Radiology Department Utilizes Facebook Algorithm to Anticipate Future CT, MRI Volumes
By Matt O’Connor | November 10, 2021
A free-use algorithm from Facebook can help radiology departments predict future imaging volume trends and better allocate resources to meet anticipated demand, according to evidence published Tuesday.
The Silicon Valley giant, now known as Meta, designed its open-source Prophet tool to forecast trends across multiple industries, taking events such as holidays or even weather changes into account. Memorial Sloan Kettering Cancer Center doctors applied the procedure to their radiology services, reporting promising results in the Journal of Digital Imaging.
Prophet proved “significantly” better at anticipating CT and MRI volumes compared to manual attempts. This proved particularly true during the height of the pandemic, with the algorithm coming within four scans per day of actual volumes.
“Resource planning is a critical component of success in a radiology department,” Anton S. Becker, with the New York institution’s Department of Radiology, and colleagues explained. “We found that the algorithm captures weekly, seasonal, and overall trends and allows for better radiologist allocation compared to manual planning,” the team added later.
Becker and co-investigators refined the Prophet tool using more than 610,000 exams, of which 67,180 were second reads. Another 13,961 images were used to validate the training.
After prospective testing in February 2020, the tool missed by a mean of 10 CT exams per day (9,553 actually performed vs. 9,942 forecasted). It fared better for MRI volumes, with a mean error of two per day (2,397 performed vs. 2,485 forecasted).
Memorial Sloan, like most hospitals, experienced a significant drop in imaging volumes during the pandemic’s peak (March-May 2020) along with a rebound shortly after. They tested the model in August of that year, which overshot CT usage by 10 per day, or 317 total. MRI predictions reached a mean error of four per day and 128 overall.
“The Prophet procedure was significantly more accurate than the manual forecast,” Becker et al. noted.
The team did warn the algorithm may underperform for organizations with “simple periodic” effects, such as quarterly estimates. But they do see significant opportunities for radiology and many other fields.
Outpatient Facilities Will Take a Financial Hit as CMS Reworks Inpatient-only List Policy
By Alex Kacik | November 10, 2021
The Centers for Medicare and Medicaid Services is walking back its push to pay for more complex services without inpatient stays, a move that will dent revenues for health systems that have boosted investment in outpatient facilities.
The agency announced during the Trump administration that it would phase out its list of around 1,700 services Medicare would only pay for on an inpatient basis due to the complexity of the procedure, the underlying physical condition of the patient or the need for at least 24 hours of postoperative recovery time. CMS began that phase-out in 2021 by removing 298 services from the list.
But after heavy lobbying from hospital and physician associations over safety concerns, the Biden administration’s CMS said it would pause the phase-out plans and add back almost all the services it removed from the inpatient-only list last year. CMS also removed most of the more than 260 procedures that had been added to a separate ambulatory surgical center covered procedures list in the 2021 rule.
The delay, as outlined in the Outpatient Prospective Payment System final rule issued last week, represents a stark change from CMS’ typical messaging. The agency has largely been proposing regulations that would move care from high-cost inpatient treatment to ambulatory surgery centers and other outpatient facilities.
CMS said in the 2022 final rule that it realized the three-year timeframe for phasing out the list was too short and that it needs more time to evaluate whether the services removed in 2021 should actually be taken off the list.
“It seems like a complete 180,” said Susan Maupin, vice president at the healthcare consultancy Advis. “But whenever there are safety concerns expressed by providers, CMS should rightfully take a step back and reevaluate if there are any legitimate concerns.”
That earlier push to move away from inpatient care, in part, has prompted health systems to increase investment in outpatient facilities. But those new surgery centers will likely take a financial hit as CMS reworks its approach.
“Business plans for those trying to build an ASC will be blown out of the water for a little bit of time, but I don’t think it will be a permanent change,” said Monica Hon, vice president at Advis, who was supportive of regulators taking a step back.
While the Ambulatory Surgical Center Association strongly opposed CMS’ removal of most services added to the ASC-covered procedures list in 2021, the organization was on board with the agency’s announced pause. In comments on the proposed rule, the group expressed concerns with completely changing course on the policy. Although ASCs can’t always immediately perform procedures removed from the inpatient-only list, allowing a service to be performed at a hospital outpatient department could be a precursor to adding it to the ASC list.
ASCA asked CMS to keep three services that have been performed in ASCs on other patient groups off the inpatient-only list in 2022, which the agency agreed to do in the final rule.
To read more, go to Modern Healthcare.
150 Members of Congress Pressure Administration to Fix Surprise Billing Rule They Say Favors Insurers
By Marty Stempniak | November 10, 2021
Bipartisan members of the U.S. House are urging the Biden administration to amend a controversial component of a recent rule aimed at eliminating surprise medical bills.
All told, 150 representatives have signed on to the letter-writing campaign, addressed to secretaries at the departments of Health and Human Services, Treasury and Labor. Last December, lawmakers approved the No Surprises Act, spelling out a process to settle disputes between payers and out-of-network providers.
But members of Congress believe recently released rulemaking has failed to honor their intent and would tip the scales in favor of insurers. Their letter echoes concerns raised by numerous provider groups including the Texas Medical Association, which sued over the issue Oct. 29, and American College of Radiology, now considering doing the same.
