Referrer–radiologist Agreement Nets 75% Follow-up Imaging Rate, and Certain Factors can Inform Interventions for the Other 25%
By Dave Pearson | October 27, 2022
When referring physicians agree with radiologists’ recommendations on the clinical necessity of follow-up imaging, three-quarters of patients go on to complete the additional exam.
Of the 25% who fail to follow through, most live in low-income neighborhoods. However, other significant predictors of patient non-completion include receiving the instructions while in the ED or upon hospital inpatient discharge and, curiously, having a surgical specialist as the referrer.
These are among the key findings to emerge from a study conducted by Harvard researchers at Brigham and Women’s Hospital. The American Journal of Roentgenology published the team’s report online Oct. 26.
Corresponding author Neena Kapoor, MD, and colleagues reviewed records from a closed-loop communications and tracking tool embedded in the PACS and EHR.
The tool included a communications component that asked referrers to indicate whether they agreed or disagreed on the clinical necessity of follow-up imaging as recommended by radiologists.
When radiologist/referrer agreement was present, the tracker alerted a “safety net” team if the patient had not been imaged within a month of a target period.
The digital monitoring system also included an EHR review to check on possible follow-through at or outside Brigham and Women’s after the 1-month window.
To read more, go to Radiology Business.
Class Action Follows Data Breach at Multistate Radiology Practice
By Dave Pearson | October 27, 2022
Patients whose private data may have been stolen by a cyberprowler last December have filed a class action lawsuit against the radiology practice whose IT systems may have been hacked.
That would be 80-hospital, investor-backed US Radiology Specialists (USRS) based in Raleigh, N.C.
The representative action, filed in a federal court in Delaware Oct. 24, refers to USRS affiliate groups affected not only as previously reported in North Carolina, Arizona and Texas but also in Colorado.
Plaintiffs Ariann J-Hanna and Nicole Pyle, both of Tucson, Ariz., charge—“individually and on behalf of all others similarly situated”— that USRS failed in their responsibility to secure and protect sensitive patient information.
The records potentially exposed to someone with criminal intent included first and last names, Social Security numbers, drivers’ license information, dates of birth, health insurance information, personal addresses and medical treatment information, according to the Oct. 24 complaint as accessed via ClassAction.org.
The action also takes issue with the lag between the December 2021 breach and the notification to patients, which didn’t go out until nine months later, according to the suit.
ClassAction.org has more on the suit, including the full complaint.
To read more, go to Radiology Business.
Specialists Seek a Reprieve from 2023 Medicare Payment Cuts
By Arielle Dreher | October 26, 2022
Radiologists, nuclear medicine specialists and vascular surgeons are bracing to see if they’ll take the worst of Medicare physician payment cuts next year.
Why it matters: The Centers for Medicare and Medicaid Services is due to release a final fee schedule as early as this week that’s expected to continue phasing in reductions to medical specialties — and likely prompt appeals to Congress for a year-end reprieve.
Driving the news: A draft fee schedule released in July put most specialties in line for modest cuts. Infectious disease doctors and internists would buck the trend and receive increases of 5% and 3%, respectively.
Interventional radiology could see the deepest cuts, with a 4% cut, while radiology, vascular surgery and nuclear medicine could each see 3% reductions.The specialty practices targeted for cuts are also some of the most lucrative.Medicare cuts could drive down other payer rates and lead to access issues, with providers rethinking how they deliver services particularly to rural regions or regions beyond their practices.Such cutbacks could lead to delayed care and “wait times for clinical issues that aren’t acceptable or shouldn’t be,” Bob Still, executive director of the Radiology Business Management Association, told Axios.The cuts could come at a time patients are still delaying screenings: Nearly half of women surveyed for the Radiology Patient Action Network this fall indicated they had not had a mammogram in the past three years.The Surgical Care Coalition argues cuts to vascular surgery will jeopardize seniors’ access to critical treatments and procedures.The physicians’ pleas come amid a year-end rush by hospitals, home health agencies and other health providers to head off Medicare payment changes.
