Radiology Digest – October 11, 2022

October 10, 2022

Radiology Digest: News from the week of October 11, 2022.
AI for Medical Imaging Must be Monitored for Bias
By Kate Madden Yee | October 6, 2022 | Included in Radiology Digest – October 11, 2022

Artificial intelligence (AI) for medical imaging is susceptible to bias based on racial or socioeconomic factors and must be monitored for this, according to a commentary published October 5 in the Journal of the American College of Radiology.

If bias in AI tools for medical imaging isn’t identified and removed, patients could be negatively affected, noted authors Dr. Madison Kocher of Duke University in Durham, NC, and Dr. Christoph Lee of the University of Washington in Seattle. The two wrote the commentary in response to a study the Journal of the American College of Radiology published August 11 that found AI algorithms can identify a patient’s demographic information with a high level of accuracy on chest x-rays.

“The prospect of sensitive sociodemographic characteristics being identifiable by AI presents a real risk of deployed models using race and other personal characteristics and incorporating them into subsequent medical decisions unbeknownst to radiologists, referring providers, and patients alike,” Kocher and Lee warned.

AI algorithms have the potential to help radiologists identify disease and predict patient outcomes, but it’s becoming clear that these algorithms may be problematic in that they can also identify the racial and sociodemographic characteristics of patients being imaged. An animated discussion about how to deal with this problem has already begun: In fact, a recent study suggested that proper data handling is crucial for mitigating imaging AI bias.

But what else can radiology do to make sure that AI algorithms don’t lead to healthcare bias or worsen existing disparities in patient outcomes based on factors such as race? It’s a question of great importance, especially since it’s likely that use of AI for medical imaging will continue to increase, Kocher and Lee cautioned.

To read more, go to Aunt Minnie.


Google Cloud Intros Ambitious Branch Dedicated to Medical Imaging
By Dave Pearson | October 5, 2022 | Included in Radiology Digest – October 11, 2022

A Big Four tech company has launched a platform it hopes will accelerate data interoperability and AI adoption in, specifically, medical imaging.

Alphabet’s Google unveiled the platform, Google Cloud Medical Imaging Suite, Oct. 4. In the process the company announced its intentions to open AI-powered medical imaging to broad swathes of patients and, in the process, lighten workloads for radiologists.

Pointing out that nearly 90% of all healthcare data is imaging data, Google Cloud suggests image interpretation has been more dependent on humans than it needs to be in the age of big data analytics.

“Google pioneered the use of AI and computer vision in Google Photos, Google Image Search, and Google Lens, and now we’re making our imaging expertise, tools, and technologies available for healthcare and life sciences enterprises,” says Google Cloud medtech strategist Alissa Hsu Lynch in the announcement. “Our Medical Imaging Suite shows what’s possible when tech and healthcare companies come together.”

Toward that end, Google Cloud is partnering with numerous technology suppliers to move the medical imaging operation forward.

For example, it’s working with NetApp and Change Healthcare on image exchange in the cloud, Nvidia and Monai on automated image labeling, and at least five companies on deploying the system at scale—CitiusTech, Deloitte, Omnigen, Slalom and Quantiphi.

Read press release here.
To read more, go to Radiology Business.


Patient Access to Radiology Reports: 2 Angles
By Dave Pearson | October 5, 2022 | Included in Radiology Digest – October 11, 2022

Should patients read their radiology reports ahead of the doctor who ordered the exam? That’s not a new question. It was supposed to have been settled in the affirmative by the 21st Century Cures Act.

President Barack Obama signed the bill into law in late 2016. Its provision calling for immediate and unimpeded patient access went into effect in 2021. Under the clause, providers who try to “block” patients may be hit with hefty fines.

However, of late the wisdom of the Cures Act’s lack of nuance is getting rethought. The timing may have to do with the American Medical Association’s lobbying HHS to make commonsense exceptions to the current Cures prescription for patient notification.

