Revised Lung Cancer Screening Guidelines Still Leave Many High-risk Groups Ineligible
By Matt O’Connor | September 23, 2021
Updated guidelines for lung cancer screening designed to address longstanding disparities still fall woefully short of their intended goal, radiologists reported Tuesday.
Back in March, the U.S. Preventative Services Task Force said individuals should begin lowdose CT screening five years earlier than previously recommended, lowering the starting age from 55 to 50 and smoking pack-years from 30 to at least 20.
Millions more became eligible for LDCT exams overnight, but some experts said it wasn’t enough to ensure vulnerable patients are screened.
New survey results from tens of thousands of respondents published in Radiology solidified those concerns. Under the 2021 USPSTF update, 14.7% of white patients were eligible for screening, compared to 9.1% of Black individuals, 4.5% of Hispanics and 5.2% of Asian/ Pacific Islanders.
Massachusetts General Hospital experts applauded the overall gains in screening eligibility but warned the improvements still fall short.
“It was great to expand eligibility, but to just change the age and the pack-years doesn’t fully address lung cancer risk,” radiologist Anand K. Narayan, MD, PhD, vice chair of equity at the University of Wisconsin in Madison, and formerly of Massachusetts General Hospital, said in a statement. “We’ve long known that some racial/ethnic minorities face a higher risk of lung cancer, and that level of risk is not adequately reflected in the new guidelines.”
The conclusions are based on data from the 2019 Behavioral Risk Factor Surveillance System, which covered upwards of 77,000 people across 20 states.
If the USPSTF wants to truly address disparities, Narayan said guidelines must incorporate risk models. These approaches include variables such as family history and COPD and social factors like employment, education status and food insecurity.
“If we put social determinants of health into our model, then we can more accurately reflect risk,” Narayan added. “It can give us tools to direct our resources toward patients in terms of how much risk they are experiencing and how much care they actually need. We can then target high-risk patients for more intensive screening and diagnostic services.”
To read more, go to Health Imaging.
Practice Interruptions Skyrocketed in April 2020 Due to COVID-19
By Anthony Vecchione | September 21, 2021
The COVID-19 pandemic disrupted the practice of medicine nationwide, especially in those early months when much of the country was on lockdown.
To learn more about how COVID-19 impacted patient care, a team of researchers examined trends in practice interruptions, sharing their findings in JAMA.
The group analyzed data from 547,849 Medicare physician claims for 100% of fee-for-service beneficiaries from Jan. 1, 2019, to Dec. 30, 2020. They also counted the number of claims billed every month by each physician.
In the analysis, practice interruption was defined as a month in which a physician who had previously billed Medicare billed zero Medicare claims.
Moreover, interruptions with return were defined as the ones for which the physician resumed billing Medicare within six months of the last billing month and interruptions without return as those for which the physician did not resume billing Medicare within six months.
Physicians in training, pediatricians, and physicians who billed fewer than 50 Medicare claims during 2018 were excluded from the analysis.
According to the authors, practice interruption rates were comparable before and during the COVID-19 pandemic apart from an increase in April 2020, when 6.93% of physicians billing Medicare had a practice interruption. In April 2019, that number was just 1.43%.
“Most practice interruptions were temporary, though not all,” wrote authors Hannah T. Neprash, PhD, of the University of Minnesota School of Public Health and Michael E. Chernew, PhD, of Harvard Medical School. “The pandemic appears to have impeded return to practice more for older physicians than for younger physicians, consistent with anecdotal reports and survey findings regarding intent to close practices, retire, or otherwise transition away from clinical medicine.”
Also, 1.14% of physicians discontinued practice in April 2020 and did not return, compared with 0.33% in April 2019.
The rise between April 2019 and April 2020 in interruption rates and interruption-withoutreturn rates was greater for physicians 55 years old and older than younger physicians.
The groups that experienced greater increases in practice interruption rates in April 2020 vs April 2019 included female physicians, specialists, physicians in smaller practices, those not in a health professional shortage area and those practicing in a metropolitan area.
What is the long-term impact of this spike in interruptions? The authors concluded that more research is needed to find out.
