Radiology Digest – May 28, 2021

May 27, 2021

Radiology Digest: News from the week of May 28, 2021.

Insurance Giant Aetna Expands Coverage for Annual Low-dose CT Lung Cancer Screening: ‘Lifesaving’

By Marty Stempniak | May 27, 2021 | Included in Radiology Digest – May 28, 2021

Commercial insurer Aetna has agreed to expand coverage for annual low-dose CT lung cancer screening exams at the urging of radiologists and other physicians.

This change comes after the U.S. Preventive Services Task Force recently updated its guidance for monitoring the disease, dropping the starting age from 55 to 50. The American College of Radiology and Society of Thoracic Surgeons pushed major payers to adopt these recommendations, and the Hartford, Connecticut-based company has responded.
“The ACR applauds Aetna for taking swift action to offer this lifesaving screening exam to an expanded group of high-risk individuals,” the college said in a news update shared Wednesday, May 26.

Aetna will cover annual CT screening for current smokers ages 50-80 with a 20 pack-year or more smoking history, along with those who have quit in the last 15 years. The new policy replaces previous guidelines that started at age 55, with a 30 pack-year or more history, ACR said. The decision is retrospective to March, when the USPSTF issued its updated guidance. Aetna, a CVS Health Company, currently covers more than 22 million Americans through its medical plans, according to its website.

Meanwhile, ACR and the thoracic surgery group have also asked Anthem, Cigna, Health Care Services Corporation, and UnitedHealthcare to do the same. The Centers for Medicare & Medicaid Services is currently contemplating whether to update its own coverage guidelines for seniors to match new task force guidelines.

To read more, go to Radiology Business.

Fresh Off Her Senate Confirmation, Imaging Group Asks New CMS Chief for Help in Post-COVID Recovery

By Matt O’Connor | May 26, 2021 | Included in Radiology Digest – May 28, 2021

The Medical Imaging & Technology Alliance congratulated CMS Administrator Chiquita Brooks-LaSure on her confirmation Tuesday and wasted no time in asking for help as the field seeks to recover from the pandemic.

MITA addressed a nine-page letter to the new health chief on May 25 following her confirmation by the Senate in a 55-44 vote on the same day. She becomes the first Black woman to lead the trillion-dollar agency.

In the document, the trade association urged Brooks-LaSure to bolster the federal response to COVID-19 and implored her to assist providers as they catch up on care skipped since the public health emergency first started.

“To avoid compounding the access, economic, and innovation challenges that beneficiaries, providers, and medical technology manufacturers have faced during the pandemic … CMS should not implement any new policies that result in additional payment cuts or unnecessary administrative burdens,” MITA Executive Director Patrick Hope wrote in the letter.
Additionally, the organization wants CMS to establish incentives to spur adoption and use of novel AI solutions; ensure appropriate coding, coverage and payment for imaging drugs; and improve rate-setting techniques for outpatient services.

MITA also called on the administration to finalize the recently delayed Medicare Coverage for Innovative Technologies rule for “breakthrough” devices, among other priorities.

To read more, go to Health Imaging.

Senate Approves CMS Administrator Nominee

By Jessie Hellmann | May 25, 2021 | Included in Radiology Digest – May 28, 2021

The U.S. Senate confirmed President Joe Biden’s nominee to lead CMS Tuesday, giving the agency a permanent leader at a key moment for the administration.
Chiquita Brooks-LaSure, who worked for the Obama administration and helped implement the Affordable Care Act, will oversee the agency’s efforts to expand the healthcare law, set the overall policy agenda for Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

The nomination was approved 55-44 with four Republicans voting yes: Sen. Roy Blunt (R-Mo.), Susan Collins of Maine, Richard Burr (R-N.C.), Jerry Moran (R-Kan.) and Lisa Murkowski (R-Alaska).

Before being nominated to lead CMS, she was a consultant for Manatt Health and previously worked for the House Ways & Means Committee, where she helped draft the ACA.
“This is clearly one of the most important healthcare jobs in America,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said Monday.

“Ms. Brooks-LaSure brings decades of health policy experience to CMS and I think it would be fair to say she has worked on healthcare from just about every angle short of scrubbing into the operating room itself.”

Brooks LaSure’s nomination became controversial among Senate Republicans after CMS reversed the Trump administration’s decision to approve a Medicaid wavier for an unprecedented 10-year period, arguing it did not give enough time for public comment.

The waiver pays Texas hospitals for uncompensated care and will remain in place until September 2022 and state officials will likely renegotiate the terms of the waiver with CMS.
But Senate Republicans used the debacle as a reason not to support her nomination.

In her new role at CMS, one of her first duties will be implementing the ban on surprise billing passed by Congress last year. The law prohibits providers from sending large bills to
patients who were treated by out-of-network providers despite seeking care at in-network facilities.

The first regulations are due July 1, with providers and insurers pushing for favorable treatment.

To read more, got to Modern Healthcare.

