Radiology Digest – November 7, 2023

November 2, 2023

Radiology Digest: News from the week of November 7, 2023.
Nearly One-third of the US Population Does Not Have Access to an Interventional Radiologist in Their County

By Marty Stempniak | November 2, 2023 | Included in Radiology Digest – November 7, 2023

Almost one-third of the U.S. population does not have access to an interventional radiologist in their county, according to a new analysis published Oct. 28.

A total of 2,989 board-certified IR specialists operate across 15.5% of all counties (or 487 such geographies), researchers detailed in the Journal of Vascular and Interventional Radiology [1]. Factors such as spending power and education appear to drive disbursement of IR services. The average median income in counties with access to an interventional radiologist is nearly $68,000 versus $54,000 in those without. And about 31% of the population has a college degree in IR-rich areas compared to 20% in places without an IR.

Experts see great opportunity in these data to address disparities and expand the volume of patients treated by the specialty.

“Interventional radiology finds itself in a unique position,” Yusuf Ahmad, a student at the Lake Erie College of Osteopathic Medicine in Pennsylvania, and co-authors advised. “These findings emphasize the need for a conversation surrounding interventional radiology care in rural settings and further exploration of specific socioeconomic variables pertaining to patients who have received interventional radiology care and how to better distribute that care to all,” they added later.

Ahmad and co-authors gathered their information from the Society of Interventional Radiology’s public database, pinpointing board-certified IRs across all U.S. cities. They also used Census data to acquire information about poverty, population, unemployment, median household income, education and racial diversity.

The average interventionalist-to-population ratio was about 0.305 per 100,000 individuals, researchers calculated. Meanwhile, higher average percentages of Black Americans (13%), Pacific Islanders (0.2%) and Hispanics (14%) were observed in counties with IRs, with the specialty more concentrated in diverse, urban areas.

Ahmad and colleagues’ findings follow a similar pattern that is present in other specialties, such as urology and dermatology.

Experts cautioned that the study is limited by its small sample of interventional radiologists and reliance on information from the SIR. Contributing to the society’s database is voluntary, and it does not capture all practicing IRs in the U.S. Still, the authors believe their analysis provides useful information for future planning within the specialty.

To read more, go to Radiology Business.


New ACS Lung Cancer Screening Guidelines Significantly Increase Eligibility

By Kate Madden Yee | November 1, 2023 | Included in Radiology Digest – November 7, 2023

The American Cancer Society (ACS) has released an updated lung cancer screening (LCS) guideline, significantly increasing eligibility and bringing it into concordance with the U.S. Preventive Services Task Force’s (USPSTF) recommendation released in 2021.

Published November 1 in CA: A Cancer Journal for Clinicians, the new guidance expands eligibility to include five million more U.S. adults compared to the previous 2013 recommendation, the ACS said. It urges yearly screening for lung cancer via low-dose CT (LDCT) exams for people aged 50 to 80 years old who are current or former smokers and have a 20-year or greater pack-year history.

“This updated guideline continues a trend of expanding eligibility for lung cancer screening in a way that will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early,” Dr. Robert Smith, senior vice president, early cancer detection science at the ACS and lead author of the lung cancer screening guideline report said in a press conference. “Recent studies have shown extending the screening age for persons who smoke and formerly smoked, eliminating the ‘years since quitting’ requirement and lowering the pack per year recommendation could make a real difference in saving lives.”

Lung cancer is the overall leading cause of cancer death in the United States and is the second most frequently diagnosed malignancy in both men and women, according to the ACS. This year, the society estimates that 238,340 new cases of lung will be diagnosed and about 127,070 people will die from the disease.

To read more, go to Aunt Minnie.


Radiology Societies Press Congress to Pass Bill that Would Blunt Medicare Cuts Tied to Clinical Labor Costs

By Marty Stempniak | November 1, 2023 | Included in Radiology Digest – November 7, 2023

Medical societies representing radiology and other specialties are pressing members of Congress to pass a bipartisan bill that would blunt Medicare cuts tied to clinical labor costs.

