‘Time has Come’ to Impose Radiology Workload, Duty Limits to Enhance Patient Care and Provider Safety
By Matt O’Connor | January 7, 2021
An American College of Radiology leadership expert is advocating to cap radiologists’ workloads and obligations in an effort to safeguard the health of patients and providers.
“I propose that national radiologist workload limits and duty rules should be set to optimize radiologists’ performance and to protect their health and professional longevity,” Frank J. Lexa, MD, MBA, chief medical officer of the ACR’s Radiology Leadership Institute, wrote recently in JACR.
Lexa said maximum shift lengths should not exceed 10 hours, with an hourly limit based on the type of cases and exams being interpreted. He maintained that such restrictions should be based on scientific data and rooted in the desire to provide the best possible care for patients.
Medical errors are a significant cause of morbidity and mortality and diagnostic radiology errors are a “clear contributor” to such outcomes, Lexa explained. He cited a handful of scientific studies showing how higher caseload demands often lead to more errors and potential harm.
And like many medical specialties, radiology workloads are increasing each year. One Mayo Clinic study found the number of images read per minute by a radiologist jumped from 2.9 in 1999 up to 16.1 in 2010. Another recent analysis reported that on-call workloads have skyrocketed by nearly 300% over the past 15 years, with rising CT utilization a top driver.
The combination of soaring workloads and the pressure to keep up also exposes readers to potential medicolegal consequences, Lexa noted.
Physicians take an oath to protect their own well-being when they put on their white coat, Lexa wrote. Exhaustion, sleep deprivation and adverse health effects have all been linked to long-term consequences such as hypertension, diabetes, and other diseases, he added.
Poor health and burnout not only impact job performance but also patients and fellow providers.
“As we have been reminded during the coronavirus pandemic, healthcare workers who become sick increase the burden on the remaining workforce, with further consequences for patient care,” wrote Lexa, who is also vice chair of Faculty Affairs at the University of Pittsburgh School of Medicine’s Radiology Department.
There’s no doubt many will object to capping rad workloads. Significant impacts on salaries, staffing schedules, workforce training and other factors will be top concerns. But the
paradigm shift would reduce burnout, improve patient safety and create a more sustainable profession, Lexa explained.
To read more, go to Health Imaging.
UnitedHealth’s Optum to Acquire Change Healthcare in $13B Deal
By Nona Tepper | January 6, 2021
UnitedHealth Group’s fastest-growing subsidiary announced on Wednesday it will pay approximately $8 billion to acquire Change Healthcare, in a move to drive greater connection and patient care among its healthcare delivery systems.
The company’s subsidiary Optum will pay $25.75 per share in cash, up 41% over Change Healthcare’s final closing price on Tuesday of $18.74. The deal includes $5 billion in debt owed by the Nashville-based data analytics and revenue cycle management company, bringing its total value to $13 billion.
Neil de Crescenzo, CEO of Change Healthcare, will lead OptumInsight once the acquisition closes. The agreement is expected to close in the second half of 2021 and is subject to Change Healthcare shareholders’ and federal regulators’ approval. Private equity funds affiliated with the Blackstone Group, which owns 20% of Change Healthcare, have agreed to the acquisition.
In a research note, SVB Leerink analysts Stephen Tanal and Stephanie Davis wrote that the deal will expand OptumInsight’s provider business, which currently represents just 35% of its revenue. The majority of Change Healthcare’s revenue, 60%, comes from healthcare provider customers.
Optum will also be able to capitalize on Change Healthcare’s “sizable” clinical and financial data to inform its value-based care initiatives for payers and providers, the analysts said. Optum said Change Healthcare will offer clinicians immediate, analytical insight on how best to care for individual patients. The company also plans to integrate Change Healthcare’s patient engagement tool—which reaches more than 200 million people per year—with individuals’ health benefit plans to make it easier for consumers to take advantage of incentive programs that reward healthy behaviors.
In addition to expanding OptumInsight’s healthcare provider business, A.J. Rice, managing director of equity research at Credit Suisse, said the deal will scale the company’s payment processing and claims review systems. Optum aims to integrate its billions of claims data and automated payment processing tool with Change Healthcare to more quickly process payments for providers and more transparently bill payers and patients.
To read more, go to Modern Healthcare.