9 Steps for Successfully Using CDS to Decrease Imaging Utilization and Join the Value Era

By Matt O’Connor | May 25, 2021 | Included in Radiology Digest – May 28, 2021

Most healthcare sites have some form of clinical decision support in place to guide imaging order entries. But many hospitals have struggled to progress their systems since the 2014 Protecting Access to Medicare Act required physicians to consult CDS tools before ordering advanced studies.

Noted imaging guru Christopher Roth, MD, MMCI, vice chair of Radiology for Clinical Informatics and IT at Duke University Medical Center, on Monday shared his own roadmap for using order entry CDS to decrease imaging utilization, fit into value-based care plans and take on risk.

“CDS is not perfect but it is the best thing we have,” Roth, who also volunteers on the American College of Radiology’s Informatics Commission, explained during the virtual session. “You absolutely can use it successfully at your organization.”

Below are takeaways from his presentation.

  1. Get the right people together: Roth first found allies in electronic health record experts and revenue cycle managers, among many others. The more he preached about this project, the more support he gained from others, including orthopedic surgeons and Duke Health’s executive vice president.
  2. Learn the process front to back: Understanding how decision support guidelines are created is key, and the ACR and Society of Nuclear Medicine and Molecular Imaging are crucial resources. The physician groups approving policies at insurance companies are quite reasonable and knowledgeable, Roth added; it’s the implementation of these rules where the trouble starts. Front-line, non-clinical representatives are required to follow rules to the tee and often don’t have all the information they need.
    “You really are turning a cruise liner to make change,” he added. “Payers are inefficient just like hospitals are.”
  3. Decide goals (and non-goals): Like any big enterprise imaging project you must decide what you’re going to do and what you’re not going to do. Roth and his team prioritized complying with PAMA and reducing the costs and nuisances of preauthorization, among other goals.
  4. Plan to educate: Budget time to educate, he urged. “It takes a lot of time to stand up and be successful in doing this,” Roth added.
  5. Understand and build analytics: Making the case for why this is important may be difficult, but “you’re going to find interest here,” he said. Gathering red rate data (guideline-
    discordant ordering) and total orders per provider plotted against days or clinical encounters are two necessary pieces of information.
  6. Build accountability: All Duke physicians have a red rate on their balance scorecard along with several other data points depending on the specialist.
  7. Gather feedback: As the program gains steam, feedback will roll in and there’s no turnkey solution to manage this deluge. Roth’s group implemented a feedback survey o give users an opportunity to comment at the exact point they’re struggling.
  8. Optimize aggressively: Use this feedback to tailor reasons for exams for providers, residents and staff. For example, if you have an urgent stroke code order for head CT, you want one reason for the exam—“just make it simple.”
  9. Recognize risks: “CDS systems when rolled out sub-optimally can hurt people,” Roth explained. Doctors may pick reasons for exams that are quick and available but aren’t totally accurate.
    To read more, go to Health Imaging.

Radiologist participation in Medicare ACOs is surging, and late comers must take notice

By Marty Stempniak | May 20, 2021 | Included in Radiology Digest – May 28, 2021

The number of radiologists participating in Medicare accountable care organizations has surged in recent years and those on the sidelines should take notice, according to a new analysis.

Rad involvement in these value-minded care-coordination efforts leapt threefold during the five years ending in 2018, from 10% up to nearly 35%. Participation rates grew faster for physicians in radiology-only rather than multi-specialty groups, experts detailed Wednesday in JACR.

About 87% of large Medicare ACOs (greater than 20,000 beneficiaries) had radiologist participation during that period, and it’s clear the specialty is being recruited into these efforts.
“Over the years, a variety of initiatives have been implemented to more judiciously manage imaging utilization. Radiologists participating in [Medicare Shared Savings Program accountable care organizations] who are incentivized to help manage imaging, however, may have opportunities to be seen as part of solutions rather than problems,” Stefan Santavicca, with the Atlanta-based Georgia Institute of Technology’s School of Economics, and co-authors wrote May 19. “We believe that our work shows that MSSP ACOs are increasingly recruiting radiologists into their plans alongside other specialty care providers, potentially preparing themselves to better assume downside risk in the program while simultaneously improving care and clinical outcomes.”

For the analysis, Santavicca et al. looked to several Medicare data sources to form a full picture of rad ACO involvement between 2013-2018. They found that most larger care organizations had radiologist participation, while medium ACOs (10,000-20,000 beneficiaries) saw a slight gain during the study period, moving from 62.5% up to 66%. Smaller ACOs (under 10,000 Medicare recipients) nearly doubled rad interest, rising from 26% up to nearly 52% by 2018. ACOs with rad participation were typically larger and more diverse in their specialty composition. “Nonparticipating radiologists should prepare accordingly,” the authors advised.

The study did not pinpoint why physicians in imaging are moving toward accountable care en masse. Motivations are likely multifactorial, including wanting to preserve their hospital relationships, avoid challenges with the Merit-Based Incentive Payment System, or feed a desire to participate in utilization management and care coordination.

To read more, go to Radiology Business.

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