Radiology Digest – May 30, 2023

May 25, 2023

Radiology Digest: News from the week of May 30, 2023.
Average Radiologist Pay Has Leapt Nearly 38% Since 2015

By Marty Stempniak | May 25, 2023 | Included in Radiology Digest – May 30, 2023

Average radiologist pay has grown nearly 38% since 2015, according to compensation data from Medscape, released on Wednesday.  

Members of the specialty earned about $483,000 last year, up from $351,000 tallied eight years ago, according to the WebMD-owned provider of news and educational offerings. Primary care and other specialists have similarly seen their wages climb since 2015, with one key motivating factor.

“Supply and demand is the biggest driver,” Mike Belkin, divisional VP at physician-recruiting firm Merritt Hawkins, told Medscape. “Organizations understand it’s not getting any easier to get good candidates, and so for the most part, physicians are getting good offers.”

Radiologists also saw their pay rise 10% year-over-year, the third highest gain after oncologists (13%) and gastroenterologists (11%). And members of the specialty scored the third highest in incentive pay among all physician types at $80,000. Only orthopedists ($134,000) and cardiologists ($88,000) earned larger bonuses.

Other findings of note in the 2023 Medscape Radiologist Compensation Report:

– 15% of radiologists surveyed said nonphysician practitioners were the biggest competitor affecting their income (up from 10% in the last survey). The vast majority (73%) said income wasn’t impacted by any of the competitors listed in the survey.
– 37% of radiologists said they took on additional work hours, up from 36% in the previous survey. Medical moonlighting was the No. 1 reason at 16%.58% of radiologists said they feel fairly paid, placing the specialty in the top third of the list.
– 70% of radiologists said they’d choose a career in medicine again, down from 72% in the 2022 survey. Another 90% said they’d choose the same specialty (vs. 92% last year).
– Radiologists spent about 11.5 hours per week on paperwork and administrative duties, compared to 13.7 previously and placing the specialty fourth from last.
– 12% of radiologists said they’d consider dropping their lowest-paying insurer. “No, I need all payers” was the top answer at 37%, followed by “no, for other reasons” (35%) and “no, it’s inappropriate” (16%).
– 59% of radiologists said they continue to participate in fee-for-service medicine. Other popular payment models included bundling (9%), value-based compensation (9%), episode-of-care pay (8%) and capitation (6%).
– 51% of radiologists said “being good at what I am doing/finding answers, diagnoses” was the most rewarding part of their job.26% said “having to work long hours” was the most challenging aspect.

Find the full survey results below:
Your Income vs Your Peers’: Medscape Radiologist Compensation Report 2023


1,129 Hospitals Reporting Losses on Patient Services, State-by-state

By Laura Dyrda | May 23, 2023 | Included in Radiology Digest – May 30, 2023

Rural hospitals across the U.S. are taking losses on patient services, meaning insurers aren’t paying enough to cover the cost of care delivery, according to a report from the Center for Healthcare Quality & Payment Reform.

Losses on patient services have forced some hospitals to close service lines and reduce access to care in already underserved communities. There are more than 600 hospitals at risk of closure across the U.S. as well due to financial constraints and inflation.

The Center for Healthcare Quality & Payment Reform compiled data on hospitals that lost money delivering patient services over a multiyear period, excluding the first year of the pandemic. Texas reported the most hospitals with losses on services at 105, while Nevada has the highest percentage of hospitals reporting losses on services at 85 percent.

Breakdown by state.
At-risk Rural Hospitals Fact Sheet.


One-fourth of Practices Say Operating Costs Are Up, With 93% Facing Clinical Staffing Shortages

By Marty Stempniak | May 23, 2023 | Included in Radiology Digest – May 30, 2023

Nearly one-fourth of practices say operating costs are up since prior to the pandemic, with professional staffing expenses the main driver, according to survey data released Tuesday.

About 93% of physicians surveyed said their business is grappling with key shortages among clinical staff, including nurses and physicists, and 80% believe such challenges are worse than in 2022. The findings are part of an American Society for Radiation Oncology survey of the specialty, released to coincide with the association’s Advocacy Day.

