Radiology Digest – May 2, 2023

April 28, 2023

Radiology Digest: News from the week of May 2, 2023.
‘Healthcare, Administration Leadership and Management’ to be Recognized as New Subspecialty in Radiology

By Marty Stempniak | April 27, 2023 | Included in Radiology Digest – May 2, 2023

“Healthcare, administration, leadership and management” will soon be recognized as a new subspecialty in radiology, the American Board of Medical Specialties announced on Wednesday.

The designation will cover clinical medicine alongside different principles in health system science. Those include quality improvement, patient safety, economics, public health, communication and informatics—all integrated into a single subspecialty certificate.

ABMS said diplomates from 13 of its 24 member boards (including the American Board of Radiology) will be eligible to apply for the subspecialty certificate. It plans to administer the first exam in 2024.

“We are pleased to recognize physicians and medical specialists with the expertise and comprehensive knowledge necessary to lead healthcare organizations in ensuring delivery of the highest quality care to their patients,” ABMS President and CEO Richard E. Hawkins, MD, said in an April 26, announcement. “The establishment of the HALM subspeciality is in direct response to requests from both the physician and medical specialists’ community as well as healthcare systems alike.”

To read more, got to Radiology Business.


Radiology Societies ‘Alarmed’ by Administrative Burden, Costs Posed by New Cigna Policy

By Marty Stempniak | April 27, 2023 | Included in Radiology Digest – May 2, 2023

Medical societies representing radiology and other specialties say they are “alarmed” by the cost and administrative burden posed by a new policy from Cigna.

The Bloomfield, Connecticut-based health insurer recently announced that beginning May 25, it will require the submission of medical office notes when physicians seek payment in certain scenarios. Cigna’s concerns relate to the delivery of additional evaluation and management services delivered on the same day of a procedure or other similar healthcare offering.

In less than a month, physicians must submit supporting documentation when they use “modifier 25” to bill for these situations. But the American Society of Neuroradiology, Society of Interventional Radiology and 100 other medical groups believe this will only serve to further hinder already-overwhelmed provider groups.

“Our organizations are alarmed by the significant administrative burdens and costs for healthcare professionals—and Cigna—that will result from implementation of this policy,” the radiology societies wrote in an April 18 letter to Chairman and CEO David Cordani, MBA. “By bluntly requiring clinical documentation for all claims for an E/M service reported with modifier 25, physicians and other providers will be forced to submit an enormous number of office notes, and Cigna will be deluged with medical records.”

The policy change applies to CPT codes 99212-99215 when a minor procedure is billed with modifier 25—used when “distinct services are performed on the same day,” according to the AMA. In certain situations, a patient’s condition may require a “significant, separately identifiable” E/M service that goes “above and beyond” the core procedure being reported by the physician on the same day. Cigna had previously announced the update about a year ago but paused implementation in July after physicians voiced their concerns, according to the California Medical Association.

Cigna did not immediately respond to a Radiology Business request for comment on Wednesday. Physicians said the insurer has contended that the purpose of the policy is to limit the inappropriate use of modifier 25. However, the groups said that Cigna has presented zero proof this is problems warrants correction.

To read more, go to Radiology Business.


Urgent Care Settings May Offer Breast Cancer Screening Opportunity

By Amerigo Allegretto | April 26, 2023 | Included in Radiology Digest – May 2, 2023

Nearly one in three women who did not obtain recommended breast cancer screening in a year have visited urgent care centers, according to an April 20 presentation delivered at the American Roentgen Ray Society (ARRS) annual meeting.

The study suggests that urgent care and other care settings could offer opportunities for mammography screening, presenter Dr. Anand Narayan, PhD, from the University of Wisconsin noted. At the meeting, he shared results from research that included data from more than 9,000 women and found that, among women who did not undergo mammography screening within the past year, about 23% reported visiting an emergency room and nearly 10% reported being hospitalized — suggesting untapped potential in these settings for preventive breast health services.

“Among the different sites, we have several opportunities to increase access for mammography screening,” Narayan said.

To improve adherence to recommended mammography screening, clinics often collaborate with primary care providers. However, Narayan said lack of access to primary care providers is a key risk factor for not being up to date with recommended breast cancer screening. He and his team sought to estimate the proportion of women visiting urgent care centers, emergency departments, or being hospitalized who were not current with recommended mammography screening. The study goal was to explore the potential impact of nonprimary care-based cancer screening interventions.

The investigators used data from the 2019 National Health Interview Survey that included information from 9,139 women between the ages of 40 and 74 with no prior history of breast cancer.

The team found the following:44.9% did not report receiving a mammogram within the last year.29.2% reported visiting an urgent care center.21.8% of women who did not report receiving a mammogram did report visiting an emergency room.9.6% reported being hospitalized.To read more, go to Aunt Minnie.


No Surprises Act is Working, New Analysis Contends, Though It’s Straining Radiology Providers’ Margins

By Marty Stempniak | April 25, 2023 | Included in Radiology Digest – May 2, 2023

The No Surprises Act is fulfilling its goal of protecting patients from unexpected medical bills and keeping them out of payment disputes, a new analysis contends.
However, the law also appears to be straining the margins of some radiology providers and placing them in danger of being pushed out of networks.

The Urban Institute published its study April 18 after interviewing more than 30 healthcare industry stakeholders. Those included federal and state regulators, insurers, providers and consumer advocates, with researchers hoping to uncover the impact of surprise-billing legislation since it went into effect last year.

“We find that providers and payers have responded to the legislation by adjusting operations to mitigate the risk of balance billing,” Urban Institute Research Analyst Erik Wengle and colleagues noted. “Still, interviewed stakeholders see reasons for caution and close monitoring of responses to the law—citing concerns about consumer awareness, insurance literacy, and billing lags—to ensure consumers are fully protected.”

