Radiology Digest – January, 31, 2023

January 26, 2023

Radiology Digest: News from the week of January 31, 2023.
Rising Trauma CT Utilization Flagged Over Costs, Incidental Findings
By Dave Pearson | January 25, 2023 | Included in Radiology Digest – January 31, 2023

Over an eight-year window ending in 2018, emergency departments markedly increased U.S. healthcare’s utilization of chest and abdominopelvic CT for commercially insured trauma patients.

The researchers who uncovered the pattern found the rise especially conspicuous in single-encounter chest/abdominopelvic scans, not least those performed for minor injuries.

The study was conducted at Emory University School of Medicine in Atlanta, supported by the Harvey L. Neiman Health Policy Institute and published in the February edition of the American Journal of Roentgenology [1].

Analyzing 8.4 million commercial claims in MarketScan research databases, radiologists Ninad Salastekar, MBBS, MPHTarek Hanna, MD, and colleagues found chest and abdominopelvic CT exams per 1,000 trauma-related ED encounters swelled from 3.4 in 2011 to 8.9 in 2018.

The increase was steeper for single-encounter chest and abdominopelvic exams than for chest CT alone or abdominopelvic CT alone.

Further, the growth was more dramatic for minor trauma than for intermediate or major trauma.

“Given cost and incidental finding detection with CT, strategies are needed to optimize order appropriateness,” Salastekar and co-authors comment.

The team computed utilization according to trauma-related encounters rather than by covered individuals.
This approach ensures that the utilization hikes owe not to ebbs and flows in ED encounters but to “a greater likelihood of performance of CT during such encounters,” the researchers point out.

The increase in CT utilization per encounter “raises concern about the appropriateness of such imaging and adherence to practice guidelines,” Salastekar et al. remark. “In addition, with the increase in use of CT, we anticipate associated increases in cost and detection of incidental findings.”

To read more, go to Radiology Business.


Just A Few Health Systems Dominate Medicare Inpatient Spending
By Jacqueline LaPointe | January 24, 2023 | Included in Radiology Digest – January 31, 2023

Medicare inpatient spending is highly concentrated in many parts of the US, causing concerns about the impact hospital consolidation will have on prices in the future.

In 10 states plus the District of Columbia (DC), just two hospital systems account for the majority of Medicare inpatient hospital spending in the state, the Commonwealth Fund reports. The Commonwealth Fund examined trends in Medicare claims data from 2021 analyzed by CareJourney, a healthcare analytics company.

They found that two-thirds of Medicare inpatient spending was attributable to two health systems, and in 16 states plus DC, a single system accounted for a least a quarter of all Medicare spending on hospital inpatient services that year.

Specifically, for-profit health system HCA Healthcare accounted for the largest share of all traditional Medicare inpatient spending that year with $21 billion. That equates to about 5 percent of annual national Medicare inpatient spending, according to Commonwealth Fund.

HCA Healthcare was also among the two largest systems with the greatest share of Medicare inpatient hospital spending, the report shows.

The findings raise even more concerns over hospital consolidation, Commonwealth Fund says.
“Evidence has shown that [healthcare] prices are higher in consolidated markets, particularly for commercial insurers. If hospital consolidation continues to increase prices in the commercial market, there could be pressure on Medicare to raise rates in line with commercial insurers to avoid access issues for beneficiaries,” they state in the report.

Commonwealth Fund fears that a growing gap between Medicare and commercial prices for the same services could prompt some physicians to stop accepting Medicare patients. Although it is unlikely hospitals would do that, they admit.

There are also concerns that hospital consolidation could indirectly impact Medicare spending through payments to Medicare Advantage plans, the report states. The report only examined traditional Medicare inpatient hospital spending because Medicare Advantage spending data as not available.

“However, if Medicare Advantage plans do not have negotiating leverage with dominant hospital systems, and need to pay higher rates to dominant hospital systems, then plans’ costs would rise as would the payments made to plans by the Medicare program,” Commonwealth Fund explains.

National healthcare spending is still on an accelerated track, with the US paying $4.3 trillion on health-related services in 2021. Medicare spending, in particular, rose last year to $734.0 billion. At this rate, Medicare is expected to be insolvent by 2020, according to the Committee for a Responsible Federal Budget.

The recent hospital consolidation trend has sparked concerns that prices will go up despite no or minimal quality improvements. Industry leaders, including the Commonwealth Fund, call on stronger federal merger review tools, including larger transaction thresholds for investigation and expanded market definitions.

To read more, go to Revcycle Intelligence.


