Radiology Digest: News from the week of September 11, 2020.
Interventional Radiology’s $68.4B Inpatient Footprint Underscores ‘Bedrock’ Role in Chasing the Triple Aim
By Marty Stempniak | September 9, 2020 | Included in Radiology Digest – September 11, 2020
Interventional radiologists treat about 1 in every 10 U.S. inpatients and with a sicker population sample, account for nearly one-fifth of all such healthcare costs, according to an analysis released Wednesday.
The subspecialty represented 18.4% ($68.4 billion) of adult inpatient healthcare spending in 2016 alone, highlighting IR’s pivotal role in reducing costs and bolstering outcomes, Stanford experts wrote in JACR. This role will only continue to grow as the population ages, with the average inpatient requiring interventional services trending older at 62.8 years, compared to 57.1 overall.
“As payers and policymakers articulate the Triple Aim, including lowering the per capita cost of healthcare, IR must play a central role in discussions of healthcare policy and funding,” Soleil Shah, an MD candidate at the Stanford University School of Medicine, and colleagues wrote Sept. 9. “Moreover, as the common denominator, IR should lead the charge that defines, measures and makes transparent the cost per capita for this complex group of patients.”
To reach their conclusions, Shah et al. analyzed the National Inpatient Sample database for 2016 and pinpointed all adults who underwent a routine image-guided procedure that year. All told, about 2.3 million out of 29.7 million (or 7.8%) had at least one such service. Along with being older, this patient population also trended sicker and logged a higher inpatient mortality of 8.2% compared to 1.7% in the non-IR population.
Interventional radiology patients represented just 7.8% of all admissions that year and yet tallied 18.4% of costs. They had a roughly three times higher mean hospitalization cost when compared to other inpatients—at $29,402 versus $11,062—which persisted even when controlling for age and other factors, Shah and colleagues reported. Lengths of stay were also about 2.5-times greater.
And certainly, there is opportunity for growth, the team noted. Currently, only about 62% of rural hospitals even offer IR services compared to 95% in urban settings. Plus, using image-guided, minimally invasive services as a substitute for surgery could offer cost savings by both decreasing therapy expenses and reducing hospital stays, they added.
To read more, go to Radiology Business.
Are Clinicians Ordering CT Lung Screening too Often?
By Kate Madden Yee | September 9, 2020 | Included in Radiology Digest – September 11, 2020
Referring providers are ordering CT lung cancer screening exams for individuals who don’t meet established clinical guidelines for the tests, according to a study published September 6 in the Journal of the American College of Radiology.
This trend may reflect a lack of understanding of lung cancer screening guidelines by both patients and providers, wrote a team led by Dr. Gary Wang, PhD, of Massachusetts General Hospital (MGH) in Boston. But it may also indicate that providers are deciding to override guidelines.
“It is possible that providers have started to knowingly request guideline-discordant screening for patients without histories of heavy smoking because of the presence of other lung cancer risk factors,” the group wrote.
The U.S. Preventive Services Task Force (USPSTF) recommends yearly screening with low-dose CT for lung cancer in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. (The task force is reevaluating whether to adjust this guideline to adults 50 to 80 years who have a 20 pack-year smoking history.)
But providers appear to be ordering CT lung cancer screening exams outside the existing recommendation.
“The potential benefits and harms of lung cancer screening for individuals with lighter smoking histories than the NLST [the National Lung Screening Trial] cohort and for those with other risk factors, including chronic obstructive pulmonary disease, radon exposure, occupational exposure such as asbestos, and family history of lung cancer, are uncertain,” the group wrote. “Nevertheless, with growing public awareness and continued nationwide expansion of screening programs, lung cancer screening has started to occur outside U.S. guidelines.”
To read more, go to Aunt Minnie.
Common Service Costs $100K Less when Delivered by an Interventional Radiologist, Underlining Subspecialty’s Value
Marty Stempniak | September 8, 2020 | Included in Radiology Digest – September 11, 2020
A common service for dialysis patients costs about $100,000 less when delivered by an interventional radiologist rather than a surgeon, according to study published Tuesday.
More than 600,000 patients each year require life-saving hemodialysis for end-stage renal disease. And such care is a costly proposition, with $34 billion spent each year in fee-for-service Medicare, largely for creating and maintaining conduits, noted experts with the University of Colorado.
Fewer than 50% of all access conduits for dialysis remain viable for longer than three years and clinical guidelines recommend regular surveillance to guard for signs of impending failure. Interventions such as angiography, angioplasty stent placement and thrombolysis are typically performed by radiologists, surgeons or nephrologists. But it appears that interventional imaging physicians’ work in this realm costs tens of thousands less, underlining the subspecialty’s value proposition, and an opportunity to save significantly in the Medicare program, experts advised.
On average, the cost per patency year of dialysis in Medicare landed at roughly $174,000 for surgeons compared to $89,000 for nephrologists and $71,000 for radiologists.