Interviewees pointed out the need to “closely monitor” services not currently on the list of ancillary offerings for which providers are banned from requesting consent waivers. Providers of such services, including radiologists, currently cannot seek a waiver from patients to allow balance billing. However, certain “almost ancillary” services are not specified on the list and may slip through the cracks.

“If providers of these services start to employ consent waivers, patients could be at risk for balance billing,” stakeholders in the insurance industry claimed.

“Several informants” underlined the need to potentially expand the NSA to address services that fall outside its scope. They described instances of patients receiving balance bills for out-of-network imaging including CT, which they underwent during a visit with an in-network, outpatient provider.

“Although such bills often come as a surprise to the patient, this type of situation is not covered by the NSA,” the report noted.

Urban Institute experts anticipate that decisions over out-of-network payments and dispute resolutions will eventually begin influencing negotiations tied to in-network providers.

“Even so, the impact may not become clear until multiyear contracts come up for renewal,” Wengle and co-authors noted. “Furthermore, the impact may be focused more narrowly on the specialties most affected by surprise billing—especially emergency medicine, anesthesiology, radiology and pathology—which could in turn limit the impact on overall health costs and plan premiums.”

A recent analysis from S&P Global Ratings shows that’s already happening. Since the roll out of the legislation, commercial insurers started terminating some of their in-network contracts that involved higher-than-average reimbursement rates. The intent, analysts noted, was to use arbitration to lower reimbursement. As one example, UnitedHealthcare knocked multispecialty provider group Envision Healthcare out of its network at the end of 2020 following the NSA’s passage, citing “egregiously high rates.”

To read more, go to Radiology Business.


American Hospital Association Wants Congress to Intervene in Medicare and Medicaid Payments

By Susan Morse | April 25, 2023 | Included in Radiology Digest – May 2, 2023

Following the release earlier this month of acute care hospital inpatient payment rates the American Hospital Association called “woefully inadequate,” the AHA has released a report that it said shows a continuation of financial pressures that began at the start of the COVID-19 pandemic.

Expenses across the board saw double-digit increases in 2022 compared to pre-pandemic levels, including for workforce, drugs, medical supplies and equipment, as well as other operational services such as IT, sanitation, facilities management, and food and nutrition services, the report said. 

There has been a 17.5% increase in overall hospital expenses between 2019 and 2022, according to the AHA, citing data from Syntellis Performance Solutions, a healthcare data and consulting firm.

“Specifically, hospital expense increases between 2019 and 2022 are more than double the increases in Medicare reimbursement for inpatient care during that same time,” the AHA said.

These factors led to the most financially challenging year for hospitals and health systems since the beginning of the COVID-19 pandemic, leaving over half of hospitals operating at a financial loss at the end of 2022, the AHA said. Negative operating margins continued in January and February 2023, putting access to services at risk.

The first quarter of 2023 saw the highest number of bond defaults among hospitals in over a decade, according to the AHA.

“This also is one of the primary reasons that some hospitals, especially rural hospitals, have been forced to close their doors. Between 2010 and 2022, 143 rural hospitals closed – 19 of which occurred in 2020 alone,” the AHA said. “Finally, despite these cost increases, hospital prices have grown modestly. In fact, in 2022, growth in general inflation (8%) was more than double the growth in hospital prices (2.9%).”


“Without additional congressional action and support from the administration, patients’ access to care is at risk,” the AHA said. “Further exacerbating the situation is the fact that the staggering expense increases have been met with woefully inadequate increases in government reimbursement.”

The AHA wants Congress to urge the Centers for Medicare and Medicaid Services to use its “special exceptions and adjustments” authority to make a retrospective adjustment to account for the difference between the market basket update that was implemented for fiscal year 2022 and what the market basket is currently projected to be for 2022.

It also wants Congress to create a special statutory designation and provide additional support for metropolitan anchor hospitals that serve historically marginalized communities.

To read more, go to Healthcare Finance


ChatGPT to be Utilized in New Medical Imaging App for Patients

By Hannah Murphy | April 24, 2023 | Included in Radiology Digest – May 2, 2023

AI chatbot ChatGPT is making its official debut in medical imaging by way of a new app that can be utilized by anyone with a smartphone. 

Earlier in April, imaging IT leader RamSoft announced that it would soon be introducing a patient-centric medical imaging app that is powered by AI program ChatGPT. The patient portal app is called Blume; it is intended to help streamline the process of sharing medical imaging and reports between patients and providers while also offering patients opportunities to seek information regarding imaging procedures and results. 

The ChatGPT integration will allow patients to ask the chatbot questions about their medical imaging exams and procedures and receive plain language answers in real-time. The hope is that it will improve outcomes by better informing patients about their medical care plan. 

Vijay Ramanathan, RamSoft CEO, commented on the new feature in a prepared statement. 

“Two key factors underline the importance of addressing patient centricity,” Ramanathan said. “First, leveraging the widespread adoption of smartphones to enhance doctor-patient communication and second, complying with the 21st Century Cures Act which mandates that healthcare providers share images and reports with patients.” 

Additional features of the Blume app include self-scheduling and managing appointment requests, the ability to complete and submit intake forms, insurance verification and medical image sharing between patients and providers. 

The app is available on Android and iOS devices and can be downloaded from Google Play and Apple’s App store. 

RamSoft made the announcement at HIMSS 2023. The app has not yet gone live, but RamSoft is offering personal online demos of it. For more information, click here.

To read more, go to Health Imaging.

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