Experts Call for a New Subspecialty in Imaging – The ‘Screening Radiologist’
By Marty Stempniak | January 5, 2021
Imaging-based screening for diseases has become a crucial component of medicine in the 21st century and yet, radiologists have little say in the decision-making process. Maybe it’s time for a new subspecialty in the profession.
That’s the argument from two experts in the field, who made their case Friday in the January issue of JACR. Oftentimes, it’s primary care physicians and epidemiologists quarterbacking imaging care, with radiologists lacking expertise in the latter, alongside concerns that the profession may be biased toward ordering more exams.
Hannah Milch and Linda Haramati—both MDs, with UCLA and the Albert Einstein College of Medicine, respectively—advocate for a new expertise in their field—the “screening radiologist.” Such an addition, they believe, could help to “close the educational gap, untangle advocacy from science, and enable more effective radiology leadership in screening.”
“Creating a dedicated fellowship in imaging-based screening would create a new generation of radiologists with mastery of screening goals, risks and biases,” Milch and Haramati wrote Jan. 4. “These screening radiologists would be well-positioned to affect decision-making in imaging-based screening by combining daily experience in image interpretation with an appropriate perspective and understanding of the value of screening.”
To further their case, the authors propose creating a dedicated fellowship, building upon the basic education in screening science that docs already receive. A potential curriculum for this new area of expertise could include collaboration with primary care and public health training programs, Milch and Haramati suggested. And beyond that, coursework would explore everything from health sciences to epidemiology, radiation biology, artificial intelligence, and quality assurance.
They suggest a possible one- or two-year fellowship for these subspecialists, depending on if a physician desires a career in private practice or academia. Pursuing such a future could position radiologists perfectly to guide healthcare’s journey toward value, the two writers concluded.
To read more, go to Radiology Digest.
‘Payviders,’ Burnout and COVID-19 are among the threats to a better year for hospitals in 2021
By Tara Bannow | January 2, 2021
Among the many looming threats hospitals will face in 2021 is the rise of so-called payviders—insurers that have bought or partnered with medical groups and other providers.
“The line between providers and payers is getting blurrier and blurrier over the course of time with major payers taking significant positions in the provider space,” said David Morlock, a managing director in Cain Brothers’ Health Systems M&A group.
Such deals exploded in 2020, a trend that will likely continue this year. That doesn’t bode well for hospitals, as these deals usually entail managing patients’ cost using global budgets. That means keeping them out of the most expensive settings—namely, anything involving a hospital.
The 2021 financial outlook for healthcare providers is more difficult to predict than ever, as so much of it depends on the trajectory of an out-of-control pandemic.
While many had expected the crisis that began in earnest in March 2020 to be contained by year’s end, it’s clearly far from over.
“It’ll be more of a two-year event,” said Megan Neuburger, a managing director with Fitch Ratings. Neuburger studies investor-owned hospitals, and she’s not forecasting a complete earnings recovery for them until 2022.
COVID-19 vaccines carry promise, but the rollout will take months and it remains unclear how many Americans will get vaccinated. In the meantime, cases and deaths continue to climb, underscoring the urgency of the undertaking.
Still, experts who follow the industry say they foresee some intriguing trends playing out this year, one involving a specific area of outsourcing. But the hard truths of lower patient revenue and higher expenses aren’t going anywhere in the near term.
To read more, go to Modern Healthcare.
Congress Mitigates Radiologist Pay Cuts, Passing Year-end Spending Bill with $3B Cash Infusion
By Marty Stempniak | December 30, 2020
After months of fierce fighting on Capitol Hill, Congress on Monday, Dec. 21, night approved legislation that will avert millions in Medicare pay cuts for radiologists and other physician specialists. President Donald Trump later signed the 2021 Consolidated Appropriations Act on Dec. 27, which also includes a long-discussed ban on surprise medical bills.
Physician advocates have pushed hard for these change in recent months, writing hundreds of letters to their representatives. Under the final bill, the feds will inject $3 billion into the Medicare Physician Fee Schedule, resulting in across-the-board payment increases “helping all providers during the ongoing COVID-19 pandemic,” according to a summary.
The American College of Radiology helped lead a group of nearly 80 medical societies, representing more than 1 million providers, opposing these specialist pay decreases, set to take effect Jan. 1. ACR said it will continue working with Congress and the administration to “build on these policies,” ensuring that radiologists and other docs can continue serving patients during these “turbulent times.”