“Discrepant use of the operating room and anesthesia services accounted for substantial payment differences across specialties,” Premal Trivedi, MD, an assistant professor in vascular and interventional radiology, and colleagues wrote Sept. 8. “Utilization of operating rooms and anesthesia services should be scrutinized moving forward. Reducing and eliminating the use of these high-cost resources would achieve major systemic savings,” the team added later.
To reach their conclusions, Trivedi and colleagues analyzed data from nearly 1,500 Medicare beneficiaries who underwent their first arteriovenous access placement in 2009. They then tracked subsequent use of healthcare services after the intervention for five years following that placement.
All told, 8,166 maintenance interventions were performed in the study population through 2014, with an unadjusted mean Medicare payment for each incremental year of patency at $71,000 for radiologists. When adjusting for clinical severity and location, intervention type and resource use, surgeons were paid 59% more than rads while nephrologists collected a 57% higher payment. Use of the OR and anesthesia were the biggest drivers of this difference, Trivedi et al. reported, accounting for 407% and 132% higher payments, respectively. Surgeons also placed stents significantly more often than other physicians, resulting in a twofold increase in costs.
To read more go to Radiology Business.
Nuclear Medicine Volume Plummets Due to COVID-19
By Rebekah Moan | September 8, 2020 | Included in Radiology Digest – September 11, 2020
It’s no secret COVID-19 has disrupted nuclear medicine clinical practice, research, and work environments. However, a new survey by the Society of Nuclear Medicine and Molecular Imaging (SNMMI) quantifies the effects: nearly 80% of respondents saw declines of 50% to 75% in non-PET nuclear medicine procedures.
An SNMMI COVID-19 task force led by Maria DaCosta, a nuclear technologist at Mount Sinai Hospital in New York, surveyed all active SNMMI members from 17 countries and asked about imaging volumes, radiopharmaceutical supplies, and a projected timeline for a return to prepandemic outputs.
“The pandemic will have evolved at the time these results are published, but the survey findings emphasize the profound manner in which COVID-19 has affected the [nuclear medicine and molecular imaging] community,” she and her colleagues wrote in the Journal of Nuclear Medicine (September 2020, Vol. 61:9, pp. 17N-21N).
How life has changed
COVID-19 has disrupted the lives of everyone, those in the healthcare industry included. But just how broadly has the pandemic affected nuclear medicine professionals in terms of their practice, research, and work environments? That’s what DaCosta and colleagues sought to find out in an electronic survey they launched on May 27 in tandem with a medical research survey. They kept the survey open for 16 days.
The research team received 263 responses from 17 countries, although the vast majority (90.4%) came from the U.S. The group found that most respondents (92.8%) saw a decrease in diagnostic nuclear medicine imaging study volumes as a result of the pandemic. For conventional nuclear medicine procedures (other than PET), most saw study volumes plummet: 37.2% experienced a 50% drop and 42.7% experienced a 75% drop.
For PET, 22.3% of respondents reported a 25% decrease in study volume while 17.8% saw a 50% decrease.
However, these respondents expected their imaging procedure volume to return to pre-COVID levels within the next six months.
To read more, go to Aunt Minnie.
Median Radiologist Pay at More than $509,000, Climbing Faster Than Docs’ Productivity Gains
By Marty Stempniak |September 04, 2020 | Included in Radiology Digest – September 11, 2020
Median radiologist compensation climbed nearly 5.3% year over year, a sharper incline than such physicians’ gains in productivity, according to recently released data.
All told, non-interventional rad pay landed at $509,447 in 2019, compared to $482,599 the previous year. Meanwhile, radiologists’ productivity also ticked upward to 10,200 work relative value units during the same period, a nearly 4% increase, the American Medical Group Association’s consulting arm noted. The survey incorporated some 1,900 radiologist responses and 73 practices.
The differences between pay increases and productivity trends were more pronounced across the entire physician population in the survey, AMGA said. Overall physician compensation swung upward nearly 3.8% during the study period versus a 0.56% gain in productivity.
“We have now seen this same trend of divergent key metrics for several years in a row, and we have to wonder how long it can continue, given that the vast majority of revenue is still, by and large, generated via work RVU productivity,” AMGA Consulting President Fred Horton said in a Sept. 2 statement. “AMGA’s members are concerned about this ongoing trend, and we suspect the industry-wide response to COVID-19 will speed up efforts to mitigate this pattern.
This is the 33rd edition of the firm’s Medical Group Compensation and Productivity Survey, which included 127,000 providers across 317 medical groups. It also covers 169 different physician and advanced practice clinician specialties such as pediatric, interventional and neuro-interventional radiology. Those three tallied a median compensation of $445,642, $587,746 and $531,056, respectively, the AMGA reported.
You can find more details about purchasing the report here.
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