Radiology Digest – July 29, 2022

July 29, 2022

Radiology Digest: News from the week of July 29, 2022.
House Passes Bill Extending Telehealth Reimbursement Through 2024
By Jessica Kim Cohen | July 27, 2022 | Included in Radiology Digest – July 29, 2022

The House of Representatives on Wednesday passed a bill to extend telehealth reimbursement flexibilities for two years.

The bill, H.R. 4040, easily passed by a vote of 416-12 and heads to the Senate.

The Committee on Rules had moved the measure, a rule dubbed the Advancing Telehealth Beyond COVID-19 Act of 2022, forward during a hearing Tuesday. The rule, introduced by Rep. Liz Cheney (R-Wyo.) and Rep. Debbie Dingell (D-Mich.) last year, would extend Medicare flexibilities established during the COVID-19 pandemic. The bill was endorsed by healthcare trade groups including the American Medical Association and the Connected Health Initiative.

Following the vote, the Alliance for Connected Care and Telehealth Access for America, two healthcare advocacy groups, applauded the bill’s passage.

“We encourage lawmakers in both chambers to work together in a spirit of bipartisan collaboration to pass solutions into law that will ensure access to virtual care is safeguarded for the millions of patients who have come to rely on telehealth during the pandemic, including seniors, rural households, and underserved communities,” Julia Mirich, a Telehealth Access for America spokesperson, said in a statement.

Lawmakers in the early days of the COVID-19 pandemic waived Social Security Act requirements that said a patient must be at a healthcare facility in a rural area to receive telehealth services. That meant Medicare could pay providers for telehealth services regardless of where a patient was located, including from their own home.

However, such requirements will go back into effect when the emergency period ends, unless Congress changes the law.

To read more, go to Modern Healthcare.  
Did New CT Lung Cancer Screening Guidelines Really Improve Access?
By Kate Madden Yee | July 26, 2022 | Included in Radiology Digest – July 29, 2022

New guidelines issued last year on who should get CT lung cancer screening nearly doubled the number of people eligible for the scans. But that doesn’t necessarily mean they will get them, due to healthcare disparities, according to a study published July 24 in Cancer Medicine.

Many Black individuals may not be able to get access to CT lung screening due to demographic factors like lacking access to transportation and appointment wait times — despite the fact that they are now eligible for screening, wrote a team led by Kristin Maki, PhD, of the University of Texas MD Anderson Cancer Center in Houston.

“Our results suggest that despite increasing the number of Black individuals who are eligible for lung cancer screening, the 2021 USPSTF recommendation highlights ongoing socioeconomic disparities that need to be addressed to ensure equitable access,” the group wrote.

Last year, the U.S. Preventive Services Task Force (USPSTF) updated its lung cancer screening recommendation, lowering the age of eligibility from 55 to 50 and adjusting smoking history from 30 pack years to 20 pack years. The change was an attempt to expand the screening eligibility pool, particularly to include more Black Americans, and it immediately prompted debate on whether the attempt was effective — with some arguing that it is and others arguing that it isn’t.

In yet another exploration of the issue, Maki and colleagues used data from the 2015 National Health Interview Survey to investigate the impact of the USPSTF 2021 lung cancer screening eligibility criteria on racial disparities between Black and white people, tracking factors such as education and socioeconomic level and employment and insurance status. The team also assessed individuals’ use of preventive care and reasons for delayed medical care.

The study included data from those who would have been eligible for CT lung cancer screening according to the USPSTF’s 2013 recommendation. The authors found that the 2021 update had a dramatic effect on expanding the eligibility pool, in line with previous studies: The number of eligible individuals grew from 7.9 million under the 2013 guidelines to 14.2 million under the 2021 recommendation, a relative increase of 81.4%.

To read more, go to Aunt Minnie.  
Patients Covered by Medicaid are Four Times Less Likely to Complete Follow-up Imaging. What Can be Done?
By Hannah Murphy | July 26, 2022 | Included in Radiology Digest – July 29, 2022

Compared to patients with commercial insurance, patients covered by Medicaid are four times less likely to complete follow-up imaging recommended by radiologists and other physicians. 

Authors of a new study published in Clinical Imaging suggest that these findings bring light to a greater need for methods to address care gaps that could result in poor outcomes for patients. 

“Without an improved understanding of which patient-level factors limit access, standardized reporting systems enabling us to provide equal care could potentially contribute to ongoing health inequities,” Andrés Ángel-González Calvillo, with the University of California San Francisco School of Medicine, and colleagues said. 

The findings are the result of an analysis of more than 13,000 imaging reports that contained additional follow-up recommendations. For the cases in which insurance type was known, 47.4% were listed as commercial, while 11.4% of patients were covered by Medicaid and 27.6% by Medicare. Having Medicaid insurance as primary coverage was the only factor found to be independently associated with reduced adherence to follow-up recommendations, even after accounting for age, gender, race/ethnicity, smoking history, primary language, BMI and neighborhood socioeconomic status. 

