Radiology Digest – October 28, 2021

October 29, 2021

Radiology Digest: News from the week of October 28, 2021.

‘Clinic that Comes to You,’ Offering Free At-home Imaging, Expands into 3 New Markets
By Marty Stempniak | October 28, 2021 | Included in Radiology Digest – October 28, 2021

A growing primary care business offering free at-home X-ray imaging is adding three new markets with an eye toward further growth.

Nice Healthcare announced Wednesday that it’s expanding into St. George, Utah, Albuquerque, New Mexico, and Las Vegas. The Minneapolis-based firm now operates in 12 states and said it hopes to add 10 additional markets by the end of 2022.

Founded in 2017, Nice Healthcare targets small and medium sized businesses, bringing musculoskeletal and primary care services into the home through a combo of virtual and in person offerings. Employers contract directly with the company, which provides unlimited access to its services for roughly $1 a day per worker.

“With Nice, you don’t have to compromise healthcare quality based on cost,” John Young, senior VP of growth, said in a statement. “We work closely with companies to deliver the highest level of care to their employees that is convenient enough to meet all their personal and family needs.”

Along with imaging, Nice also offers 35 lab tests and more than 550 free prescriptions via in person pickup or mail. Mobile techs visit homes to deliver X-rays or EKG and where available, patients can view the results through the Nice Healthcare smartphone app. Nurse practitioners and physician assistants typically handle the in-person visits.

To read more, go to Radiology Business.

The $40 Million Price Tag of Prior Authorizations Exposed in New Study
By Hannah Murphy | October 26, 2021 | Included in Radiology Digest – October 28, 2021

Prior authorizations for treatment are a necessary evil in our modern medical system. Without them, patients might not be able to pay for imperative care due to the associated high costs. But a new study presented at ASTRO’s annual meeting this week focuses not on patients’ financial burdens, but those of the clinics obtaining such authorizations, specifically in radiation oncology.

Using published compensation data, work-hour estimates and the standard cost of supervisory/physician requirements, researchers were able to come up with the average range for costs associated with a prior authorization (PA) event. The results showed that the average time it takes to complete a PA is between 51-95 minutes, at a cost of $28-$101.

However, significant time and expense increases were noted when PAs required a peer-to peer review before approval. Those discussions took an average of 92-95 minutes and cost $75-$101. Annually, the study notes that the average departmental cost of PAs exceeds $491,000. Nationally, this equates to a $40,125,848 expenditure for academic radiation

“The sheer magnitude of the cost was surprising. We expected that prior authorization was expensive, but the degree of expense was eye-opening, especially given how often we go through this time-intensive process without significant changes to what we’ve prescribed,” said Brian S. Bingham, MD, chief radiation oncology resident at Vanderbilt University Medical Center in Nashville, and lead author on the study.

Obtaining prior authorizations is vital for those in need of timely treatment, especially for radiation oncology patients. This study makes clear that excess time and money are spent on this process, and suggests clinics should closely re-examine their own PA roadmaps and communication methods with those involved in securing approvals.

You can view the detailed breakdown of the numbers in this study here.
To read more, go to Health Imaging.

“Great Resignation” Hits Healthcare Hard As Physician Burnout Persists
By Jacqueline LaPointe | October 26, 2021 | Included in Radiology Digest – October 28, 2021

Besides an ongoing global pandemic, another phenomenon is happening in 2021 and healthcare appears to be at the center of it.

The phenomenon known as the “Great Resignation” has to do with high levels of turnover across industries as businesses and their employees grapple with the economic consequences of 2021. Healthcare, in particular, appears to be the most impacted by this trend, with high percentage of nurses, physicians, and other providers reporting burnout, reports Jackson Physician Search and Medical Group Management Association (MGMA).

In a new white paper On the Verge of a Physician Turnover Epidemic: Physician Retention Survey Results, the organizations find that healthcare organizations need to address clinician burnout to get ahead of massive turnover, which could cost the organizations not only a lot of money but patient outcomes.

“Successful business decisions begin by recognizing threats and opportunities, and the pandemic exposed many for healthcare organizations, so we’ve seen a rapid and sustained increase in the number of physicians actively looking for new jobs,” Tony Stajduhar, president of Jackson Physician Search, said in a press release.

