut to the majority of providers, some more depending upon modality mix. The RBMA is advocating for congressional intervention to try and blunt some of these cuts in order that we don’t have significant access to care issues down the line for Medicare patients.”
The Centers for Medicare and Medicaid Services‘ budget is limited by a rule made by Congress that requires CMS to maintain a balanced budget, despite rising patient volumes and increasing costs. This clause necessitates reimbursement cuts to physicians to ensure the budget remains neutral in expenses. Crancer said, when more patients access care or CMS grants higher payments for another specialty or technology, budget neutrality necessitates cuts to other physicians.
Medical societies have warned for years that at some point reimbursement cuts will reach a tipping point where it is no longer economical to provide services to Medicare patients. Radiology Business asked Crancer how close we are to that point.
“I think we’re there. We need some accountability when it comes to cutting Medicare. And the fact is a reimbursement cut to a radiologist, a reimbursement cut to a physician, is a cut to a Medicare beneficiary,” he said.
Years of lobbying by more than 100 medical societies have failed to motivate Congress to do anything about the annual CMS cuts. So, the RBMA, along with Rayus and several other provider groups, started the Radiology Patient Action Network in an attempt to give patients a voice in the conversation with Congress.
“Policymakers do react when it becomes a patient access issue or when it becomes a patient quality issue,” Crancer said. “So, we started the Radiology Patient Action Network to try and really bring some of those patient issues to light. We started running polls. We just asked Americans how they feel when it comes to significant cuts to their services. They agree: A cut to their physicians, a cut to their benefits is a cut to Medicare. So, getting that issue across to policymakers has been a top priority from the RBMA, but we have a long way to go.”
He emphasized the detrimental effects already witnessed with patients having to travel farther for care, longer wait times, and the potential abandonment of prescribed treatments due to access hurdles.
“There is a real possibility of clinics and hospitals refusing Medicare patients service due to these cuts. This predicament could trigger further consolidation within hospital systems, reducing patient options and potentially exacerbating healthcare disparities,” Crancer said.
To read more, go to Radiology Business.
Many Employee Docs Say Non-physician Practice Ownership Cuts Quality, Survey Finds
By Anastassia Gliadkovskaya | December 5, 2023
Nearly 60% of doctors who practice as employees of hospitals and other corporate entities say that non-physician practice ownership results in lower quality patient care, per a new survey.
The 1,000-physician poll was conducted by the National Opinion Research Center at the University of Chicago and was commissioned by the Physicians Advocacy Institute. It aimed to examine the experiences of docs employed by hospitals and health systems, VC and private equity firms, payers and staffing agencies.
Most docs surveyed cited decreased time with patients and greater focus on financial success as elements negatively affecting quality at non-physician-owned medical practices, with 70% saying their employer uses incentives or penalties to have them see more patients a day.
Less than a fifth of respondents felt that the growth in corporate ownership of medical practices has improved care quality. This group cited greater investment in infrastructure and technology and increased focus on patient-centered outcomes as the key benefits of corporate ownership.
The findings exemplify the widely held belief among many employed docs that corporate ownership may erode key aspects of the patient-physician relationship and impact patient outcomes, the Physicians Advocacy Institute said.
“The patient-physician relationship is the foundation of our healthcare system,” Kelly Kenney, CEO of the Physicians Advocacy Institute, said in an announcement. “With corporate ownership comes a higher emphasis on financial outcomes and shareholder returns. This focus on the bottom line can interfere with best clinical practices.”
Employed docs in the survey cited concerns about several corporate owner policies. Sixty-one percent said they have moderate or no autonomy to make referrals outside their practice or ownership system. Nearly half (47%) reported policies or financial incentives to adjust patients’ treatment options to reduce costs, including lower-cost drug therapies.
To read more, go to Fierce Healthcare.
CMS to Crack Down on Medicaid Redetermination Compliance
By Rylee Wilson | December 5, 2023
CMS has laid out how it will sanction states that do not comply with Medicaid redetermination requirements.
In an interim final rule issued Dec. 3, the agency said it will take several actions against states that do not comply with federal Medicaid eligibility rules or reporting requirements. The interim rule takes effect Dec. 6.