“With the economic impact of COVID-19, immediate double-digit Medicare provider cuts would have devastated patient access, communities and provider practices,” Howard Fleishon, MD, chairman of the college’s board of chancellors, said in a statement. “The mitigation in this bill is a far better immediate outcome for radiologists and other providers than we would have otherwise faced Jan. 1.”
Along with the cash infusion, the bill also blocks a new code created by the MPFS for three years to further blunt payment reductions by one-third. Diagnostic radiologists were slated to see a 10% drop to help offset corresponding pay increases for primary care and others who bill for evaluation and management services. With Monday’s change, the rad reduction would fall to about 4% in 2021, with phased-in adjustments to follow, ACR noted.
Imaging groups such as the Radiology Business Management Association have said they supported much-needed reimbursement hikes for PCPs, but not if they came on the backs of other physicians.
“The house of medicine needs to continue to work together in 2021 to create a more balanced approach methodology that can reward primary care providers without penalizing specialists,” RBMA Executive Director Bob Still told Radiology Business Monday.
The legislation would also continue current Alternative Payment Model thresholds for two more years. This, lawmakers noted, would allow more providers to qualify for the 5% APM payment who might not have otherwise, due to statutory increases in threshold amounts.
“Together, these policies will greatly benefit all providers during the pandemic and mitigate at least two-thirds of the cuts to certain providers due to Medicare budget neutrality requirements,” the summary noted.
Finally, the Appropriations Act incorporates a ban on “surprise” medical bills from out-of-network radiologists and other providers, first hinted at earlier this month. ACR called the final version “vastly improved” from previous iterations. Lawmakers have now removed any minimum monetary threshold to start dispute resolutions between radiologists and payers, along with provisions using the median in-network rate as a benchmark for payment.
In addition, the bill has excluded traditionally lower Medicare, Medicaid and workers’ comp pay rates from consideration in the dispute-resolution process, which ACR had cited as a key sticking point.
“This legislation provides needed protections for patients and a broad, first step framework to address provider-payer payment disputes,” Fleishon said. “We are glad that Congress acted on the improvements we offered to make this policy better for patients and providers.”
In even more good news for the provider community, the spending package pushes back implementation of the radiation oncology bundled payment model by another six months. The effort was slated to kick off on July 1 after another recent delay but will now move to Jan. 1, 2022.
To read more, go to Radiology Business.
Hospitals Lose Appeal in Price Transparency Case
By Morgan Haefner | December 29, 2020
An appeals court rejected hospitals’ challenge of a rule that requires hospitals to disclose the rates they negotiate with insurers beginning in 2021.
On Dec. 29, the U.S. Court of Appeals for the District of Columbia Circuit affirmed the district court’s grant of summary judgment to HHS.
Under the final rule issued in November 2019, hospitals are required to disclose the standard charges, including payer-specific negotiated rates, for 300 services beginning Jan. 1. Seventy of the services are stipulated in the final rule. Hospitals can choose the other 230 services they post online. Hospitals that fail to publish the negotiated rates online could be fined up to $300 per day.
The American Hospital Association, Association of American Medical Colleges, Children’s Hospital Association and the Federation of American Hospitals sued HHS in December 2019,
arguing the department lacks statutory authority to require public disclosure of individually negotiated rates between commercial insurers and hospitals. HHS argued its definition of standard charges is permissible under a 2010 law enacted to lower the cost of healthcare coverage.
Both sides filed motions for summary judgment, and Judge Carl Nichols with the U.S. District Court for the District of Columbia granted HHS’ motion and denied the hospital groups’ motion on June 23.
The AHA announced June 27 that it was appealing the decision. On appeal, the trade groups argued that CMS unlawfully expanded the definition of “standard charges” that hospitals must disclose under a provision in the ACA to include negotiated rates.
In response to the appeals court’s Dec. 29 decision, the American Hospital Association said it continues to “believe that the disclosure of privately negotiated rates does nothing to help patients understand what they will actually pay for treatment and will create widespread confusion for them.”
The AHA said it has urged the incoming Biden administration to review the rule. The association added that it is reviewing the appeals court’s decision to determine next steps.
To read more, go to Becker’s Hospital Review.