Radiology Digest – May 20, 2022

May 20, 2022

Radiology Digest: News from the week of May 20, 2022.

6 Categories of Contrast CT Prove Ripe for Revisiting During Supply Shortage
By Dave Pearson | May 19, 2022 | Included in Radiology Digest – May 20, 2022

Challenged to maintain service levels during the present shortage of iodinated contrast agents (ICAs) for CT scans, researchers at a quaternary academic medical center have developed a short-term workaround that they report is now reducing the institution’s ICA consumption by more than 50% without compromising care quality.

Mahmud Mossa-Basha, MD, and radiology colleagues at the University of North Carolina at Chapel Hill share their overall strategy and targeted tactics in special commentary published online May 17 in JACR [1].

“The ACR Committee on Drugs and Contrast Policy published guidelines on approaches during the ICA shortage, which include diverting imaging to other modalities (noncontrast CT, MRI, ultrasound) when possible, use of alternative brand ICA [to stand in for GE Healthcare’s Omnipaque (iohexol), reduced individual dosing and supply prioritization,” the authors write to introduce their article. “Our target was to reduce contrast usage by 50% to 70% in a short period of time.”

Toward that end, UNC-Chapel Hill’s radiology department co-led UNC Health—with cardiology and hospital operational leadership—in modifying CT scan protocols, substituting MRI and ultrasound for CT, working with nonradiology provider teams, and prioritizing interventional and neuro-interventional radiology procedures by acceptable delay times.

Mossa-Basha and co-authors list various changeable exams and procedures under six categories. Here are illustrative examples from each:

  1. CT examinations switched from contrast-enhanced CT to noncontrast CT: chest CTs for evaluation of cancer or mediastinal disease; abdominal CT for pain with concern for appendicitis, hernia, diverticulitis and abscess; cardiothoracic CT for status check of postendovascular aneurysm repair …
  2. CT exams for which Omnipaque can continue to be administered unabated: CT pulmonary embolism; CT angiography for evaluation of aortic dissection in unstable patients; CT angiography or CT perfusion for stroke code …
  3. Contrast dosing adjustments: CT transcatheter aortic valve replacement (TAVR)—dose reduced from 150mL to 60-80mL; CT pulmonary embolism—from 75mL to 50mL …
  4. CT exams redirected to MRI when possible: from CT abdomen/pelvis for right upper quadrant pain to MRI abdomen or magnetic resonance cholangiopancreatography (MRCP) …
  5. Prioritization of neuro-interventional procedures: Emergent: stroke thrombectomy, ruptured aneurysms, carotid blowout. Delay one month: elective unruptured aneurysm, arteriovenous fistula. Delay three months: follow-up diagnostic angiograms, tumor embolizations and spinal angiograms …
  6. Prioritization of interventional radiology procedures: Emergent: large splenic aneurysms with impending rupture, acute venous thromboembolic event with complicating features, Percutaneous biliary and nephrostomy drainages for obstruction with sepsis. Delay one
    month: interventional oncology procedures, venography for dialysis access planning. Delay three months: venous embolizations, recanalizations, malformations and stenting …

To read more, go to Radiology Business.

GE Provides Update on Contrast Media Shortage
By Hannah Murphy | May 18, 2022 | Included in Radiology Digest – May 20, 2022

In the wake of a nationwide iodinated contrast media shortage, many lingering questions loom as patients, providers and organizations continue to adapt while waiting for the lockdowns that triggered the supply chain issue to ease in Shanghai, China.

In an exclusive statement to Health Imaging, representatives of GE provided an update on the situation:

“Our priority is delivering for our customers and their patients, and we are working around the clock to expand capacity of our iodinated contrast media products. After having to close our Shanghai manufacturing facility for several weeks due to local COVID policies, we have been able to reopen and are utilizing our other global plants wherever we can. We are working to return to full capacity as soon as local authorities allow.” said a GE Healthcare spokesperson.

The other global plant referred to in the statement is GE’s manufacturing plant in Cork, Ireland, where production capacity has been expanded to compensate for the reduction in Omnipaque (iohexol).

Initially, it was expected that there would be a reduction of up to 80% in supply for 6 to 8 weeks. The COVID lockdowns at the Shanghai plant began on March 31 amid a new wave of infections there. Although the plant has since resumed operations, they are not yet at 100% capacity. GE shared that the plant is currently at 50% capacity and it is working with local authorities in Shanghai around the clock to try and increase the number of operators at the site in controlled groups over the next week.

Additionally, GE has also adjusted its logistic routes to speed up contrast deliveries. Shipments from both Cork and Shanghai have been switched from sea to air to deliver supplies more quickly.

GE indicated that their mitigation strategies, as well as those implemented at organizations across the country, have helped to improve the situation — a situation that is expected to continue to improve as the Shanghai plant increases worker capacity.

GE says hospitals are OK to find other sources of contrast during the shortage.

To read more, go to Health Imaging.

Employer Health Plans Pay Hospitals 224% of Medicare
By Alex Kacik | May 17, 2022 | Included in Radiology Digest – May 20, 2022

Employers continue to pay hospitals more than double the amount Medicare would pay for the same services, a new study shows.

Private employer-sponsored health plans paid hospitals 224% of Medicare prices, on average, according to an updated RAND Corp. analysis of claims from 4,000 hospitals across every state except Maryland. Hospitals with higher market shares tended to have higher prices, according to the study, which supports past research.

A 10% increase in hospital market share was associated with a 0.5% increase in a hospital’s price relative to Medicare, researchers found. Still, some researchers noted that a 0.5% increase for a significant 10% boost in market share was relatively small.

