Radiology Digest – May 14, 2021

May 14, 2021

Radiology Digest: News from the week of May 14, 2021.

90% of Radiology Residents Rely on Two Online Resources for Help During Their On-call Shifts

By Matt O’Connor | May 12, 2021 | Included in Radiology Digest – May 14, 2021

Nearly 90% of radiology residents now rely on two specific online resources for guidance during their on-call shifts, new data published in Clinical Imaging suggests.

There’s been a growing trend towards ramping up 24-hour emergency radiology attending coverage for trainees, yet some studies report nearly 65% of residency programs still lack overnight help. And those looking for quick assistance overwhelming turn to open-source website Radiopaedia and paid service STATdx in these situations, researchers reported May 6.

The authors say this is an extension of trends reported in the mid-2000s showing a move toward online-based resources within resident education. But they also found other important factors.

“The ease and speed of access of these resources appear to be the major attractions in pursuing today’s online resources; and furthermore, these resources are perceived to be effective,” Ahrya Derakhshani, MD, MPH, with the Neuroradiology Section at UCLA’s Department of Radiology, and co-authors added. was launched in 2005 and houses more than 14,000 radiology articles and upward of 39,000 patient cases. It’s monitored by an expert panel and has become a go-to resource for imaging providers, particularly from low-income countries.

STATdx, meanwhile, is owned by publishing group Elsevier and is written by radiologists across various specialties. An individual subscription costs $2,300 per year in the U.S., according to its website.

To better understand residents’ usage of these resources, and others, the researchers surveyed fellows and residents from UCLA, New York University and Emory University. They received 78 responses for a 30.5% return rate.

Overall, 89.7% of rads said they use either Radiopaedia or STATdx as their first resource. Most turned to the open-access website first (70.5%) followed by StatDX (19.2%) and Google search (7.7%). Approximately 60% said they looked for information 6-10 times during their 10-hour shift.

The ease and quick access of these sources proved to be valuable for 75% of respondents. Additionally, 70% placed the likelihood of finding the info they wanted as 4 out of 5 stars.

To read more, go to Health Imaging.

HHS Considering Extending Provider Relief Fund Deadline, Secretary Tells Congress

By Jessie Hellmann | May 12, 2021 | Included in Radiology Digest – May 14, 2021

HHS Secretary Xavier Becerra on Wednesday said the agency is considering extending the deadline that providers have to spend relief funds by but did not provide a timeline of when more aid might be delivered.

Provider Relief Funds must be spent by June 30 or returned to the federal government but the American Hospital Association (AHA) and some lawmakers have called on HHS to extend that deadline through at least the end of the year.

“Some folks have asked for an extension. We’re looking at all that very, very closely,” Becerra said at an Energy & Commerce Committee hearing on the HHS budget request. “What I will tell you is again; we’ll be driven by facts in this case to make sure providers who have a need get those needs addressed.”

Providers have also anxiously awaited the disbursement of the remaining $33 billion in the fund, which is intended to help providers weather the financial pains of the pandemic.
Becerra didn’t offer a timeline for when the funding will be awarded, or to what specific types of providers, although Congress appropriated another $8.5 billion for rural providers earlier this year. The last disbursement from the fund was in in December.

“We’ll make sure we can dispense it in a way that’s not only accountable but it goes to those who need it most,” Becerra said. “We’re going to demand accountability and transparency.”

He later added under questioning from Rep. Lori Trahan (D-Mass.) that safety-net hospitals and other front line providers should not be allowed to “fall through the cracks.”
“Those safety-net hospitals on the front-line deserve our attention,” he said.

Nearly $178 billion in provider relief funding has already been spent under President Trump but some have questioned whether it has been spent wisely.
Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) argued Wednesday that the Trump administration didn’t use the funding for providers who had the “greatest need” and urged Becerra to make changes.

“This Provider Relief Fund ensures front-line workers can keep their doors open during this time, it’s just imperative funds go to those who need it the most,” Pallone said.

To read more, go to Modern Healthcare.

Hospital-based Doctors Order more Inappropriate MRI Scans

By Kate Madden Yee | May 11, 2021 | Included in Radiology Digest – May 14, 2021

The odds of a patient receiving a referral for an inappropriate MRI scan is 26% higher when the patient is referred by a hospital-based primary care physician compared with a doctor in private practice, according to a study published May 3 in Health Affairs.

The results suggest that concerns about the influence of hospital-based employment on patient care are valid, wrote a team led by Gary Young, PhD, of Northeastern University in Boston.

“The odds of a patient receiving an inappropriate MRI referral increased by more than 20% after a physician transitioned to hospital employment,” Young and colleagues wrote. “Most patients who received an MRI referral by an employed physician obtained the procedure at the hospital where the referring physician was employed. These results point to hospital-physician integration as a potential driver of low-value care.”