ASCs Livid Over CMS Plan to Curb Approved Procedures
By Michael Brady | September 20, 2021
Ambulatory surgery centers are fuming over potentially losing more than 250 procedures they can offer patients if the Centers for Medicare and Medicaid Services reinstates the inpatient-only list limiting them to hospitals, according to comments on CMS’s proposed outpatient pay rule for 2022.
Ambulatory surgery centers argue that CMS doesn’t have enough information to support such a significant policy change. The providers also claim the agency made a series of flawed assumptions about the real-world impact of restoring the inpatient-only list and limiting the procedures allowed under the ambulatory surgery center covered procedures list, known as the ASC-CPL, according to the Ambulatory Surgery Center Association.
“While ASCA was not expecting the 267 codes that were proposed—and later finalized—to be added to the ASC-CPL in 2021, we were even more surprised that one year later CMS is proposing to completely reverse course. We have serious concerns with the way this was handled and the discussion surrounding this issue included in the proposed rule,” ASCA wrote in a letter. “The same medical officers who allowed for the codes’ addition in 2021 are now claiming, without evidence, that these codes may not be safely performed in the ASC setting.”
CMS maintains that halting reimbursements to ambulatory surgery centers for hundreds of procedures would have little effect because ambulatory surgery centers had not yet started performing the newly added procedures. But that isn’t true, the ASCA wrote.
“This supposition ignores the reality that it takes time to add new procedures in a facility, and the data CMS would have at this point in the year is extremely limited. In addition, CMS’s addition of codes to the ASC-CPL often opens the door for other payors to reimburse for these procedures, and as such, many facilities may have started with other patient
populations before taking on any sort of significant Medicare volume,” ASCA wrote.
To read more, go to Modern Healthcare.
Hundreds of Radiologists Flood Feds With Pleas to Avoid Massive Medicare Pay Cuts
By Marty Stempniak | September 17, 2021
Hundreds of radiologists and other physicians have flooded Washington with pleas to avoid massive Medicare cuts set to hit the specialty in a few months.
They’re concerned about changes outlined in the 2022 physician fee schedule, expected to reduce rads’ reimbursement to make up for spending increases elsewhere in the federal budget. Providers, in particular, have voiced concerns about updating wages for clinical labor staffers such mammography technologists, which would lead to sizable pay reductions for interventional radiologists and radiation oncologists.
Professional associations such as the American College of Radiology have urged members to contact lawmakers and the Centers for Medicare & Medicaid Services. Physicians have responded, ACR said Thursday, submitting 900 comments to CMS about the clinical-labor issue, and 1,300 emails to members of Congress. The college hopes the letter-writing campaign pays off, similar to docs’ success curtailing cuts in the 2021 fee schedule.
“Last year the advocacy efforts and support from ACR members helped stave off cuts by CMS that would have inadvertently affected patient access to care during a very critical time. With your help, the ACR can continue its fight for patient access,” the professional association said in a Sept. 16 news update.
Meanwhile, U.S. Reps. Bobby Rush, D-Ill., and Gus Bilirakis, R-Fla., have been circulating their own letter opposing the clinical-labor change. As of Tuesday, the two said 73 bipartisan members of the House now oppose the update, which would reduce specialists’ pay by more than 20% for some services. Lawmakers believe the policy could force providers to close practices and disproportionately impact Black and Latino patients’ access to interventional radiology care.
“These ongoing cuts to specialties under the PFS also are weakening our healthcare system’s ability to deal with the ongoing COVID-19 pandemic,” representatives wrote to CMS Sept. 13.
Two other physician lawmakers are circulating their own letter to House leaders, seeking to extend a 3.75% physician pay increase set to expire Dec. 31. The adjustment was added late last year to help offset Medicare reductions for rads, necessitated by increased spending on primary care and other services. ACR said this “dear colleague letter” from Ami Bera, MD, DCalif., and Larry Bucshon, MD, R-Ind., prompted its members to write more than 1,000 messages to Capitol Hill in less than a week.
To read more, go to Radiology Business.