In any case, two opinion pieces published over the past few days exemplify the quandary.

‘The Bar for What Counts as Harm Is High’
In the “Well” section of the New York Times, author and freelance journalist Danielle Friedman begins a well-sourced article with a personal anecdote. Upon receiving an alert from MyChart, she logged in only to come face to face with an unexpected and jarring pathology report.
The Cures Act’s anti-blocking rule has surely done some good for some people, Friedman suggests.

“But it has also led to experiences like mine, in which patients are confronted with material they never wanted to see,” writes Friedman, who doesn’t single out radiology for special consideration. “Some have learned about life-altering diagnoses and developments—from cancer to chronic illness to miscarriage—through emails and online portals, left to process the information alone.”

To read more, go to Radiology Business.


Medical Coding is the Next Stop for Artificial Intelligence in Healthcare
By Jacqueline LaPoint | October 3, 2022 | Included in Radiology Digest – October 11, 2022

To a layperson, medical codes look like a different language, and in a way they are. Medical coding is a highly complex process in healthcare in which clinicians and revenue cycle staff work together to translate clinical encounters into billable codes for not only reimbursement but other performance tracking efforts. The codes that ultimately end on claims tell the story of a patient’s encounter.

Understanding a clinical encounter is extremely important for patient care and for keeping the doors open. However, in a world of ever-changing payer rules and documentation requirements, medical coding is perhaps more complex than ever.

“Something that is challenging for us is getting payment in a timely fashion so that we can actually make payroll to make sure doctors and APPs [advanced practice practitioners] are paid correctly,” explains Eric Wilke, MD, Eric Wilke, an emergency medicine doctor and chief operations officer at TECHealth, an ER physician staffing company.

Medical coding can get in the way of timely reimbursement. Payers may reject or deny claims because of medical coding errors or missteps. In fact, a survey of hospital executives found that about a third cite coding as their top concern when it comes to denials and denials prevention.

With denial rates on the rise, optimizing medical coding to prevent claims denials is critical. Healthcare organizations must identify the right codes for services provided during a clinical encounter while adhering to payer requirements. Organizations must ensure they are not leaving money on the table by neglecting to code a service or applying the appropriate severity level or modifier.

Organizations are also trying to implement medical coding best practices with fewer coders and revenue cycle staff.

“We’ve experienced hiring challenges for billing and coding positions, especially in the wake of COVID-19,” Wilke says. “We had extended interviews to several people, and they never even bothered to show up.”
The “Great Resignation”—a term used to describe high levels of turnover during and in the aftermath of the COVID-19 pandemic—has hit healthcare particularly hard. Provider organizations have especially faced shortages of qualified revenue cycle talent, with entry-level roles taking an average of 84 days and over $2,000 to fill. Mid-level revenue cycle positions, which require six to ten years of experience, are taking an average of 153 days and over $3,500, survey results also show.

Many healthcare organizations choose to offshore medical coding to combat domestic staffing shortages and the high costs of filling open roles. But for organizations like TECHealth, “all of the work we were doing was domestic,” Wilke states.

Unfortunately, Google Translate does not recognize medical codes as a language. However, TECHealth found a “bit of an equalizer in that standpoint.”

To read more, toRevcycle Intelligence.


Disparities in Breast Cancer Detection and Care Persist, Despite a Drop in Mortality, New ACS Report Reveals
By Hanna Murphy | October 3, 2022 | Included in Radiology Digest – October 11, 2022

Although early detection methods have significantly contributed to the decrease in breast cancer mortality rates, new data from the American Cancer Society reveal that these rates for Black women continue to lag. 

Breast cancer remains the leading cause of cancer deaths in Black women, according to the latest edition of American Cancer Society’s Breast Cancer Statistics, 2022. The new data indicate that while Black women have lower incidence of breast cancer diagnosis, their mortality rates are 40% higher than those observed in white women.  