Hospital Price Transparency: Fines or Rule Compliance?
By Alex Kacik | January 24, 2023 | Included in Radiology Digest – January 31, 2023

Hospitals’ compliance with the 2021 price transparency law has improved over the past year, but some operators remain reluctant to publicize their pricing data or do not have the resources to do so

As of the end of September, 65% of U.S. hospitals had posted the rates they negotiated with commercial insurers, according to data from data aggregator Turquoise Health. That marks a significant improvement from June 2021, when researchers from Michigan State University and Johns Hopkins University found fewer than half had posted machine-readable files with negotiated prices.

Still, many hospitals fall short of full compliance, as defined by the Centers for Medicare and Medicaid Services’ 21-point checklist. Hospital and health system administrators claim the administrative burden is not worth it and will not achieve CMS’ goals.

The price transparency law for hospitals took effect in January 2021. CMS hoped data analysts would use machine-readable files to compare prices across hospitals and that patients would scan consumer-friendly documents before they received care. Ideally, the data on prices that hospitals negotiated negotiate with payers, gross charges and discounted cash prices for 300 “shoppable services” would reduce overall healthcare costs and curb high-priced providers. CMS threatened a maximum yearly fine of more than $2 million for larger hospitals that didn’t comply and almost $110,000 for noncompliant hospitals with fewer than 30 beds.

It took about 10 full-time workers at Evansville, Indiana-based Deaconess Health System and the help of a third-party data analysis firm over the course of year to meet the requirements, said Rebecca Conen, director of revenue cycle at the 16-hospital regional nonprofit system.
“We tried to do it in-house, but we didn’t have the bandwidth,” she said. “The issue is keeping it up to date. That is a challenge because our contracts with insurers change at different time periods.”

To read more, go to Modern Healthcare.


Prestigious Medical Schools Hide Vital Information from Radiology Residency Programs
By Dave Pearson | January 23, 2023 | Included in Radiology Digest – January 31, 2023

When selecting trainee applicants, should radiology residency programs prefer graduates of big-name medical schools regardless of individual academic performances?
Or would they do better to favor high-achieving students from schools of more modest status?

The riddle may be moot. Many medical schools that annually rank high in US News & World Report are withholding granular performance data from residency directors, banking on their brand alone to ensure desirable residency placements for their students.

Meanwhile lower-ranked schools are pressured by this dynamic to disclose their students’ academic records fully and without hesitation.

The phenomenon is fleshed out in a study published Jan. 20 in JACR [1].

Conducted by radiology researchers at Duke University School of Medicine (a perennial top-10 finisher in US News rankings), the study builds on prior research showing widespread inconsistency in the depth of data schools supply via Medical Student Performance Evaluations (MSPEs).

The present study follows not long after a recent survey showed radiology residency directors count on the MSPE comparative summaries to serve as the “most impactful” insight for helping them identify strong matches for residency openings [2].

The authors suggest high-ranking schools that keep such information from residency program directors are exercising an “elite privilege” and, in the process, doing a disservice to all stakeholders.  

To read more, go to Radiology Business.


Increased Use of CCTA Improves CAD Outcomes Without Raising Costs
By Michael Walter | January 23, 2023 | Included in Radiology Digest – January 31, 2023

Using coronary CT angiography (CCTA) to evaluate coronary artery disease (CAD) is associated with lower hospitalization and mortality rates, according to new findings published in JACC: Cardiovascular Imaging.[1] In addition, researchers noted, CCTA provided additional value by providing clinicians with a cost-neutral cardiac imaging option.

In 2016, the United Kingdom’s National Institute for Health and Care Excellence (NICE) issued a guidance recommending CCTA as a first-line test for suspected angina. With this decision in mind, study’s authors explored data from nearly 2 million patients treated in the United Kingdom for suspected CAD from 2012 to 2018.

Overall, CCTA use increased significantly as a result of the NICE recommendation. This shift was linked to a reduction in cardiovascular mortality, ischemic heart disease mortality and myocardial infarction-related hospitalizations; there was also an “apparent trend” toward reduced all-cause mortality.

In addition, researchers found that using CCTA as recommended by the NICE guidance—even though it resulted in more imaging examinations being performed—was not associated with increased costs over the course of “These real-world findings in a very large patient cohort provide strong evidence that the use of CCTA as a first-line investigation in those with suspected CAD reduces cardiovascular mortality and proves the use of CCTA as the first-line test—as proposed in the U.K. NICE guidance—is highly cost-effective,” co-author Edward Nicol, MD, MBA, president-elect of the Society of Cardiovascular Computed Tomography, said in a prepared statement.

Nicol also provided additional context on how CCTA was able to increase without costs increasing significantly.

“This cost neutrality was driven by a reduction in more expensive investigations, such as invasive coronary angiography, with a replacement with less expensive CCTA,” he said.

The full JACC: Cardiovascular Imaging study is available here.

To read more, go to Cardiovascular Business.
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