Radiology Digest July 4, 2023

June 28, 2023

Radiology Digest: News from the week of July 4, 2023.

Here’s the Highest-paying Job in Every State

By Madison Hoff | June 2023 | Included in Radiology Digest – July 4, 2023

Radiologist is the best-paying job in California and three other states, with average annual pay over $300,000 in each of those states.

Many other states’ highest-paying jobs are also healthcare occupations. That’s based on Insider’s analysis of May 2022 annual wage data from the Bureau of Labor Statistics (BLS). We looked at the best-paying job for each state and Washington, DC, based on available averages.

For our analysis, Insider only looked at jobs with at least 1,000 employees in the state and for which BLS published a specific average annual wage estimate. Insider omitted jobs without an employee estimate, without a specific average annual wage amount, or without any average annual wage data at all from our analysis.

The interactive map shows the highest-paying occupation for every state and Washington, DC, based on our methodology. You can hover over each place to see what the job was, the average annual pay, and the estimated number of employees for that occupation.
To read more go to Business Insider.


Physician-owned Hospitals Charge Less for Imaging Than Their Counterparts

By Marty Stempniak | June 26, 2023 | Included in Radiology Digest – July 4, 2023

Physician-owned hospitals actually charge less for imaging services than their counterparts, according to a new analysis published Friday in JAMA Network Open [1].

The median commercial-negotiated price for a CT scan of the abdomen and pelvis, for instance, is about $1,265 or 20% lower than at hospitals that are not owned by physicians. An MRI of the lower spinal canal costs even less, running $989 or 33% cheaper than the charge at other institutions.

Researchers reached their findings after analyzing data from a sample of 156 physician-owned hospitals and another 1,116 other institutions, spread across 78 different hospital referral regions. The results run counter to the authors’ hypothesis—and popular belief—that doc ownership leads to more expensive healthcare.

“Understanding how physicians’ ownership of hospitals affects patients and payers is an important research area,” Ge Bai, PhD, CPA, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, and co-authors wrote June 23. “This cross-sectional study found that nationwide median commercial negotiated prices and cash prices were lower for general acute-care POHs than for non-POHs in the same market for most common hospital procedures,” they added later.

Bai et al. identified doc-owned acute care hospitals using information from Physician Hospitals of America, a nonprofit that provides lobbying and other support to the industry. They limited the analysis to physician-owned hospitals located in hospital referral regions that contain at least one competitor with a different type of ownership arrangement. Prices, made available via the Hospital Price Transparency Rule, were obtained as of January 13. The team focused on eight services including two imaging exams, spinal injections, physical therapy (therapeutic exercise), a comprehensive metabolic panel, and level 3 or 4 ED visits.

On average, physician-owned hospitals were smaller (55 beds vs. 162), more lucrative (15% profit margin vs. 7%), and likelier to be run as for-profit entities (99% vs. 24%). Doc-held hospitals also were more likely to be nonacademic (88% vs. 72%), noncriticial access (99% vs. 76%) and located in a metropolitan area (99% vs. 76%) compared to other private hospitals in the same market, the analysis found.

“POHs served fewer Medicaid patients (3% vs. 7%) and provided less charity care (1% vs. 3%), which might enable them to accept lower commercial prices (these factors were controlled for in the regression models),” Bai et al. wrote.

Across the eight services studied, median commercial-negotiated price and cash price at physician-owned hospitals were 33.7% and 32.7% lower, respectively, than procedures performed at other institutions. POH status also was associated with 17.5% lower negotiated prices and 46.7% lower for the cash cost. This included a 35% lower cash price for an MRI of the lower spinal canal ($1,113 vs. $1,713) and 36% cheaper for a CT of the abdomen and pelvis ($1,628 vs. $2,531).

The analysis comes as lobbying groups such as Physician-Led Healthcare for America urge Congress to repeal an ongoing moratorium on doc hospital ownership. The U.S. House Energy & Commerce Committee recently held a hearing on healthcare transparency and competition, with PHA and some lawmakers arguing that broader physician hospital ownership could help to keep costs in check. Others such as the American Hospital Association have advocated against changes to the law, asserting that ending the moratorium would lead to price increases and weakened competition. Members of Congress earlier this year proposed legislation repealing current law limiting self-referral to physician-owned hospitals.

To read more, go to Radiology Business.


Physician-owned Hospitals’ Negotiated, Cash Prices Lower Than Nearby Facilities, Study Finds

By Dave Muoio | June 23, 2023 | Included in Radiology Digest – July 4, 2023

Physician-owned general acute care hospitals charge less than other non-physician-owned facilities in their region for several common shoppable care services, according to a new analysis published Friday in JAMA Network Open.

The review, which looked at a sample of 156 physician-owned hospitals (POHs) and 1,116 non-POHs, found median commercial negotiated and cash prices to be roughly a third lower at POHs in the same hospital referral region as a non-POH, researchers wrote in the journal.

Of note, those POHs also tended to be for-profits with, on national-level average, larger profit margins and a third of the beds. They also served significantly fewer Medicaid patients and had lower charity-care-to-expense ratios, potentially implying that POHs have fewer low-paying patients they would need to offset with higher prices.