“This approach is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care—the exact opposite of the goal of the law,” representatives led by Thomas Suozzi, D-N.Y., Brad Wenstrup, R-Ohio, Raul Ruiz, MD, D-Calif., and Larry Bucshon, MD, R-Ind., wrote Nov. 5. “It could also have a broad impact on reimbursement for in-network services, which could exacerbate existing health disparities and patient access issues in rural and urban underserved communities.”
Lawmakers believe the interim final rule places too much emphasis on the “qualifying payment amount,” established by health insurers, in dispute resolutions. Generally, this would amount to the median contracted rate for the same or similar service in the geographic area. Instead, they believe it should consider several factors including quality of outcomes, market share, complexity of services, case mix, and prior contract history between the two sides. The original law “expressly directs” arbitrators to incorporate all such factors, the letter writers noted.
If the administration fails to act, the rule will take effect on Jan. 1. Meanwhile, members of the GOP Doctors Caucus (with some overlap from the other letter) also wrote to the three departments to voice their “deep concerns” over the issue. They also asked the administration to operate in a timely fashion when implementing other patient protections in the act, including requiring advanced estimates of benefits and cracking down on inaccurate provider directories.
“The medical professionals in Congress stand ready to collaborate with your offices to ensure implementation meets statutory requirements before regulations take effect on January 1, 2022,” the caucus wrote.
To read more, go to Radiology Business.
Health Insurers’ 2021 Looking Like a Rerun of Last Year
By Mari Devereaux | November 10, 2021
This year is looking to be very similar to last year for health insurance companies: Older patients continue to defer care, COVID-19 costs are a burden and record profits are the end result.
Reality isn’t matching expectations. Health insurance companies predicted a flood of patients who’d gotten sicker as they put off care during the first year of the pandemic would rush back. The assumption that medical expenses would rise was built into higher premiums for this year. But insurance companies guessed wrong and utilization remains depressed.
On net, this has worked out fine for insurers. Lower-than-expected costs tend to translate into higher profits, although the Affordable Care Act’s medical-loss ratio rebates limit how much insurance companies can benefit financially when they overshoot on premiums.
Health insurers have eyed their surprise boon as a means to spend on new initiatives, said Adam Block, a public health professor at New York Medical College and founder of Charm Economics.
“Health plans are looking at these [claims] reductions and switches to telehealth—a less expensive platform—and thinking about ways that they can invest the savings into improving the health of their population,” Block said.
Insurers are particularly focused on caring for the lucrative and growing Medicare Advantage population. Older people forgoing care makes it harder for insurers to anticipate their current and future medical needs. Incomplete information can lead to inaccurate risk scores, which can cut into Medicare reimbursements under the risk-adjustment program.
To read more, go to Modern Healthcare.
American College of Radiology Contemplating Legal Action to Halt Provision In Surprise Billing Law
By Marty Stempniak | November 8, 2021
The American College of Radiology is contemplating legal action to halt a controversial provision in legislation to address surprise medical bills, according to an update shared Thursday.
Late last month, the Texas Medical Association filed suit against the Biden administration, claiming the feds failed to follow congressional intent in a recently released interim final rule. Lawmakers had laid out a robust process to settle disputes between insurers and out-of network providers to keep patients from receiving unexpected IOUs. But Texas docs argue the rule ignores such parameters, creating a process that heavily favors payers.
ACR highlighted the lawsuit in a Nov. 4 update and said it is crafting a response to the interim final rule while contemplating other options.
To read more, go to Radiology Business.
60% of Radiologists Surveyed Oppose MARCA Bill that could Spur Wider Use of Registered Rad Assistants
By Marty Stempniak | November 5, 2021
Nearly 60% of physicians oppose legislation that could spur wider use of registered radiologist assistants, according to new survey data revealed Thursday night.
Introduced in the Senate last summer, the Medicare Access to Radiology Care Act would ensure imaging practices or departments receive reimbursement when using such certified radiographers in all healthcare settings. MARCA would not pay assistants directly, supporters emphasize, and free up radiologists to focus on core duties.
The American College of Radiology has remained neutral on the issue, drawing anger from some members of the specialty who worry it could result in non-physicians taking over their duties. ACR recently conducted a survey to further explore the topic and hosted a town hall Thursday night to reveal the results.
“Most respondents (60%) to an American College of Radiology member survey on Non-Physician Radiology Providers (NPRPs) do not support Medicare Access to Radiology Care Act passage,” ACR said Nov. 4. “Yet only 43% of the survey population, which represents 16% of ACR membership, oppose NPRP use in their practice.”
The college conducted its survey in September, targeting the professional association’s member physicians including residents and fellows. A total of more than 4,200 completed the interview, according to slides presented at Thursday’s town hall (which was closed to the media).
About 62% of respondents said radiology practices should be able to dictate whether they use non-doc providers such as physician assistants or advanced practice registered nurses. Another 57% said their organization uses such providers; 40% agree they can serve an important role in imaging; and 55% believe NPRPs pose a threat to patient care. Two-thirds of those surveyed suspect the use of such providers will remain consistent or grow further in the future.
ACR said it may hold focus groups to gather greater understanding of younger physicians’ concerns around the MARCA legislation. However, it plans to remain neutral on the matter, noting that the bill has “little congressional support.” No committees have held hearings on the legislation, and it has garnered only eight total cosponsors between the House and Senate. The college said its lobbying focus will remain on other matters such as pay cuts spelled out in the 2022 Medicare physician fee schedule, and how out-of-network payment disputes are settled under surprise billing legislation.
To read more, go to Radiology Business.