House representatives first introduced the Providing Relief and Stability for Medicare Patients Act of 2023 in May. The proposal would lend relief to radiologists, radiation oncologists and others by increasing nonfacility practice expense relative value units for procedures performed in office settings that require high-tech devices or equipment.

The House Energy and Commerce Subcommittee on Health held an Oct. 19 hearing to discuss House Resolution 3674, among other legislative proposals. Trade groups including the American College of Radiology, Society of Interventional Radiology and American Society for Radiation Oncology urged lawmakers to pass the proposal and provide much-needed relief to these specialties.

“The clinical labor update policy, finalized in the CY2022 MPFS Final Rule, recognized the need for increased salary rates for all types of clinical labor (e.g., nurses and technologists),” 24 groups, together called the Clinical Labor Coalition, said in an Oct. 19 statement commending the proposal’s inclusion at the hearing. “But, due to the budget neutrality constraints in the Medicare Physician Fee Schedule, decreased reimbursement rates for those services with high supply and equipment costs when performed in a community-based office setting. H.R. 3674 would provide critical relief for office-based specialists by increasing the nonfacility/office-based practice expense relative value units negatively impacted by CMS’ clinical labor policy for the next two years.”

ACR highlighted the recent legislative push in an Oct. 26 news update, noting that it “appreciates the subcommittee’s efforts to highlight this bipartisan legislation.” Lawmakers also discussed a second radiologist-supported policy proposal, the Provider Reimbursement Stability Act of 2023, which would grant automatic, annual inflation-based payment increases tied to the Medicare Economic Index.

“While it is unclear if any of the proposals will be advanced, ACR looks forward to working with Congress to ensure policies to address Medicare reimbursement are included in any year-end legislative package,” the college said Oct. 26.

To read more, go to Radiology Business.


FDA Grants Paige ‘Breakthrough’ Status for Breast Cancer Detection

By Chad Van Alstin | October 27, 2023 | Included in Radiology Digest – November 7, 2023

The U.S. Food and Drug Administration (FDA) has granted Paige, a technology company that supports cancer diagnosis, Breakthrough Device Designation for its artificial intelligence application, Paige Lymph Node. The Breakthrough Device Designation is awarded to technologies with the potential to improve diagnosis or treatment of life-threatening diseases. 

Paige Lymph Node is designed to assist pathologists in detecting breast cancer metastases in lymph node tissue. Its AI model utilizes deep learning trained on over 32,000 digitized lymph node slides. The software highlights areas of concern, aiding pathologists in their assessments. 
According to a statement about the Breakthrough status, Paige Lymph Node shows near-perfect sensitivity in detecting breast cancer metastases. 

“Pathologic assessment of lymph nodes in breast cancer patients is critically important for prediction of outcome and treatment, yet the process is time-consuming and error-prone,” David S. Klimstra, MD, founder and chief medical officer at Paige, said in the statement. “Paige Lymph Node uses the power of AI to help the pathologist identify even small lymph node metastases rapidly and accurately, ensuring that breast cancer patients receive the optimal management of their disease.” 

Paige previously received Breakthrough Designation for Paige Prostate Detect, the first FDA-authorized digital pathology application. However, according to the statement, Paige Lymph Node is the first AI application of its kind to receive this designation from the FDA.

To read more, got to Health Imaging.


Biden Admin Proposes Overhauls to Lambasted Out-of-Network Billing Dispute Resolution Process

By Dave Muoio | October 27, 2023 | Included in Radiology Digest – November 7, 2023

The Biden administration has proposed a new rule refining several aspects of the healthcare services billing process in response to criticisms levied from all sides of the industry.

Unveiled Friday afternoon, the proposed rule (PDF) brings new requirements for payers, providers and the third-party arbitrators who settle out-of-network billing disputes under the No Surprises Act’s independent dispute resolution (IDR) process.

If finalized, the administration said its changes would improve communication between the parties, create efficiencies, speed up payment determinations and make the process more accessible.

“The Biden-Harris Administration continues to take actions to protect patients from junk health insurance and unfair billing practices. This rule is the next step in ensuring we take patients out of the middle of billing disputes between insurers and healthcare providers,” Department of Health and Human Services (HHS) Secretary Xavier Becerra said in his department’s announcement. “Eliminating surprise medical bills, reducing the burden of medical debt and curtailing junk insurance plans continue to be high priorities.”