“But what we’re learning is that post-COVID business recovery actually requires making the experience of being a doctor better for physicians. Recognizing the all-consuming nature of practicing medicine and considering physicians as partners versus employees are where it starts.”

To read more, go to Revcycle Intelligence.

ACR Releases New Benchmarks to Help Radiology Departments Optimize Radiation Dose Levels
By Matt O’Connor | October 26, 2021 | Included in Radiology Digest – October 28, 2021

The American College of Radiology has released long-awaited benchmarks designed to help providers optimize radiation dose levels when imaging younger patients.

ACR detailed its Dose Index Registry diagnostic reference levels for the 10 most common pediatric CT scans Tuesday in Radiology. The guidance incorporates nearly five years’ worth of data taken from more than 1,600 healthcare facilities.

Up until now, the few guidelines published on pediatric dose standards were outdated. The new benchmarks represent a “step forward” for optimizing children’s imaging, lead author Kalpana M. Kanal, PhD, said Oct. 26.

“Establishing these national benchmarks is a vital tool to guide local facilities in adjusting pediatric CT protocols and resultant doses for their patients,” Kanal, past chair of the ACR Dose Index Registry, added. “All efforts toward understanding how much radiation is used for common CT examinations is valuable, especially if one finds that local dose indices exceed the diagnostic reference levels provided in this study.”

The college gathered data on CT scans performed in patients 18 years or younger between 2016 and 2020, with most (66%) coming from community hospitals.

Head CT without contrast proved to be the most commonly performed exam, with median volume dose levels ranging from 23-55 mGy. And for body CT exams of the abdomen and pelvis with contrast (the most common body scan), age based metrics ranged from 2.4-11 mGy.

The study also included guidance on chest CT with and without contrast, C-spine without contrast, soft tissue neck exams and maxillofacial CT scans, among others.

“Radiologists, medical physicists and radiologic technologists have to work together to ensure that each patient receives an optimized dose while maintaining image quality,” said Donald Frush, MD, senior author of the study and chair of the Image Gently Alliance. “These national level benchmarks provide contemporary and robust guidance for these groups
toward ensuring quality patient care. This is especially valuable in practices where pediatric scanning is relatively infrequent.”

Read the ACR’s breakdown of the new benchmarks here and the full study here.
To read more, go to Health Imaging.

Lawmakers Push Feds to Fix Key Surprise Billing Provision that has Enraged Radiologists
By Marty Stempniak | October 22, 2021 | Included in Radiology Digest – October 28, 2021

Bipartisan members of the U.S. House are urging the administration to quash a key piece of efforts to address surprise medical bills that has enraged radiologists and other provider groups.

Reps. Tom Suozzi, D-N.Y., and Brad Wenstrup, R-Ohio, recently started circulating a letter addressed to Health and Human Services and other agency heads, asking for their intervention. The two are asking other members of Congress to join them in fighting to fix the interim final rule, released on Sept. 30.

Lawmakers approved the No Surprises Act late last year, with the feds recently beginning the rulemaking process. Suozzi and Wenstrup are concerned, however, the rule does not match congressional intent. In particular, the proposal spells out a process to settle out-ofnetwork payment disputes that places too much emphasis on the “qualifying payment amount,” established by health insurers. (Generally, this would amount to the median contracted rate for the same or similar service in the geographic area.)

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,” the two wrote in their draft letter, slated to be sent to leaders in the departments of Labor, HHS and Treasury. “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.”

Instead, the two believe the dispute-resolution process should use a variety of factors in settling such payment disputes. Those should include quality of outcomes, market share, complexity of services, case mix, and prior contract history between the two sides. Suozzi and Wenstrup note that the original law “expressly directs” arbitrators to consider all such factors.

Their sentiments echo the concerns of numerous other provider groups including the American Medical Association, American Hospital Association and American College of Radiology. ACR shared the draft letter in a Thursday news update and encouraged members of the specialty to contact their representatives to convince them to sign on.

“If the administration’s [independent dispute resolution] approach is fully implemented, the American College of Radiology and others believe this will establish a de facto benchmark payment rate and will result in a downward trend of in-network payment rates and/or physicians being forced out of insurer networks, ultimately making it harder for patients to find in-network care,” the college said Oct. 21.

To read more, go to Radiology Business.

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