Radiology Digest | February 12, 2021

February 16, 2021

Radiology Digest: News from the week of February 12, 2021.

Radiology Should Consider Ditching RVUs for A Time-based Productivity Metric, Study Suggests

By Marty Stempniak | February 10, 2021 | Included in Radiology Digest – February 12, 2021

Relative value units do not accurately capture radiologists’ productivity and the specialty should consider adopting a time-based alternative, according to a new investigation published on Wednesday.

Medicare has long used such units to measure the value of physician work in the United States. Yet they’ve led to contention in both private practice and academic radiology when used to gauge productivity, noted the University of Pennsylvania’s Ronnie Sebro, MD, PhD.

Harnessing data from one institution’s electronic health record, Sebro aimed to assess whether the current RVU system allows for a fair comparison between radiologists. He discovered that one physician could work as little as 41% of the time as a peer in the same subspecialty but record the same number of such value units.

“The data shows that the current RVU system for evaluating radiologist productivity is inaccurate and does not adequately capture physician work/effort,” Sebro, an assistant professor with Penn’s Department of Radiology, wrote Feb. 10 in Clinical Imaging. “Because of this, the current RVU system likely contributes to radiologist burnout because of the propensity to underestimate the true radiologist work effort in terms of time,” he added later.

To reach his conclusions, Sebro analyzed more than 600,000 imaging studies performed and interpreted between 2018-2019 at a single tertiary care hospital. He further excluded those interpreted with the help of trainees or other software systems.

Landing on a final set of 241,627 studies, the author calculated study ascribable times—an alternative measure of productivity—for each CPT code. And he further calculated the number of days it would require a physician to achieve the Association of Administrators in Academic Radiology’s 65th percentile interpretation time.

Bottom line: Variability in radiologists time to hit that benchmark was highest in musculoskeletal imaging (reaching a range of nearly 198 days) and lowest for thoracic imaging (84 days). Neuroimaging and body imaging, meanwhile, fell in the middle at 162 days and 186 days, respectively.

“The [study ascribable time] increases the likelihood that a radiologist working for a given number of hours has the same perceived productivity regardless of the imaging study types on work list or regardless of the work schedule or work list he/she is assigned,” Sebro noted in the study’s discussion session. “A metric that accounts for the time worked is an objective measurement, however it does not take into account the intensity of the work.”

For all these reasons, he noted that RVUs are still needed and should not be done away with, since they are critical to determining reimbursement. And the study ascribable time metric is “not a panacea,” as it can vary from one hospital to the next, and likely only remain valid within the institution.

“We suggest that using a data-driven, time-based RVU metric could reimburse all activity equally in radiology,” he added later.

You can read much more of the analysis in Clinical Imaging here.

Here’s How Far Medicare Claims Dropped Last Spring Due to COVID-19

By Robert King | February 19, 2021 | Included in Radiology Digest – February 12, 2021

COVID-19 caused a massive 51% drop in outpatient Medicare fee-for-service claims last April compared to 2019 as the pandemic reached full swing, according to a new analysis.

The analysis, released Tuesday from consulting firm Avalere Health, sought to explore the impact of the pandemic on healthcare utilization from March through May. The pandemic caused doctors’ offices to close and hospitals to shutter elective procedures to preserve capacity to fight the virus.

“The impact of delayed or avoided care on the health status of Medicare beneficiaries will need to be examined over the following months and years as there could be lasting effects even as the pandemic recedes,” the analysis said.

Avalere found the greatest drop in claims for Medicare fee-for-service occurred in April. The biggest decline was the 51% drop of outpatient claims compared with 2019, compared with a 42% drop for inpatient fee-for-service claims and a 23% drop for professional and physician service claims.

The consulting firm looked at a random sample of Medicare Part A and B fee-for-service claims between January and June 2019 and the same time frame last year.

The declines started to occur in March, when lockdowns began to spread across the country. Outpatient claims declined by 18% that month and inpatient claims by 13%.

Increases also weren’t as pronounced in May, when states started to ease lockdowns and shelter-in-place orders. Outpatient claims declined by 32% in May 2020 compared with 2019, and inpatient by 25%.

Claims also started to rise slowly in June as inpatient rose by 3% compared to 2019 and professional/physician services by 4%. However, outpatient claims continued to decline and were down 1% that month.

To read more, go to Fierce Healthcare.