ASTRO is highlighting the data as it presses Congress to address flagging reimbursement rates that are failing to keep pace with inflation.

“A decade of relentless Medicare cuts and rapidly increasing costs are pushing community-based clinics to the breaking point,” Geraldine M. Jacobson, MD, MBA, chair of the society’s board of directors, said in a May 23 statement. “Radiation oncologists are asking lawmakers to support our fight against any new cuts, and to join us in our efforts to ensure stability, access, value and equity in cancer care.”

The society conducted a survey of its members between March and April, reaching a total of nearly 250 radiation oncologists. About 53% of respondents said staffing shortages are causing treatment delays, while 44% believe they’re fostering anxiety among patients. Another 77% think clinical staffing is what’s driving up costs at their practice. And 48% of those surveyed said they’re cutting ancillary services such as patient navigation to counter surging expenses.

Radiation oncology is among those facing the highest cuts across medical specialties, with Medicare reimbursement sliding 20% during the past 10 years, ASTRO estimated. This includes declining payment for all 16 of the most common radiation therapy courses in the decade leading up to 2020, according to a recent study.

Along with Medicare reform, ASTRO wants lawmakers to address prior authorization. Another 2021 study found that radiation oncology faces the heaviest burden from this utilization-management tactic used by payers, ahead of diagnostic radiology and cardiology. About 90% of practice leaders said patients have been forced to wait for treatment because of these roadblocks. The majority of respondents said delays have lasted a week or longer.

The society praised CMS for a recent final rule aimed at curtailing prior authorization tactics used by Medicare Advantage plans. However, ASTRO wants Congress to now “hold insurers accountable for following these new requirements.”

“Prior authorization for proven treatments ultimately causes more harm than good by squandering valuable time and resources, which negatively impacts patient outcomes,” Jacobson said in the statement.

To read more, go to Radiology Business.


Lawmakers Press UnitedHealthcare, Aetna, Humana on Medicare Advantage Claims Denials

By Rylee Wilson | May 22, 2023 | Included in Radiology Digest – May 30, 2023

Lawmakers are seeking more information about claims denials from the largest Medicare Advantage insurers. 

On May 17, the Senate Permanent Subcommittee on Investigations sent letters to CVS Health, Humana and UnitedHealth Group seeking internal documents detailing how the companies decide to approve or deny claims, including how the payers use artificial intelligence in the process. 

“I want to put these companies on notice. If you deny lifesaving coverage to seniors, we’re watching, we will expose you, we will demand better, we will pass legislation, if necessary,” subcommittee Chair Sen. Richard Blumenthal said in a news release. 

Around 13 percent of prior authorization claims denials in Medicare Advantage were for services that met Medicare coverage rules, Megan Tinker, chief of staff for HHS’ Office of Inspector General, told the subcommittee May 17. 

These denials likely delayed or prevented Medicare Advantage beneficiaries from receiving needed care, she said. 

CMS is implementing new rules aimed at curtailing the use of prior authorization in Medicare Advantage. 

Ms. Tinker told the subcommittee the OIG needs more resources to fully investigate claims denials in Medicare Advantage. The agency is turning down 300 to 400 viable healthcare fraud cases each year because of a lack of sufficient staff, she said in her testimony. 

“Despite extensive reviews and enforcement, our limited resources do not allow us to provide comprehensive oversight of Medicare and Medicaid,” Ms. Tinker said.

“Notwithstanding rigorous efforts by OIG and support from Congress, the administration and HHS for OIG work and resources, serious fraud, waste, and abuse continue to threaten HHS programs and the people they serve.” 

Sen. Ron Johnson, a member of the subcommittee, said the prior authorization process can be improved by reintroducing “consumerism and free market competition into healthcare.” 

“Under a third-party payment system, everyone wants the best quality treatment and couldn’t care less what it costs. That is what is driving our healthcare costs through the roof,” Mr. Johnson said at the May 17 hearing. “Pre-approval programs for some treatments and tests are the third-party payer’s attempt to limit wasteful spending.”
To read more, go to Becker’s Payer Issues.


