Radiology Digest – January 14, 2022

January 17, 2022

Radiology Digest: News from the week of January 14, 2022.

Imaging Advocate Concerned After CMS Grants Limited Coverage of Controversial Alzheimer’s Drug, Related PET Scans
By Marty Stempniak | January 12, 2022 | Included in Radiology Digest – January 14, 2022

Imaging advocates are expressing concern after the Centers for Medicare & Medicaid Services proposed granting limited payment approval for the controversial, $28,000-a-year Alzheimer’s drug Aduhelm and corresponding brain imaging.

CMS said Tuesday that Medicare will pay for any such Food and Drug Administration approved monoclonal antibodies in the context of clinical trials. The agency’s determination does not require a beta-amyloid PET scan before or after treatment. But Medicare will cover one such imaging exam for beneficiaries participating in CMS-approved studies, or those supported by the National Institutes of Health.

The Society of Nuclear Medicine & Molecular Imaging expressed dismay with the decision on Wednesday. Leaders with the Reston, Virginia-based group have hoped for a broad, national coverage determination for beta-amyloid PET, either through an official NCD process or by granting Medicare Administrative Contractors discretion to do so. They believe the present payment pathway will prevent patient access to diagnosis and treatment.

“We are concerned that CMS did not significantly change their [Coverage with Evidence Development] requirement for beta-amyloid PET scans,” SNMMI said in a Jan. 12 update. “In addition, the current limited CMS coverage pays the provider far less than the cost of the imaging agent, a situation that limits access to the scans for our most vulnerable populations.”

If its proposal is finalized, CMS said it will review each submitted clinical trial to determine whether it meets criteria outlined in the policy. Stakeholders have 30 days to comment on the proposal, which the feds hope to finalize by April 11. SNMMI said it continues to review the announcement and plans to submit more detailed feedback in the coming weeks.

“Our preliminary thoughts are that CMS’ decision to cover Alzheimer’s therapy under CED is an incomplete solution rather than a productive resolution that would allow widespread and equitable patient access to monoclonal antibody therapy or clinical trials of that treatment,” the society added. “We hope CMS will change its position in its final decision.”

To read more, go to Radiology Business.

6 COVID-related Changes that Radiology Departments Should Maintain Beyond the Pandemic
By Marty Stempniak | January 12, 2022 | Included in Radiology Digest – January 14, 2022

Departments have adopted several changes during the pandemic to keep radiology residents safe, and experts believe there’s no reason to lift them when (or if) the COVID cloud parts.

Challenges faced over the last two years are numerous, including maintaining fairness and equity, navigating financial instability and surviving social isolation. But imaging leaders have risen to the task, pivoting to maintain continuity in the face of such uncertainty, experts noted Monday in the Journal of the American College of Radiology.

“The COVID19 pandemic created challenges for nearly all aspects of radiology practice, including a significant impact on the radiology trainee experience,” Samantha Harrington, MD, a pediatric radiology fellow with Boston Children’s Hospital, and colleagues wrote Jan. 10. “Many workflow changes implemented during the pandemic were positive in terms of advancing trainee wellness and maximizing educational opportunities, and consideration should be given to making these permanent,” they added later.

Harrington and co-authors detailed five examples of pandemic-related changes they believe should stick around for the foreseeable future:

Workplace safety: “The pandemic has highlighted the essential value of masking, handwashing and workplace cleanliness,” the authors wrote. “Perhaps more attention in the past should have been spent on workstation cleanliness, particularly in light of high rates of bacterial colonization of computer mice and microphones. The value of handwashing and workstation cleanliness are lessons we have learned.”

Education: “Going forward a hybrid of both in-person and remote meetings will likely be beneficial,” the authors argued. “Remote multidisciplinary meetings allow for collaboration with local and regional academic centers and promote a sharing of expertise,” they added later. “Educationally, residents, fellows and junior faculty can now participate in learning opportunities at other institutions where previously distance was a barrier.”

Equity: “Beyond the pandemic, supporting diversity, equity and inclusion (DEI) initiatives is essential. This includes strong leadership that prioritizes the representation of diverse faculty and trainees. Additionally, an active and supported DEI committee will help promote initiatives within the department to support underrepresented groups.”

Outside the hospital: “A parenting group was created within the authors’ radiology department. Flexible or remote scheduling is paramount for caregivers. Allowing flexible scheduling of diagnostic radiology work (facilitated by asynchronous readout capabilities) around childcare and increasing the availability of backup childcare will help offset the burden of reduced childcare options.”