CMS was granted additional oversight authority over the redetermination process by Congress in the Consolidated Appropriations Act of 2023.
According to the interim rule, CMS will require states that are not complying with federal laws or reporting requirements to submit a corrective action plan. If the state does not submit or implement the plan, the agency can fine the state up to $100,000 for each day it is not in compliance. CMS can also pause procedural disenrollments in the state.
CMS can also reduce the amount of federal funding to state Medicaid programs up to 1 percentage point for states not complying with reporting requirements.
In April, some states began determining if Medicaid beneficiaries are still eligible for the program for the first time since the COVID-19 pandemic began.
As of Dec. 1, more than 11.7 million Medicaid beneficiaries have been disenrolled from their coverage through the redeterminations process, according to KFF. Of those beneficiaries, 71% were disenrolled for procedural reasons, such as failing to return required paperwork, rather than being determined ineligible for the program.
More than 22 million beneficiaries have had their coverage renewed through the process, according to KFF.
CMS has previously urged states to reduce the number of procedural terminations. In July, the agency said it had paused procedural terminations in a “half-dozen” states, though the agency did not specify which states.
In August, the agency told states to correct an issue in automatic renewal systems that could result in eligible people being removed from Medicaid. The agency paused terminations in 30 states while the issue was resolved, and coverage was restored for more than 500,000 Medicaid beneficiaries.
To read more, go to Becker’s Payer Issues.
Fewer Than 1 in 3 Consumers Pay Medical Bills Immediately
By Jacqueline LaPointe | December 1, 2023
Healthcare revenue cycle leaders may need to readjust their patient collection strategy to help consumers understand and pay their medical bills, a new survey suggests.
The survey of over 1,000 consumers conducted by AccessOne found that fewer than one in three respondents pay their medical bills in full right away, leaving a remaining 72 percent of consumers waiting to pay healthcare-related expenses. The latter respondents said they either can’t or don’t pay their medical bills right away and need different options and support.
Some consumers who don’t pay medical bills immediately simply haven’t paid as of yet (13 percent), while 7 percent wait until just before the bill’s due date to pay in full and 2 percent pay after the due date.
Affordability is a major challenge for consumers. About 68 percent of consumers responding to the survey said they cannot afford to pay their bills on time. Overall, nearly half of respondents (44 percent) said they’ve seen an uptick in healthcare costs recently.
Middle-aged consumers responding to the survey were the most impacted by rising healthcare costs, as well as higher-earning individuals and households with children.
With affordability being a major barrier to paying medical bills, consumers, especially younger adults, are skipping or delaying care to manage or reduce their medical expenses. About one out of three 18- to 34-year-olds said they postponed needed care or procedures and 40 percent of 18- to 44-year-olds have opted not to fill a prescription or delayed the prescription.
Some consumers are even dipping into personal savings (10 percent of respondents) to pay for healthcare-related expenses, while nearly a third have used a personal credit card to pay their bills.
The survey highlighted several drawbacks of using credit cards to pay for medical bills, including potential late fees and interest, especially since leveraging personal cards negates the potential advantages of incurring strict medical debt. The top three credit bureaus recently agreed to drop medical debt from consumer credit reports, but late or missed payments to a personal credit card still impact one’s credit rating, the survey explained.
To read more, go to Revcycle Intelligence.
4 Key Trends in Radiology at RSNA 2023
By Dave Fornell | December 1, 2023
The rapidly growing shortage of radiologists and technologists was by far the biggest point of discussion across sessions, discussions with vendors, industry analysts, physicians and professional societies at the Radiological Society of North America 2023 meeting.
Radiology Business found staffing issues were mentioned prominently in almost all discussions with vendors and in video interviews conducted this year at RSNA.
Here is an overview of four key trends we observed at RSNA 2023:
– Radiologist shortage takes center stage
– AI in radiology continues to expand in number and clinical use
– Continued reimbursement cuts require running lean radiology programs
– Elevation of cardiac CT
To read more, go to Radiology Business.
|Learn more about what Zotec Partners can do for your radiology practice here.