“This is not new, and it is not explained by more aggressive cancer,” said Rebecca Siegel, senior scientific director, surveillance research at the American Cancer Society and senior author of the report. “We have been reporting this same disparity year after year for a decade. It is time for health systems to take a hard look at how they are caring differently for Black women.” 

The report indicates that this disparity has persisted since 2004. Additional insight from the most recent statistics provided by ACS including the following:
 Breast cancer incidence has risen by .5% every year since 2004; this is attributed to a rise in localized-stages and hormone-receptor-positive diagnoses.From 1989 to 2020, breast cancer deaths dropped by 43% thanks to earlier detection methods, increased awareness and improved treatments.Black women are the least likely of any racial/ethnic group to be diagnosed at a localized stage (57% vs 68% for white women).Black women also have the lowest 5-year relative survival rate of any racial/ethnic group for breast cancer of any subtype and stage, other than stage 1.“Coordinated and concerted efforts by policy makers and healthcare systems and providers are needed to provide optimal breast cancer care to all populations, including expansion of Medicaid in the non-expansion Southern and Midwest states, where Black women are disproportionately represented,” Dr. Ahmedin Jemal, senior vice president, surveillance & health equity science and contributing author of the study, said in a statement.
Jemal also called for increased investments dedicated towards early detection methods and treatments.

Echoing this sentiment,  Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), called for funds to be directed specifically to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), stating that this was a “critical” step in closing the persistent gaps in care among Black women.

For more information on the report, click here.
To read more, go to Health Imaging.


New Recommendations Highlight the Importance of CCTA When Treating Acute Chest Pain in the ED
By Michael Walter | September 29, 2022 | Included in Radiology Digest – October 11, 2022

Coronary computed tomographic angiography (CCTA) should be the go-to imaging option when treating most emergency department patients who present with acute chest pain (ACP), according to new recommendations published by the Society of Cardiovascular Computed Tomography (SCCT).
The new document, published in full in the Journal of Cardiovascular Computed Tomography, is based on data from eight different randomized controlled trials and five meta-analyses.[1] The American College of Radiology (ACR) and North American Society for Cardiovascular Imaging (NASCI) both endorsed the SCCT’s recommendations.

“This document serves as a framework for hospitals and emergency departments looking to implement and expand their CCTA programs,” radiologist Christopher Maroules, MD, the document’s lead author, said in a prepared statement. “With the detailed operational guidelines and best practices outlined in this document, physicians and administrators will be equipped to leverage the maximum value of this pathway, improving health outcomes for their patients, decompressing busy emergency rooms and lowering healthcare costs.”

CCTA has continued to gain momentum as a first-line treatment option since the American Heart Association (AHA) and American College of Cardiology (ACC) released their 2021 chest pain guidelines, which gave the modality a new 1A indication for evaluating stable and acute chest pain.[2]

“We believe in our community this is long overdue,” Eric Williamson, MD, 2021-2022 SCCT president, said in a recent interview with Cardiovascular Business. “But it is nice to see the broader medical community of medical care acknowledging and understanding the strengths of this technology.”

Those 2021 guidelines highlighted the importance of shared decision-making, which is also a key component of the SCCT’s latest recommendations.

“Once CCTA is deemed appropriate, shared decision-making between the clinician and patient is encouraged to review pros and cons of CCTA and to improve understanding and facilitate risk communication,” according to the document. “Alternative diagnostic strategies should be discussed, including no further testing, observation and/or functional testing, if available.”

Additional coverage of the 2021 chest pain guidelines is availablehere and here.
To read more, go to Cardiovascular Business.


Specialty-specific Workflow Training Could Increase Radiologist Satisfaction with EHRs
By Hannah Murphy | September 29, 2022 | Included in Radiology Digest – October 11, 2022

A new KLAS Arch Collaborative report offers insight into healthcare providers’ satisfaction with their experience using electronic health records, revealing that opinions of EHR use remain conflicted between specialties. 