To date, federal agencies’ rollout of the No Surprises Act has been assailed by grievances and interruptions.

Providers have brought lawsuits against the administration’s guidance on how determinations should be made and how disputes should be initiated, several of which led to court-ordered pauses and rewrites. The process was recently resumed in full after the third and fourth such successful challenges.

Payers, meanwhile, have highlighted a “small subset of providers” that abuse the dispute process. Three individual companies are responsible for more than half of all emergency or nonemergency services disputes, the insurance lobby recently testified.  

Congress is similarly displeased with the bumpy road its out-of-network billing legislation has faced. Architects of the law have critiqued federal agencies for undermining “one of the greatest consumer protection reforms in our country’s history” and ignoring congressional intent. They’ve also grilled Becerra and other officials on huge backlogs of IDR cases and lengthy delays in judgments.

Reduced fees, batching, open negotiation notices and more

Friday’s proposed rule—released jointly by HHS, the Department of Labor, the Department of the Treasury and the Office of Personnel Management—aims to address the criticisms with a slew of new processes and requirements.

Per an HHS fact sheet, the administration is proposing that payers include additional information alongside their initial payments or notices of denials, such as the qualifying payment amount and contact information for initiating the open negotiation period.

This, along with other standardized information, “would facilitate communication between parties prior to and during open negotiation and reduce the number of ineligible payment disputes submitted to the Federal IDR process,” HHS said.

To encourage parties to more meaningfully engage in the 30-day open negotiation period, the administration said it will be requiring parties to provide a formal open negotiation notice to the other entity and HHS through the Federal IDR portal. The other party would also be required to respond to the notice before the fifteenth day of the open negotiation period.

“These proposed changes would create more certainty regarding whether and when an open negotiation period occurred by ensuring that start and end dates are documented in the Federal IDR portal,” HHS said.

To further cut down on dispute volume, the proposed rule would establish an eligibility review process the government can invoke “when dispute volume is high” to help clear the queue.

As for the IDR process’s contentious administrative fees, the administration said it will be setting a reduced fee when the highest offer made during open negotiation by either disputing party was less than a predetermined threshold. These fees—which will be collected directly by the departments rather than IDR entities—will also be reduced for the non-initiating party if a dispute is eventually determined to be ineligible for arbitration.

Other updates proposed by the departments would permit certain related payment determinations to be “batched” into a single dispute for efficiency, broaden the “extenuating circumstances” that qualify for an extended timeline and IDR registry requirements for payers.

“The No Surprises Act continues to protect consumers from surprise medical bills,” Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure said in a release. “The Biden-Harris Administration continues to demonstrate a commitment to implementing the law for the American people. Today’s proposed rule will strengthen the communication between healthcare payers and providers and improve upon the independent dispute resolution process.”

To read more, go to Fierce


Bill Aims for More Mammograms, Other Breast Imaging in Illinois

October 27, 2023 | Included in Radiology Digest – November 7, 2023

An act making mammograms more accessible in Illinois is now in lawmakers’ hands. House Bill 4180 (HB 4180), introduced October 23, 2023, includes several instances of new and specific provisions, such as the following:

– Coverage for certain types of mammography shall be made available to patients of a specified age (rather than only women of a specified age).

– Coverage for molecular breast imaging will be required and, in those cases where it is not already covered, breast MRI will also be covered.

– The Department of Healthcare and Family Services shall convene an expert panel, including representatives of hospitals, free-standing breast cancer treatment centers, breast cancer quality organizations, and doctors, including radiologists who are trained in all forms of FDA-approved breast imaging technologies, breast surgeons, reconstructive breast, surgeons, oncologists, and primary care providers to establish quality standards for breast cancer treatment.

HB 4180 is sponsored by Reps. Nabeela Syed (D-51st District), Michael J. Kelly (D-15th District), and Jeff Keicher (R-70th District).

Read the full text here.
To read more, go to Aunt Minnie.
Learn more about what Zotec Partners can do for your radiology practice here.