Radiology Digest – May 9, 2023

May 5, 2023

Radiology Digest: News from the week of May 9, 2023.
American College of Radiology Releases New Breast Cancer Screening Guidelines

By Marty Stempniak | May 3, 2023 | Included in Radiology Digest – May 9, 2023

The American College of Radiology released new breast cancer screening guidelines on Wednesday, calling for increased vigilance among certain patient populations.

All women should undergo risk assessment by age 25 to determine if surveillance is needed earlier than their 40s. ACR emphasized the need for more intensive screening among Black women and those of Ashkenazi Jewish decent, who face increased risk of developing the disease.

“The latest scientific evidence continues to point to earlier assessment as well as augmented and earlier-than-age-40 screening of many women—particularly Black women and other minority women,” Debra Monticciolo, MD, primary author of the new guidelines and chief of breast imaging at Massachusetts General Hospital, said in an announcement. “These evidence-based updates should spur more-informed doctor-patient conversations and help providers save more lives.”

ACR now recommends those with genetics-based predispositions, calculated lifetime risk of 20% or greater, and individuals exposed to chest radiation at a young age undergo MRI surveillance at ages 25-30. Depending on risk, they additionally should begin annual mammography screening between 25-40. Women diagnosed with breast cancer before 50 (or with a personal history of the disease and dense tissue) should have annual supplemental MRIs. And individuals who desire such screening, but who cannot receive magnetic resonance imaging, should consider contrast-enhance mammography or ultrasound.

Experts cited several motivations for the need to closely monitor minority populations. They are 72% more likely to be diagnosed with breast cancer after age 50, with a 127% greater risk of death from the disease. Black women, in particular, face a 42% higher mortality rate, despite equal incidences of the disease compared to other populations. And they face a twofold higher chance of developing more aggressive, triple-negative tumors, the guidelines note.

Since the proliferation of mammography screening in the 1980s, the breast cancer death rate dropped 43% after staying stagnant for 50 years, ACR noted. Yet, mortality rates among Black women have decreased about half as fast as those for their white counterparts since the ’90s. A recent study recommended that women in this population should start screening eight years earlier to begin addressing such disparities.

To read more, go to Radiology Business.


84% of Group Practices See Increase in MA Prior Authorization Requirements: MGMA

By Andrew Cass | May 3, 2023 | Included in Radiology Digest – May 9, 2023

Eight-four percent of group practices surveyed said prior authorization requirements have increased for Medicare Advantage over the past year, while less than 1 percent said those requirements have decreased, according to a May 3 survey from the Medical Group Management Association.

MGMA’s survey includes responses from executives representing 601 group practices, according to the report. The survey was conducted in March. 

Six things to know: 

1. Forty-six percent of respondents said Medicare Advantage plans were the most burdensome for obtaining prior authorization. Thirty-two percent said commercial plans were the most burdensome, followed by Medicaid (20 percent) and Traditional Medicare (4 percent). 

2. Fifty-eight percent of practices saw 15 percent or more of their patients either switch from traditional Medicare to Medicare Advantage, or from one Medicare Advantage plan to another. Eighty-four percent of practices said they had to reauthorize existing Medicare-covered services for those Medicare beneficiaries who have switched plans. 

3. Sixty percent of practices said there are at least three employees involved in a single prior authorization request. 

4. Seventy-seven percent of respondents said their practice has hired or redistributed staff to work on prior authorizations due to an increase in requests. 

5. Ninety-seven percent of medical groups reported their patients experience delays or denials for medically necessary care due to prior authorization requirements. 

6. Ninety-one percent of respondents said a single stand electronic prior authorization system across all insurers would alleviate the burden on their practice. 

Read the full report here
To read more, go to Becker’s Payer Issues.

North Carolina Senate Passes Bill Waiving UNC Health from State, Federal Antitrust Enforcement

By Dave Muoio | May 3, 2023 | Included in Radiology Digest – May 9, 2023

North Carolina lawmakers are on track to exempt UNC Health from antitrust enforcement, a contrast to the increased scrutiny from federal regulators regarding hospital consolidation.