Gone are the days of rooms filled from floor to ceiling with patients’ paper medical records. Since the arrival of the “paperless” era, electronic health records (EHRs) have become an integral part of the healthcare system, with both compliance metrics and reimbursement rates hinging on appropriate EHR use. And although clinicians across the board are obliged to comply, not everyone reveres the use of such technology. 
The latest EHR satisfaction report from KLAS reflects the disharmony.

For example, ophthalmologists and orthopedists rate their EHR experiences at only 8.4 and 11.2 points on a 100-point scale. By contrast, those working in hospital medicine and pediatrics report much better experiences, with ratings of 38.8 and 31.1. 

How do radiologists feel about EHRs?

Radiologists’ experiences fell close to the middle tier of the 26-specialty KLAS study, with an average rating of 20.3 based on responses from 1,528 physicians. While radiologists held EHRs in higher regard than many of their peers, the report data indicate that needs specific to radiology are not met by many EHR systems. 

Of note, additional insight from the report suggests that clinicians who receive specialty-specific workflow training are 24 times more likely to agree that the EHR meets their functionality needs. This notion is further supported by survey data indicating EHR satisfaction is more user/specialty-specific rather than EHR-specific.  

Additional data from the Exploring EHR Satisfaction by Provider Specialty report can be found here
To read more, go to Health Imaging.


Medical Groups May Reduce Staff, Patients Amid Medicare Payments Cuts
By Victoria Bailey | September 28, 2022 | Included in Radiology Digest – October 11, 2022

As medical groups expect to see Medicare payment cuts in 2023, practices are considering limiting the number of new Medicare patients and reducing clinical staff to ensure financial stability, according to the Medical Group Management Association (MGMA).

The report reflects responses from 517 group practices across 45 states that shared how they plan to respond to the proposed Medicare payment reductions.
The 4.5 percent decrease in the Medicare conversion factor included in the 2023 Physician Fee Schedule (PFS) proposed rule coupled with the 4 percent Pay-As-You-Go (PAYGO) sequester will reduce 2023 Medicare payments by at least 8.5 percent.

The majority of practices (92 percent) said that 2022 Medicare reimbursement rates already do not adequately cover the cost of care provided.

In order to maintain finances in the wake of even further reductions, medical groups will have to adjust some of their practices, MGMA found.

“As a regional safety net academic Health System in one of the poorest regions of the country, we will not stop caring for our Medicare patients. However, our ability to maintain a sustainable financial situation will be so challenging,” a multispecialty group employing 1,800 physicians in urban Alabama said. “We are already stretched due to increasing labor and supply costs – a cut in Medicare would be beyond anything we could manage.”

Nearly 60 percent of groups are considering limiting the number of new Medicare patients they accept, while 66 percent have considered reducing charity care. Fifty-eight percent of respondents said they might have to reduce the number of clinical staff and 29 percent are considering closing satellite locations.

“This would most likely force us to eliminate 2 to 3 staff members,” a small physician family practice in rural Iowa shared. “With the increased stresses associated with care, our staff is already spread too thin. Medicaid reimbursement is dismal and adding Medicare reductions to our already stressed environment will most likely require us to close one of our two satellite clinics.”
MGMA has urged Congress to act accordingly to prevent the significant Medicare payment reduction.

The organization asked federal leaders to provide a 4.5 percent increase to the PFS conversion factor to prevent additional reimbursement cuts and extend the funding provided in 2022.

MGMA also requested that Congress provide an inflationary update based on the Medicare Economic Index (MEI), which would give medical groups more financial stability. In addition, Congress should waive the 4 percent PAYGO sequester, MGMA said.

Other physician groups have been vocal about opposing the reimbursement cut proposed in the Medicare PFS.
To read more, go to Revcycle Intelligence.
Learn more about what Zotec Partners can do for your radiology practice here.