Radiology Digest – June 4, 2021

June 4, 2021

Radiology Digest: News from the week of June 4, 2021.

Radiology Malpractice Cases Most Often Involve Cancer-related Diagnostic Errors

By Matt O’Connor | June 01, 2021 | Included in Radiology Digest – June 4, 2021

Oncology is the most common culprit of radiology malpractice cases involving diagnostic allegations and more often involves high-severity harm, new research published May 28 suggests.

While only a shade under 4% of all imaging nationally is cancer-related, researchers found 44% of radiologic cases involving a disputed diagnosis were oncologic in nature, “particularly worrisome,” they explained Friday in JACR.

Paired with the fact that anywhere between 40,000 and 4 million individuals in the U.S. will suffer serious, misdiagnosis-related injury each year, the authors said something needs to be done.

“Based on our findings, actions to address diagnostic error as it pertains to oncologic imaging are warranted,” Andrew B. Rosenkrantz, MD, section chief of Abdominal Imaging at NYU Langone Health’s Department of Radiology, and colleagues added.

A large database made up of medical malpractice claims from both captive and commercial insurers across the U.S. shows cancers account for the greatest proportion of high-severity, diagnostic errors (37.8%), followed by vascular events and infections.

Wanting to know more about radiology’s role, the authors searched that same database, keying in on malpractice claims between 2008 and 2017.

Over a 10-year period, radiology was primarily responsible for 3.9% of all claims (2,582 of 66,061) and 12.8% involving diagnostic allegations (1,756 of 13,695).

Furthermore, oncology accounted for 44% of radiology cases with diagnostic allegations, a larger percentage than any other medical condition. And in cases disputing a rads’ diagnosis, harm occurred in 79% of cancer cases but only 42% of nononcologic situations, the authors noted.

To read more, go to Health Imaging.

Biden Proposes 23% Funding Increase for HHS

By Jessie Hellmann | May 28, 2021 | Included in Radiology Digest – June 4, 2021

President Joe Biden’s proposed budget requests a 23% funding increase for HHS and urges Congress to take action on high drug costs while expanding and improving health coverage.

The fiscal 2022 budget plan reiterates Biden’s calls on Congress to pass legislation allowing the federal government to negotiate for lower prices on drugs covered by Medicare, reducing deductibles in ACA plans, improving Medicare benefits to include dental, hearing and vision, creating a public option, lowering the Medicare eligibility age and closing the Medicaid coverage gap in non-expansion states.

The request doesn’t specify how much those policies would cost or how to pay for it. The president’s budget is mostly a messaging document that Congress is unlikely to pass in full. But it lays out his priorities for his time in office.

Overall, Biden’s proposed budget, which totals $6 trillion, is asking for substantial increases in health spending, a departure from the four years of the Trump administration which sought to cut health programs.

Under the Biden budget request, HHS would get $134 billion in discretionary funding, a 23% increase over what Congress approved last year.

“The increased investment supports families in areas such as behavioral health (mental health and substance use), maternal health, emerging health threats, science, data and research, tribal health, early childcare and learning, and child welfare,” HHS Secretary Xavier Becerra said in a statement Friday. “To build back a prosperous America, we need a healthy America, and President Biden’s budget builds on that vision while investing in the many programs housed at HHS to save lives,” he said.

To read more, go to Modern Healthcare.

Radiology 3rd Among Specialties with Heaviest Prior Authorization Burden

By Marty Stempniak | May 28, 2021 | Included in Radiology Digest – June 4, 2021

Radiology is among the medical specialties with the highest rate of services subjected to prior authorization, according to a new large-scale analysis published Friday in JAMA Health Forum.

Experts from several notable institutions, including Harvard and CVS Health, reached their conclusions by analyzing coverage rules from a large Medicare Advantage insurer. They found wide variation among different types of physicians in how this extra check on utilization is applied.

Diagnostic radiology services landed at 91%, third behind the rates for radiation oncology (97%) and cardiology (93%).

These policies, however, do not apply in Medicare Part B, which pays for physician care, outpatient treatment and home health, among other costs. Out of nearly 6.5 million beneficiaries covered by this part of the federal payment program, 41% received at least one service per year that would have been subject to prior authorization under Medicare Advantage.

“There is almost no public data on how often prior authorization is required for medical services. This study shows what many radiologists probably already expect: that private insurers have instituted broad prior authorization policies, which often affect radiology services,” lead author Aaron Schwartz, MD, PhD, with the Department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine, told Radiology Business. “There is also a big gap between how private insurers and traditional Medicare approaches this issue, though Medicare has taken steps to expand prior authorization in recent years,” he added.

To reach their conclusions, Schwartz and colleagues analyzed claims and enrollment data for a random 20% sample of Medicare fee-for-service beneficiaries treated in 2017. They measured the use of services that would have been subject to prior authorization in Part B, regardless of whether the request was approved or denied. Researchers also obtained proprietary prior authorization data from Aetna’s Medicare Advantage for the same year.

If the federal government applied the same rigorous utilization tactics as private insurers in Part B, 2.2 services per beneficiaries would fall under prior authorization annually, including 0.8 in radiology. In dollar terms, each beneficiary in Part B paid an average of $1,661 (or $270 for radiology) per person, which would have fallen under PA policies in private pay. Diagnostic radiology was the largest source of nondrug expenditures at 16%.

“The spending associated with prior authorization services was concentrated in particular clinical domains. Accordingly, prior authorization services varied substantially across clinician specialty, suggesting an uneven administrative burden for different specialties and institutions,” the authors noted. “Developing and applying appropriateness criteria may also be more complex for nondrug services. Although assigning appropriateness criteria to imaging studies proved challenging in a recent Medicare demonstration project, Aetna has broad prior authorization requirements for outpatient radiology,” they added later.

You can read much more about their analysis in JAMA Health Forum here.

To read more, go to Radiology Business.

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