Lawmakers in a post-election lame duck session will decide what gets wrapped into a year-end spending deal that’s likely to also take up disaster relief, Ukraine aid and a host of other non-health issues.Between the lines: Physicians are the only health provider group not receiving an inflation adjustment to their Medicare payment rates in 2023, and there’s a statutory freeze through 2026.
Those practicing in independent or small practices say the cuts, combined with inflation and staffing pressures, could be economically ruinous and prompt more mergers and buyouts.”The discrepancy between what it costs to run a physician practice and actual payment, combined with the administrative and financial burden of participating in Medicare, is incentivizing market consolidation,” provider groups wrote in a September letter to congressional leadership.To read more, go to Axios.
Some State Surprise Billing Resolution Processes Favor Providers
By Jacqueline LaPointe | October 25, 2022
The No Surprises Act gives states the opportunity to enforce surprise billing provisions, but most are leveraging the federal independent dispute resolution process to determine out-of-network rates, according to a new report.
The report from Commonwealth Fund analyzes state and federal regulatory documents to evaluate the federal-state partnerships implementing the No Surprises Act. The analysis finds that most states are partnering with the federal government, and this includes payment disputes.
The No Surprises Act looks to fill gaps in existing state laws protecting consumers from surprise medical bills, including in areas where other federal laws preempt state actions. For example, the Employee Retirement Income Security Act of 1974 (ERISA) bans states from adopting surprise-billing protections for consumers enrolled in self-funded plans. The Airline Deregulation Act also prohibits states from applying protections for consumers using air ambulance services. The No Surprises Act provides consumer protections for both.
The federal law has a framework similar to the Affordable Care Act, the report says. States can directly enforce consumer protections, the federal government can directly enforce them, or the state and federal governments can collaborate.
Just Idaho, Iowa, Maryland, Pennsylvania, and West Virginia have opted for full state enforcement, the report shows. Meanwhile, Wyoming, Oklahoma, Missouri, Louisiana, Indiana, and Alabama have elected for full federal enforcement.
The majority of states—three-fourths, according to the report—are sharing enforcement responsibilities with the federal government.
States are also more willing to enforce provisions relating to payers. Sixteen states will take on the responsibilities themselves, while 26 will share with the federal government. Meanwhile, just five states plan to enforce provisions related to providers and facilities, and 27 share responsibilities with the federal government. That leaves 18 states leaving enforcement of provider and facility provisions solely to the federal government and just 8 states leaving enforcement of payers.
Each enforcement approach is different, but the report shows that, when it comes to out-of-network payment disputes, the majority of states will use the federal independent dispute resolution process.
To read more, go to Revcycle Intelligence.
Study Shows Many Women Aren’t Receiving Mammograms
October 24, 2022
A new study of over 1,600 current or eligible U.S. Medicare recipients shows that nearly half of women report not receiving a mammogram in the last three years.
The study, led by the Radiology Patient Action Network, also found that 80% of Americans are concerned with proposed cuts to Medicare, and 90% view maintaining Medicare coverage as important.
Network leaders said these results show that the U.S. Congress should take note of these findings and protect Medicare. Almost half of the study’s respondents said they would be less likely to support a member of Congress if they advocate for cuts.
Also, one in four current patients reported having difficulty scheduling doctors’ appointments due to delays or rescheduling.
These results corroborate findings from other recent studies showing that many women are not receiving their recommended mammograms.
The survey was conducted between 25 September and 27 September and included 1,632 Americans either enrolled in Medicare or Medicare-eligible. The study was jointly sponsored by the Medical Imaging and Technology Alliance (MITA), Imaging for a Cause, and the Radiology Business Management Association (RBMA). It was conducted by the Remington Research Group.
To read more, go to Aunt Minnie.