“The Affordable Care Act (ACA) imposed severe restrictions on physician-owned hospitals, such as prohibiting the development of new physician-owned hospitals and the expansion of existing ones,” Ge Bai, a professor of accounting and health policy at Johns Hopkins University and one of the coauthors of the study, said. “Our study suggests that these hospitals actually deliver care at lower prices, instill competition to the hospital market, and expand patient access to hospital care.”

Bai and colleagues limited their analysis to POHs in hospital referral regions that contained at least one non-POH. They used RAND hospital data from 2020, which is based on Medicare Cost Reports, to describe the hospitals’ characteristics. They compared the commercial negotiated and cash prices for eight CMS-designated shoppable services (such as spinal injection and high-level emergency department visits) as posted on the hospitals’ websites on Jan. 13, 2023.

The researchers’ work was supported by a grant from price transparency organization, which had no role in the study itself. “Most” of the hospitals included in the analysis posted prices for at least one of the eight shoppable services, the researchers wrote, though other potential limitations could include the small number of shoppable services included or missed data from hospitals excluded because they did not post price data.

To read more, go to Fierce Healthcare.


Latest Version of ChatGPT has Potential as a Clinical Decision Support Tool

By Hannah Murphy | June 22, 2023 | Included in Radiology Digest – July 4, 2023

The latest versions of OpenAI’s ChatGPT—GPT-3.5 and GPT-4—could have potential use as clinical support tools that triage patients for imaging services. 

A new paper in the Journal of the American College of Radiology details how these large language models are able to refer patients for imaging exams based on various clinical needs. Experts recently put the LLMs to the test in scenarios when women present to discuss breast cancer screening or for concerns about breast pain to see what the infamous chatbot would recommend in terms of imaging. When compared to ACR Appropriateness Criteria for these indications, the LLMs performed well in both open-ended (OE) and select-all-that-apply (SATA) formats, prompting experts involved in the study to suggest that these tools will have clinical feasibility in the future—with additional updates and more training, of course. 

“Integration of an AI-based tool into existing clinical workflows and systems could drastically improve efficiency, since such tools could take advantage of the wealth of information available from patient pretest odds, diagnostic likelihood ratios, and the medical records themselves,” corresponding author Marc D. Succi, MD, with the Department of Radiology at Massachusetts General Hospital in Boston, and colleagues suggested. 

In the team’s analysis, both GPT-3.5 and GPT-4 performed well with OE formats, achieving an average score of 1.83 out of 2 for the breast cancer prompts. Similarly, GPT-3.5 achieved a SATA average percentage correct of 88.9%, while GPT-4’s average was 98.4%. Both LLMs saw a slight decrease in performance for breast pain prompts, but the newer model, GPT-4, continued to outperform GPT-3.5.

The authors concluded that their results support LLMs’ “promise for future use as an adjunct for radiologic decision-making at the point of care.” In the future, accuracy could be improved with prompts engineered in a hybrid format that offer both a list of options for ChatGPT to choose from and a request for ChatGPT to rationalize its choices, the group suggested. 

The study abstract is available here

To read more, go to Health Imaging.


About a Quarter of Residents in 18 States Have Medical Debt

By Jacqueline LaPointe | June 22, 2023 | Included in Radiology Digest – July 4, 2023

Medical debt is a problem for Americans, with as many as a quarter of residents in 18 states having medical debt in collections, according to a new Commonwealth Fund report.

The states with the highest number of residents with medical debt collections are primarily the South, where state uninsured rates are also the highest in the country. However, medical debt is an issue across the country, the June 22nd report highlights.

The report is the “2023 Scorecard on State Health System Performance,” which uses the most recent data to assess how well the healthcare system works in every US state and the District of Columbia. The scorecard considers healthcare access, quality, use of services, costs, health disparities, reproductive care and women’s health, and health outcomes.

Massachusetts, Hawaii, New Hampshire, and Rhode Island scored the highest overall out of all the states. These states are also the top-performing states in terms of healthcare access and affordability, which includes the share of residents with credit bureau records who have medical debt in collections.

The lowest-performing states overall, according to this year’s scorecard, are Arkansas, Texas, Oklahoma, West Virginia, and Mississippi. Texas, Oklahoma, and Mississippi also rank at the bottom for healthcare access and affordability, joining Wyoming and Georgia.

But all states face challenges with historically high rates of premature death stemming from the aftermath of the COVID-19 pandemic, as well as increasing rates of maternal mortality and health inequities in pregnancy-related outcomes, the report states. Rising healthcare costs and a potential increase in the uninsured rate are also plaguing Americans no matter where they live.

Health insurance coverage rates reached record highs in 2021 thanks to several Medicaid expansions — Idaho, Maine, Missouri, Nebraska, Oklahoma, Utah, and Virginia — and pandemic-era policies, including increased federal funding for outreach and enrollment in the Affordable Care Act’s marketplace and continuous enrollment in Medicaid.

However, some pandemic-era policies have expired this year and many Americans still remain uninsured or inadequately covered, the Commonwealth Fund says. An estimated 15 million people may lose Medicaid over the next year because of changes in eligibility and administrative errors as states unwind the continuous enrollment benefit.

Higher uninsured rates, coupled with a substantial amount of people who are underinsured, could exacerbate the medical debt problem in the US.

To read more, go to Revcycle Intelligence.

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