“With such a complex interplay of factors affecting follow-up adherence rates, a multifaceted approach is needed to better understand and address these potential gaps in patient care,” the authors explained, before offering up some potential solutions to the dilemma. 

To read more, go to Health Imaging.  
VIDEO: CMS’s Proposed PFS for 2023—A Real and Present Threat to Radiology’s Capacity to Contribute?
By Dave Pearson | July 26, 2022 | Included in Radiology Digest – July 29, 2022

Unless it undergoes physician-friendly changes in Congress, CMS’s proposed 2023 PFS will cut overall provider payments 4.4%. And radiology is anything but immune.

In fact, so disheartening are the looming slashes across the board in radiology—diagnostic, interventional, nuclear medicine—that a sage and seasoned radiology leader is sounding something of a doomsday warning.

The proposed 2023 PFS will not only hurt vulnerable Medicare and Medicaid populations, he says, but also “do incalculable damage to the medical profession.”

Radiology Business asked the leader behind those words, Bob Still, to expound on his expression of alarm. “We’re simply at a breaking point,” Still, executive director of the Radiology Business Management Association, responded.

“We’ve gone through close to three years of COVID, and we’re not out of the woods yet. In fact, we’re heading back into the forest with COVID of late.

”Still hastens to add that radiology’s impending pain is even worse than previously reported. “When you combine the -4.4% conversion factor with -3% for MPFS and -4% for PAYGO,” he says, “we think we’re looking at an 11.4% hit for diagnostic radiology.”

To see the interview, go to Radiology Business.  
What Amazon’s $4B One Medical Play Reveals about Its Healthcare Ambitions
By Heather Landi | July 25, 2022 | Included in Radiology Digest – July 29, 2022

With Amazon’s proposed deal to buy One Medical, the company is placing another massive bet on its healthcare strategy—to the tune of nearly $4 billion.

Amazon has been rapidly expanding its reach in the healthcare space, most notably in 2018 with its acquisition of online pharmacy PillPack. 

“Amazon is obviously making decisions based around assets in the market at the right price. Frankly, [the One Medical acquisition] is one of the more foundational ones for them because this is where you are touching the patient. This is likely going to be the largest driver for them to be able to execute the rest of their strategy,” Brad Haller, a senior partner in West Monroe’s mergers and acquisitions practice, said in an interview.

The online retail giant announced plans last week to buy One Medical for $18 per share in an all-cash transaction valued at approximately $3.9 billion including the company’s net debt, according to a press release.

The company made waves a year ago when it announced plans to expand its virtual health service benefit, called Amazon Care, to all its U.S. employees while also making it available to other companies as an employee benefit. It marked Amazon’s first foray into direct patient care on a national scale.

If the One Medical deal goes through, it would significantly expand Amazon’s foothold in the nearly $4 trillion healthcare market, specifically in the competitive primary care market.

One Medical markets itself as a membership-based, tech-integrated, consumer-focused primary care platform. The company operates 188 offices in 29 markets. At the end of March, One Medical had 767,000 members.

The deal also gives Amazon rapid access to the lucrative employer market as One Medical works with 8,000 companies.

To read more, go to Fierce Healthcare.  
Radiology Report Follow-up Recommendations: 4 Ways to Improve Patient Compliance
By Hannah Murphy | July 25, 2022 | Included in Radiology Digest – July 29, 2022

One out of every seven radiologist follow-up recommendations contained in imaging reports is not carried out, experts recently reported in JAMA Network Open

“Recommendations for additional imaging (RAIs) are found in more than 10% of all reports, yet adherence rates range from 29% to 77%. Such lack of follow-up has the potential to cause substantial patient harm and malpractice risk, particularly by causing delayed diagnosis and treatment of cancers and other serious diagnoses,” corresponding author Gordon D. Schiff, MD, with the Center for Patient Safety Research at Brigham and Women’s Hospital, Harvard Medical School, and co-authors recently discussed. 

Schiff and colleagues sought to investigate what factors influence patient follow-through, as well as how such factors can be adjusted to improve patient compliance. For this, they analyzed 598 radiology reports from a primary care clinic at a large academic center, each of them containing follow-up recommendations.

The authors paid particular attention to three domains—specific instructions, recommended completion time frames and contingency language qualifying the recommendation. An overall rate of 87.4% of completed follow-up actions was observed, of which 31 cases were revealed to pose substantial clinical risks for patients. 

Three factors that were found to positively influence compliance were: 
Clearer, more concise language with the absence of accompanying contingency verbiage (example: “if warranted depending on clinical correlation”). 
Shorter recommended time frames. 
Evidence of direct communication between the radiologist and referring provider

The experts suggested that having standardized processes and templates in place for actionable recommendations could avert consequential missed follow-ups, noting that the radiology department involved in the study had dedicated report sections for actionable recommendations

To read more, go to Health Imaging.  
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