Radiology Could Witness ‘Enforcement Perfect Storm’ as Feds Ratchet Up Pressure in 2021

By Mary Stempniak | February 9, 2021 | Included in Radiology Digest – February 12, 2021

Radiologists and other physicians might witness an “enforcement perfect storm” this year as the feds ratchet up pressure following a slowdown in 2020, experts said Monday.
COVID-19 assistance funds could be one area of scrutiny, with relief programs doling out billions of dollars to the healthcare industry to counter catastrophic losses but offering little guidance. The pandemic slowed down the Department of Justice as recoveries dropped by 30% in the fiscal year that ended in September, falling to $2.2 billion—a 10-year low. But collections for fiscal 2021 have already surpassed last year at $4 billion and counting, Bass, Berry & Sims noted in its Healthcare Fraud & Abuse 2020 analysis.

“The early days of the pandemic may have delayed enforcement efforts somewhat, but the activity toward the end of last year and so far this year suggests the lull is over,” Matthew Curley, a member of the firm’s Healthcare Fraud Task Force and lead editor of the report, said in a statement.

Curley and colleagues highlighted several DOJ actions against radiology providers last year in the analysis. Southern California-based practice Omega Imaging Inc. topped the list for its $5 million payout to resolve allegations that it delivered contrast-enhanced exams without physician supervision and administered care at unaccredited facilities. DOJ officials similarly targeted Florida-based Advanced Imaging of Port Charlotte for physician oversight concerns and missing credentials, reaching a $501,000 agreement in September. And a third settlement in August had a Pennsylvania mobile x-ray provider ponying up $50,000 for allegedly overbilling Medicare for transportation costs.

Fiscal 2021 has already seen several more cases targeting imaging, including a $1.4 million payout from a practice that allegedly delivered teleradiology services from outside the U.S. As providers looks to remain compliant during this period of increased scrutiny, the Nashville, Tennessee-based firm recommended keeping a keen eye on relationships with referral sources. Closely monitoring quality metrics, documenting support for COVID relief funds, and staying cautious about speaking engagements are also wise, the law firm noted.

To read more, go to Radiology Business.

Claim Automation Up, But $16.3B Remains in Potential Savings

By Jacqueline LaPointe | February 8, 2021 | Included in Radiology Digest – February 12, 2021

Levels of claim automation have risen in healthcare over the past year, but so has the opportunity for further savings through technology, the Council for Affordable Quality Healthcare, Inc. (CAQH) reports.

Released last week, the 2020 CAQH Index showed that the healthcare and dental industry has avoided $122 billion in costs by streamlining administrative processes, such as obtaining prior authorizations, submitting claims and supplemental information, and receiving payments electronically.
Despite the savings from increased automation of these functions, payers and providers could still save $16.3 billion by fully automating nine common transactions, an increase of $3 billion in potential savings annually.

“This year’s report found that adoption of electronic processes generally increased across the medical and dental industries,” Kristine Burnaska, director of research and measurement at CAQH, said in an announcement. “The data also indicates that future efforts to automate could yield even greater returns.”
The industry, for example, could avoid $6.7 billion annually by fully automating eligibility and benefit verification, including $2.7 billion in savings by switching from partially to fully automated transactions, according to the report.

Payers and providers have already saved $85.6 billion on eligibility and benefit checks through automation. Yet automation of the transaction has remained around 84 percent of all checks in 2019, with the partially automated and manual transactions also remaining at about 15 percent and one percent, respectively.

This puts eligibility and benefit verification at the top for savings opportunities for medical plans and providers yet again, CAQH stated.

The savings opportunity for switching to fully automated eligibility and benefit verification is especially open to medical providers who represented an overwhelming majority (96 percent) of the total spending on these checks compared to medical plans in 2019.

The largest single per transactions savings opportunity for medical plans and providers was associated with prior authorizations, the Index also showed.

Providers have cited prior authorizations as one of the most complex and burdensome transactions, and that burden continues to increase each year, impacting both provider time and patient care, according to a survey conducted by the American Medical Association (AMA).

To read more, go to Revcycle Intelligence.

Study Makes Case for Baseline Mammography Exam at Age 40

By Emily Hayes | February 8, 2021 | Included in Radiology Digest – February 12, 2021

A baseline mammography exam at age 40 for average-risk women to identify breast density appears to be cost-effective, according to a study published February 8 in Annals of Internal Medicine.