In the traditional healthcare model, physicians have cared for patients through private practices, securing affiliation with a nearby hospital in order to provide inpatient services. But this care model has begun to shift, and physicians are now more and more likely to be employed directly by a hospital. The trend can translate to better patient care, but it can also lead to ordering inappropriate services to boost the hospital’s bottom line.

“[As] hospital employees, physicians may be more inclined to refer patients for services that financially benefit the hospital that employs them but that might not be clinically beneficial for patients,” the authors noted. “Some studies point to such an effect, finding that physicians employed in hospital-based arrangements have relatively more expensive patterns of patient care.”

Yet despite some evidence of “more expensive patterns of patient care” among hospital-employed physicians, these studies don’t necessarily settle the question of whether that care is inappropriate.

To read more, go to Aunt Minnie.

American College of Radiology Urges UnitedHealthcare to Revise ‘Onerous’ New Prior Authorization Process

By Marty Stempniak | May 7, 2021 | Included in Radiology Digest – May 14, 2021

The American College of Radiology and other physician groups are urging the nation’s largest commercial insurer to reconsider “onerous” new prior authorization processes that recently took effect.

UnitedHealthcare began making providers jump through extra hoops on April 1 before they can obtain payment for certain outpatient services. Those include imaging-guided radiation therapy, along with fractionation for breast, prostate, lung and bone metastasis cancer.

ACR, the American Society for Radiation Oncology and the Association of Community Cancer Centers said they respect the insurer’s decision. But they are asking UnitedHealthcare to make modifications to lessen administrative burdens on busy physicians.

“We appreciate the need to curb services that are not medically necessary; however, we are concerned that the prior authorization tool contains onerous processes that will delay care for cancer patients,” the three wrote in an April 28 letter to Jennifer Malin, MD, PhD, the Minnesota-based payer’s medical director of oncology and genetics.

Following a recent demonstration of United’s new prior authorization portal, ACR and others advocated for several updates to simplify use. Streamlining the tool to remove any clinically irrelevant options is one choice, they wrote, along with only asking physicians to obtain very specific information that would trigger prior authorization. They additionally suggested exempting physicians with high rates of approval from these requirements when delivering standard oncology treatments.

“While addressing clinical and administrative concerns is vastly important, the most fundamental issue UHC must consider is the impact of the prior authorization tool on patients,” the doc groups wrote. “UHC can take meaningful steps toward reducing administrative burden by ensuring the prior authorization tool asks only those questions necessary to determine if the authorization request is appropriate,” they added later. “Anything beyond this only increases burden.”

You can read the full letter, signed by ASTRO CEO Laura Thevenot and American College of Radiology chief William Thorwarth Jr., MD, here. ACR also posted a news update on the issue Thursday.

To read more, go to Radiology Business.

‘Under Siege by Consolidation’: Antitrust Trade Group Comes Out Against UnitedHealth-Change Merger

By Marty Stempniak | May 6, 2021 | Included in Radiology Digest – May 14, 2021

An antitrust trade group has come out against UnitedHealth’s proposed acquisition of radiology vendor Change Healthcare, worried the deal could harm both competition and consumers.

The American Antitrust Institute voiced its concerns in a letter to the U.S. Department of Justice sent on Wednesday. In it, AAI President Diana Moss argued that letting the two healthcare giants merge would eliminate competition between UnitedHealth Group’s IT-enabled health services subsidiary Optum, and Change.

Moss and the institute also believe that making Optum more powerful might boost the sway of its parent company’s already “dominant” health insurance plan, UnitedHealthcare, to the disadvantage of rivals.

“The U.S. healthcare system is under siege by consolidation and high and rising concentration, to the proven detriment of consumers and healthcare providers,” she wrote to Richard Powers, acting assistant attorney general for the DOJ, on May 5. “The current matter presents an important opportunity for the Antitrust Division to advance the ball on protecting competition in critically important healthcare markets, but also to leverage its knowledge of digital technology markets and the unique challenges they pose for competition enforcement.”

AAI, a Washington-based nonprofit advocacy group, joins numerous others lining up to oppose the $13 billion deal, first proposed in January. Those include the title=”Change in Healthcare DOJ” American Hospital Association, American Medical Association, and some of Change Healthcare’s stockholders (though the overwhelming majority approved the transaction in April). Following a similar letter from the hospital association and its legal counsel, the Justice Department launched an investigation of the merger in March.

Optum did not immediately respond to a Radiology Business request for comment Thursday, nor did Change, a Blackstone Group-backed, Nashville, Tennessee-based provider of software solutions in radiology and other specialties.

To read more, go to Radiology Business.

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