Federal Law Change Would Require All Insurers to Cover Any Supplemental Breast Imaging

By Marty Stempniak | May 22, 2023 | Included in Radiology Digest – May 30, 2023

U.S. House lawmakers are proposing a bill that would require all insurers to cover any supplemental breast imaging, beyond screening mammograms, with no patient out-of-pocket costs.

The Find it Early Act would apply to private payers, along with traditional Medicare and Advantage plans, Medicaid and TRICARE. Introduced by Reps. Rosa DeLauro, D-Conn., and Brian Fitzpatrick, R-Pa., the bill has drawn support from several patient and provider advocacy groups, including the American College of Radiology.

Journalist and breast cancer survivor Katie Couric also is throwing her weight behind the effort.

“We must strengthen access and coverage for additional testing, specifically for women like me with dense breasts,” Couric said in an announcement from the two lawmakers. “Breast cancer is treatable, and 99 percent of women who are diagnosed early survive. That is why everyone needs to get screened. The Find It Early Act is a critical step toward improving access to these life-saving screenings.”

In the wake of the Affordable Care Act, insurance carriers are required to cover screening mammograms. However, women at high risk for the disease or with dense breast tissue may sometimes require additional testing via ultrasound or MRI. Numerous analyses have charted challenges arising from women having to pony up when their insurer won’t cover these exams. A March study including nearly 231,000 commercially insured women found that individuals faced with higher cost-sharing received significantly fewer subsequent procedures.

DeLauro and Fitzpatrick also previously proposed the Find it Early Act in December, but it failed to find passage.

Others voicing their support this time included Dense Breast-info, the Brem Foundation to Defeat Breast Cancer and the Susan G. Komen organization. Absent any federal action, several states have proposed bills to address insurance coverage gaps in breast cancer imaging.

H.R. 3086 was reintroduced on May 8 at the start of the American College of Radiology’s Annual Meeting in Washington. More than 450 radiologists advocated for the bill—along with the recently reintroduced FIND Act—as part of ACR’s 2023 Capitol Hill Day.

“ACR’s Government Relations team was encouraged by the late-breaking action and continues to monitor and advocate on these bills,” the college said in a Friday, May 19, news update.

To read more, go to Radiology Business.


Medicaid Redeterminations Are Going Worse than Expected, Experts Say

By Jakob Emerson | May 19, 2023 | Included in Radiology Digest – May 30, 2023

After a three-year period of continuous Medicaid/CHIP enrollment under the COVID-19 public health emergency, states could begin terminating coverage for ineligible residents in April. With redeterminations underway, health policy experts say too many people in some states are losing health coverage for the wrong reasons.

“Too many people are falling through the cracks in the system,” Alison Yager, executive director of the Florida Health Justice Project, told Vox on May 19. “This should be of grave concern to all those charged with protecting the health of our residents.”

In Florida, nearly 250,000 individuals have been disenrolled from the state’s Medicaid program over the last month, but 82 percent of those disenrolled saw their coverage terminated because their information was not updated with the state. About 44,300 individuals made too much to be eligible and were referred to other coverage options.

“This is extremely troubling and is similar to the scary numbers we saw in Arkansas last week, where approximately 80 percent of the terminations were for procedural reasons,” Joan Alker, executive director and co-founder of the Georgetown University Center for Children and Families, wrote in a blog post May 16.

“When governors see such large numbers of terminations of coverage for procedural reasons, they should pause the process and see what is going wrong.”

In Indiana, which began terminating coverage in May, nearly 53,000 people have been disenrolled from Medicaid, with 88 percent of the terminations due to procedural reasons, according to Ms. Alker.

She noted that it is difficult to compare states’ redetermination processes because each Medicaid program is prioritizing different groups and reporting data differently. 

Other states, however, such as Pennsylvania, are reporting fewer terminations due to procedural reasons, according to Ms. Alker. In Pennsylvania, more than 77,000 people have been reviewed, about 8,000 people have lost coverage, and 45 percent lost coverage due to procedural reasons.

HHS has estimated that 15 million people total will lose Medicaid coverage during redeterminations.

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To read more, go to Becker’s Payer Issues.
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