“No one expects prices to go down year over year given how consolidated most hospital markets are,” said Glenn Melnick, a health economist and policy professor at the University of Southern California, whose work shows that prices tend to increase as hospitals grow. “My prediction is that once the study is updated again, prices are going to shoot up. The wage push and cost pressure on these facilities is enormous, so they are going to pass it on.”

Private insurers paid 222% of Medicare prices in 2018 and 235% in 2019. The 224% total for 2020 was less than the 247% figure reported for 2018 because the sample size increased with data from states like Washington, Oregon and Utah where hospitals tend to have lower prices, the researchers noted.

That decline was telling, said Rick Pollack, president and CEO of the American Hospital Association.

“This suggests what we have long suspected: You simply cannot draw credible conclusions from such a limited and biased set of claims,” he said in a statement.

Hospitals also claim that Medicare does not fully cover the cost of care for Medicare beneficiaries. Relying solely on Medicare rates would likely cause hospitals to cut services, which would reduce access to care, Pollack said.

That implies that hospitals shift costs, meaning they charge higher rates for their commercially insured patients to make up for the relatively lower pay for care provided to Medicare and Medicaid beneficiaries and the uninsured. But RAND researchers did not find evidence to support the cost-shifting premise.

Medicare, in part, bases its payment levels on hospitals’ labor costs. Medicare may boost its rates in 2022 and 2023 to account for the average 13% increase in hospitals’ wage and benefit expenses from October 2020 to October 2021, industry observers said.

“We know that Medicare rates have not increased much, and as my Brookings Institution colleagues have pointed out, they may go up in 2022 or 2023,” said Paul Ginsburg, a health policy professor at USC and senior fellow of the USC Schaeffer Center for Health Policy and Economics. “It might be a temporary change allowing higher wages to factor into the Medicare input price data.”

To read more, go to Modern Healthcare.

A Dramatic Shift: New Survey Highlights Salaries and Staffing Concerns in Radiology
By Marty Stempniak | May 17, 2022 | Included in Radiology Digest – May 20, 2022

Imaging leaders are living in a hyper-competitive market for talent in 2022, finding it difficult to fill physician, technologist and nurse positions, according to new survey data gathered by Radiology Business.

Across all titles surveyed—including administrators, radiologists, technologists, and IT and PACS managers—overall staffing levels were cited as the biggest challenge in the specialty by 55% of respondents. Amid hiring crunches, workplaces are forcing radiology staffers to assume additional duties too, with increased workloads due to organizational changes ranking as the No. 2 concern.

Case in point: Corvallis (Oregon) Radiology PC has been trying to recruit physicians in neuroradiology, breast and body imaging, along with an interventional assistant. However, the hiring process has been challenging, says longtime administrator Mark Kalmar. Prior to the pandemic, the private practice might receive upward of 40 responses to a job post. Now, they get fewer than five, with salary considerations 10% higher than anticipated.

“The landscape has changed dramatically in the last couple years,” says Kalmar, who is also president of the Radiology Business Management Association (RBMA) Board of Directors. “In our experience, there is a national shortage of radiologists.”

High demand for physicians
In this frenzied hiring market, physicians are shopping around. About 28% of radiologists who chimed in on our survey say they’re fairly compensated, but the great resignation is real. Some 35% of survey respondents tell us they’ve been applying to or considering new employment opportunities over the past year. Many may be only testing the waters, of course; 14% of those surveyed say it is somewhat likely they’ll change employers in the next 12 months while 9% say it is very likely.

Looking at the bigger picture, radiologists were the third most requested search by healthcare employers in 2021, behind only nurse practitioners and family medicine, according to physician recruiting firm Merritt Hawkins. The specialty was in high demand roughly 20 years ago, but saw a slowdown in the late 2000s. Now it is roaring back, with the Dallas-based physician recruiting firm witnessing a “feeding frenzy” for radiologist talent, says Michael Belkin, Merritt Hawkins’ divisional VP of physician and leadership solutions.

Whereas yesterday’s boom was fueled by hospitals gobbling up radiology groups to staff their own departments, private practices are driving demand in 2022. Belkin estimates hospitals represent less than 20% of Merritt Hawkins’ 2021 radiologist requests. National imaging organizations that previously created a market primarily for night-time reads and are now moving aggressively into the daytime hours. “This iteration [of demand] is very heavy private group practice,” Belkin says.

Out of 200 radiologists responding to our survey, 49% work in private practice. Hospital or health system clinicians represent the next largest portion of the pie at 26%, followed by university or academic institutions (15%) and medical groups (4%).

To read more, go to Radiology Business.

US Set to Extend COVID-19 Public Health Emergency Past July
By Riley Griffin | May 16, 2022 | Included in Radiology Digest – May 20, 2022

The US government will extend the Covid-19 public-health emergency past mid-July, continuing pandemic-era policies as the nearly 2 1/2-year outbreak drags on.

The Department of Health and Human Services has repeatedly renewed the public-health emergency since implementing it in January 2020. The declaration allows the US to grant emergency authorizations of drugs, vaccines and other medical countermeasures, as well as administer those products to millions of people at no out-of-pocket cost. It’s also enabled millions of Americans to get health coverage through Medicaid, among other benefits.

On April 16, HHS extended the public-health emergency an additional 90 days through mid July. The declaration will be extended beyond that period, according to a person familiar with the matter, who asked not to be identified because the details aren’t public. That means various measures to relax restrictions in how care is accessed across the health system will continue.

An HHS spokesperson said the public-health emergency remains in effect, and the department will continue to provide a 60-day notice to states before any possible termination or expiration.

To read more, go to Bloomberg news.

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