Monday, the state’s Senate voted 48-0 on a bill that would overhaul the governance rules for the state-owned nonprofit academic system affiliated with the University of North Carolina.

Senate Bill 743 was passed in the state’s Senate with “almost no debate,” according to local media, and has since passed its first reading in the House and been referred to commission.

According to the bill’s text, UNC Health’s board would be able to “enter into cooperative agreements with any other entity for the provision of healthcare, including the acquisition, allocation, sharing or joint operation of hospitals or any other healthcare facilities or healthcare provider, without regard to their effect on market competition.”

“When partnering with community hospitals and other health systems in various regions of the State, the System is acting according to State policy by ensuring that healthcare is made available to all parts of North Carolina; its activities constitute ‘State action’ for purposes of antitrust law,” the bill reads.

UNC Health was formed under state law in 1998 and has been operating under the same unamended statute ever since. It employs about 40,000 people across 16 hospitals, 20 hospital campuses and over 900 clinics.

To read more, go to Fierce Healthcare.


Private Equity Firms Acquired Over 700 Oncology Practices in 20 Years

By Victoria Bailey | May 3, 2023 | Included in Radiology Digest – May 9, 2023

Private equity acquisition of oncology practices has grown in the past two decades, with over 700 clinics becoming affiliated with a private equity firm between 2003 and 2022, a study published in JAMA Internal Medicine found.

Private equity firms typically invest in platform companies and then acquire healthcare practices, open new clinics, reduce costs, and increase revenues to seek financial returns.

Researchers used financial databases and publicly available data to identify private equity-backed transactions involving medical and radiation oncology clinics from 2003 to 2022.

They found that 724 oncology clinics became affiliated with a private equity-backed platform company during this time. Around half (53 percent) were radiation clinics, 23 percent were medical clinics, and 15 percent were multi-oncologic clinics. These clinics account for 10 percent of the estimated 6,919 oncology clinic locations in the US.

At least 2,060 oncologists were affiliated with clinics at the time of an initial private equity acquisition, accounting for 10 percent of practicing medical oncologists and 15 percent of radiation oncologists.

A third of clinics experienced multiple changes in private equity ownership, leading to a total of 1,074 private equity-backed transactions occurring during the study period.

The private equity acquisitions happened across 45 states. Nearly 20 percent occurred in Florida and 16 percent were in California, the study noted. Clinics affiliated with private equity firms accounted for over 25 percent of all oncology clinics in seven states, including Tennessee (28 percent), Florida (27 percent), and Nevada (26 percent).

Ten of the 23 private equity-backed platform companies identified in the study were acquired by another private equity-backed entity or public company. Most platform companies had a regional focus and completed acquisitions in areas with little competition, researchers said.

Private equity’s involvement in the healthcare industry has raised concern among stakeholders.

The oncology sector, in particular, may attract private equity firms because of the profit potential related to the volume of chemotherapy administered and the expensive drugs involved in treatment.

Additionally, private equity acquisitions may appeal to community-based oncologists struggling with prior authorization and other nonclinical aspects of care.

To read more, go to Revcycle Intelligence.


Pennsylvania Bans Out-of-pocket Costs for Breast Cancer Screenings, Genetic Testing 

By Jakob Emerson | May 2, 2023 | Included in Radiology Digest – May 9, 2023

Pennsylvania Gov. Josh Shapiro signed legislation May 1, that will require all payers operating in the state to eliminate any out-of-pocket costs for annual breast cancer screenings and genetic testing for high risk individuals.

Specifically, the new legislation requires coverage for genetic counseling and testing for hereditary breast, ovarian, prostate and other cancer syndromes, along with yearly supplemental breast MRIs or ultrasounds for women with a high risk of breast cancer.

High-risk conditions include those that have dense breast tissue, a personal or family history of breast cancer, a genetic predisposition to cancer, and previous radiation therapy.

Pennsylvania has required payers to cover the cost of breast cancer MRIs and ultrasounds since 2020, and the new legislation expands that requirement to copays and deductibles.

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

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