The microsimulation modeling study evaluated various scenarios for mammography screening, including baseline testing at age 40 and more intensive screening for those with breast density, which is a known risk factor for breast cancer.

For women with average risk for breast cancer, it makes clinical and economic sense to perform a baseline mammogram at age 40, followed by annual screening for those with dense breasts and biennial screening starting at age 50 for those who do not have dense breasts, reported a team led by Ya-Chen Tina Shih, PhD, chief of cancer economics and policy at the University of Texas MD Anderson Cancer Center in Houston.

“Compared with other screening strategies examined in our study, this strategy is associated with the greatest reduction in breast cancer mortality and is cost-effective but involves the most screening mammograms in a woman’s lifetime and higher rates of false-positive results and overdiagnosis,” the authors wrote.

The findings are at odds with guidelines from the U.S. Preventive Services Task Force (USPSTF), which recommends screening starting at age 50 with biennial screening subsequently, and the U.K.’s National Health Service (NHS), which backs triennial screening starting at the same age. The USPSTF is currently performing a review of its guidelines.

The current study, which was funded by a grant from the U.S. National Cancer Institute, was aimed at evaluating the costs and potential harms associated with the identification of women with dense breasts at the age of 40.

Density, which is discovered through mammography, has been appreciated as a breast cancer risk factor since 1976 and in more recent years has gained attention from advocacy groups and legislators, the authors noted. Since February 2019, providers have been required by federal law in the U.S. to notify patients of breast density, but women who follow screening guidelines may not get that important information until the age of 50, the authors wrote.

Researchers used a microsimulation model informed by several data sources to assess screening strategies, subsequent diagnostics and treatments, diagnoses of breast cancer, and deaths. They modeled outcomes for a population of 500,000 women born in 1970 and with an average risk for breast cancer. Density was defined as BI-RADS categories C and D — about 50% of women in the U.S. fit this description.

To read more, go to Aunt Minnie.

Breast Cancer Surpasses Lung as the Most Commonly Diagnosed Form of the Disease

By Marty Stempniak | February 5, 2021 | Included in Radiology Digest – February 12, 2021

For the first time ever, female breast cancer has surpassed lung as the most commonly diagnosed form of the disease across the globe, experts announced on Thursday.
Clinicians diagnosed roughly 19.3 million new cancer cases worldwide last year alone, with 10 million deaths. Female breast cancer led the way in diagnoses with 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10%), prostate (7.3%) and stomach (5.6%) cancers, the American Cancer Society noted.

Breast cancer cases are even rising in countries where rates have been historically low, ACS and the International Agency for Research on Cancer detailed in a collaborative report released Feb. 4.

“Dramatic changes in lifestyle and built environment have had an impact on the prevalence of breast cancer risk factors such as excess body weight, physical inactivity, alcohol consumption, postponement of childbearing, fewer childbirths, and less breastfeeding,” Hyuna Sung, PhD, principal scientist in cancer surveillance research for the ACS, and co-authors wrote in the journal CA.

Meanwhile, lung cancer remained the leading cause of cancer mortality at 1.8 million deaths (18%) in 2020, followed by colorectal (9.4%), liver (8.3%), stomach (7.7%) and female breast (6.9%) cancers. Experts are predicting an estimated 28.4 million new cancer cases will occur in 2040, a roughly 47% uptick from last year.

And these numbers do not even factor in the novel coronavirus, as they are based on extrapolations of data collected prior to the public health crisis.

“Delays in diagnosis and treatment associated with the concerns of individuals, health system closures—including suspension of screening programs, and reduced availability of and access to care—are expected to cause a short‐term decline in cancer incidence followed by increases in advanced‐stage diagnoses and cancer mortality in some settings,” Sung and co-authors noted.

Anecdotally, these trends are starting to materialize, Northwestern University radiologist Sarah Friedewald, MD, wrote in blog post shared Thursday. She’s heard reports of “unfortunate cases” where missed screenings are resulting in delayed breast cancer diagnoses. At the height of the pandemic, some had witnessed breast imaging volume declines as high as 94%, and data will eventually confirm the long-term ramifications of such interruptions.

She’s expecting a drop in scheduled appointments from March to May this year, after patients weren’t screened at the same time in 2020. But Friedwald sees a “prime opportunity” to both reach out to patients who missed their mammogram, and court those who never had one, she urged in the ACR’s Voice of Radiology Blog.

To read more, go to Radiology Business.

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