Social isolation: “Creating a buddy or mentoring system with regular touchpoints provided additional connections between trainees at different training levels. The buddy system will continue beyond the pandemic,” Harrington and co-authors wrote. “Going forward, working while masked helps facilitate important social interactions during side-by-side readouts, as well as challenging conversations and constructive feedback that are more appropriate in person,” they added later.

Interviews: “Going forward with remote interviews, there will be a continued emphasis on informational videos, focusing on the trainee experience and life in a new location,” the authors noted. “Virtual gatherings, as opposed to a traditional dinner, will also be important,” they wrote later. “Looking beyond the pandemic, if the interview season returns in person, programs can consider travel stipends for those experiencing financial difficulties.”

Read much more of their pre-proof piece in JACR here.

To read more, go to Radiology Business.

Medical Organizations Continue to Fight Surprise-billing Dispute Process: 5 Details
By Alia Paavola | January 11, 2022 | Included in Radiology Digest – January 14, 2022

A coalition of medical organizations, including the Physicians Advocacy Institute and 16 state medical associations, filed an amicus brief supporting a legal challenge to the No Surprises Act dispute resolution process, according to a news release emailed to Becker’s.

Five things to know:

  1. The groups are supporting a lawsuit filed by the American Hospital Association and American Medical Association. The lawsuit challenges the dispute resolution process outlined in CMS’ surprise-billing rule released Sept. 30.
  2. The lawsuit alleges that the independent dispute resolution process, which requires arbiters to first consider the health plan’s median in-network rate as the appropriate reimbursement amount, unfairly favors health plans.
  3. Specifically, the medical organizations that filed the brief Jan. 4 argue that federal regulators ignored congressional intent of the No Surprises Act by relying almost exclusively on the median in-network billing rate to resolve billing disputes instead of considering a multitude of factors.
  4. “Physicians have an obligation to reinforce for the court just how far federal regulators walked away from the No Surprises Act’s balanced approach to resolving
    payment disputes and explain how bypassing the law will unfairly empower insurers at the expense of patients and their physicians,” said Dustin Corcoran, president of Physicians Advocacy Institute and CEO of the California Medical Association, both of which joined the amicus brief. “If the court allows this damaging example of regulatory overreach to stand, patients and physicians will pay the price.”
  5. There are 26 physician organizations that joined the amicus brief. Read the full list of organizations here.

To read more, go to Becker’s Hospital.

How Radiologists Can Avoid Becoming ‘Invisible’ in the Artificial Intelligence Era
By Matt O’Connor | January 10, 2022 | Included in Radiology Digest – January 14, 2022

The emergence of teleradiology programs and PACS resurfaced the notion of the “invisible” radiologist tucked away in the reading room. But a new era presents the specialty with an opportunity to step out and establish its role in clinical care, experts said recently.

Artificial intelligence is slowly changing the field and will be key to helping radiologists manage growing workloads, reduce wasteful imaging and improve reporting. In order to carve out a visible spot on the care team, rads must redefine their clinical identity and lead the AI revolution, experts argued in the European Journal of Radiology.

“The more radiologists are involved in evolving technology, the harder it is for clinicians to invade radiology,” Apostolos H. Karantanas, MD, PhD, with the University of Crete’s Department of Radiology in Greece, and colleagues wrote Jan. 3. “Thus, AI ‘will not weaken radiologists.’ Instead, AI will modify their role in healthcare and will strengthen their presence and contribution to patient management whereas under certain action, it will make them more visible.”

4 tips for radiologists to lead the change

  1. Radiology training must take a broader approach to education. Residents need to learn how to use and integrate AI into their practice. Programs should also teach biomedical engineering, big data analysis and machine learning to ensure the specialty is guiding technological change.
  2. Radiologists must adopt new clinical skills, including emotional intelligence and communication strategies for interacting with patients. These traits must be clearly defined and taught during medicals school and residency. A central role in multidisciplinary team meetings will also ensure rads remain visible.
  3. Young rads will need to be adaptable. This includes upgrading job certifications throughout their career. Being able to conform to a changing workplace may be the most important “soft skill” that radiologists can invest in and embrace, the authors noted.
  4. The growing power of technology, including AI, will continually alter diagnostic imaging, and radiologists cannot rest on their laurels, the authors noted. A successful “marriage” of artificial intelligence and imaging will make rads more accurate and, in some cases, more visible.

You can read the entire study here.

To read more, go to Health Imaging.

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