Zotec Partners Radiology Digest | Nov 20, 2020

November 20, 2020

Radiology Digest: News from the week of November 20, 2020.

94% of Patients at High Risk for Lung Cancer Failed to Undergo LDCT Screening

By Marty Stempniak | November 18, 2020 | Included in Radiology Digest – November 20, 2020

Out of an estimated population of 8 million at high risk for lung cancer, only 5.7% underwent low-dose CT screening in 2019, according to a new report published Tuesday.

There is also widespread imaging variation in this patient population from one state to the next, with rates as high as 18.5% in Massachusetts, down to 1% in Nevada. The numbers highlight the daunting task radiologists and other providers must tackle to begin addressing this “silent killer,” according to the American Lung Association’s third annual report on the disease.

“The ‘State of Lung Cancer’ highlights that too many people are being left behind when it comes to making progress against lung cancer,” ALA President and Chief Executive Officer Harold Wimmer said in a statement. “To turn the tide against this deadly disease, Congress needs to protect and expand access to quality and affordable healthcare that helps more people who may be at high risk get screened and ensures that those diagnosed have access to treatment.”

For the report, authors used data from North American Association of Central Cancer Registries and the American College of Radiology’s National Data Registry, among other sources. This year’s version was the first to also explore the lung cancer burden among racial and ethnic minority groups at both national and state levels.

To read more, go to Radiology Business.

Imaging Experts Slam Humana for ‘Ill-informed and Wrong’ Decision to Deny Coverage for PET/CT Exams

By Matt O’Connor | November 18, 2020 | Included in Radiology Digest – November 20, 2020

Two nuclear medicine experts railed against Humana for its recent decision to refuse coverage for PET/CT exams, calling the move “nonsense” in an editorial published recently.

The critique comes two weeks after the American Society of Nuclear Cardiology said it “adamantly disagrees” with the insurance giant’s coverage determination; a sentiment echoed last week by the Society of Nuclear Medicine and Molecular Imaging.

Authors Johannes Czernin, MD, of UCLA’s School of Medicine, and Andrei Iagaru, MD, of Stanford University’s School of Medicine, both sharply questioned the anonymous authors of the “noncoverage” document, indicating they are either unaware of current imaging best practices or are willfully deceiving patients.

“The nonsense of all these decisions is blatantly apparent,” the pair argued on Nov. 13 in the Journal of Nuclear Medicine.

“It is also apparent that the anonymous authors had extremely limited insights into standard-of-care and state-of-the-art diagnostic imaging, cancer care, and care of cardiovascular patients,” Czernin and Iagaru added. “The alternative is that the document’s goal is to mislead the public in an attempt to block access to technology that is the standard of care in 2020.”

To read more, go to Health Imaging.

41% of Radiologists Separated From at Least One Practice Recently, Underscoring Specialty’s Growing Mobility

By Marty Stempniak | November 16, 2020 | Included in Radiology Digest – November 20, 2020

More than 41% of radiologists separated from at least one practice over a recent four-year period, underscoring the specialty’s increasingly mobile nature, experts wrote Friday.

In a recent analysis of Medicare data, researchers found that the annual radiologist-practice separation rate increased by 38.4%, a change that persisted across different office sizes, locations, types and specialties.

“With over 40% of radiologists separating from at least one practice in recent years, the U.S. radiologist workforce is highly and increasingly mobile,” Stefan Santavicca, with the Georgia Institute of Technology’s School of Economics, and colleagues wrote Nov. 13 in JACR. “Because reasons for separation cannot be assessed using administrative data, further attention is warranted given the manifold financial, operational and patient care implications,” they added.

For the study, the authors analyzed data from Medicare Physician Compare and other sources to assess trends in practice separation. Examples of this might include termination, resignation, timely retirement, or practice acquisition.

All told, Santavicca et al. identified 25,228 unique radiologists, associated with 4,381 group practices. Among the study group, 41.1% of physicians separated from a group practice between 2014 and 2018. Separation rates varied widely from state to state, with Utah logging the highest number at 57.4% versus Virginia’s 26.3%. Same for subspecialists who logged rates as high as 43% in breast imaging compared to 33.5% for cardiothoracic radiologists.

To read more, go to Radiology Business.

CMS’ Move to Reimburse Doctors for Imaging Algorithm Use is Encouraging. But is it Enough?

By Matt O’Connor | November 13, 2020 | Included in Radiology Digest – November 20, 2020

Just last month, the U.S. Centers for Medicare and Medicaid Services said it would start reimbursing for the use of two imaging-based artificial intelligence algorithms. And while many hope the move drives wider adoption, some want CMS to do more.

San Francisco startup Viz.ai and Digital Diagnostics both received U.S. Food and Drug Administration approval for their tools ContaCT and IDx-DR, respectively. The latter analyzes retinal photos to diagnose diabetic retinopathy, while the former alerts neurosurgeons when an algorithm spots a blood clot on a patients’ CT scan.

CMS determined hospitals are eligible for up to $1,040 for using ContaCT in certain patients, which has already prompted more hospitals to sign up for the tool, WIRED reported on Nov. 10.

But CMS is also proposing doctors get paid much less for using IDx, around $20, Executive Chairman of Digital Diagnostics Michael Abramoff told the tech news outlet. He, along with others including the American Academy of Ophthalmology, have asked CMS to boost that price to make its platform “economically attractive.”

Retina specialist and NYU Langone Health faculty member Ravi Parikh co-authored a paper in July that backed up that sentiment, indicating many clinics wouldn’t find the algorithm worthwhile unless reimbursement increased.

“This [artificial intelligence] has to be incentivized to push adoption,” he told WIRED.

Read the entire story here: The US Government Will Pay Doctors to Use These AI Algorithms

Report: Missed Mammograms May Never Be Made Up

By Theresa Pablos | November 13, 2020 | Included in Radiology Digest – November 20, 2020

It may be impossible to make up the thousands of mammograms missed in the first half of 2020 due to the COVID-19 pandemic, according to an analysis on November 4 in Health Services Research. The shortfall could lead to several hundred delayed breast cancer diagnoses at just one commercial insurer alone.

A team led by University of Pennsylvania researchers analyzed claim data from Independence Blue Cross, a private insurer that primarily serves southeastern Pennsylvania. The authors estimated there were 45,500 missed mammograms during the pandemic, compared with a normal year.

In a best-case scenario, it would take more than five months to make up for the thousands of missed mammograms. But in the worst-case scenario, which seems increasingly likely with spiking COVID-19 cases, the queue of missed mammograms will continue to grow.

“In the worst-case scenario, providers would need to resort to prioritizing high-risk patients and delaying low-risk patients’ screenings for a year or more,” wrote the authors, led by Hummy Song, PhD, an assistant professor at the University of Pennsylvania Wharton School.

Song and colleagues pulled deidentified claims and eligibility data from members of Independence Blue Cross, which serves more than 8 million people. They parsed the data of women ages 40 or older who received a mammogram in the first 30 weeks of 2018, 2019, and 2020, then compared mammography rates between March and July of this year with what they would have expected based on pre-pandemic data.

The insurer data clearly showed that mammography use plummeted during the COVID-19 pandemic. The authors estimated there were approximately 45,500 missed diagnostic and screening mammograms just from this one insurer alone.

The decline accounted for a 58% decrease in screening mammography and a 28% decrease in diagnostic mammography compared with what would be expected in a normal year. During week 15, the worst week of the year in early April, almost no screening mammograms at all occurred, and diagnostic mammography plummeted by 74%.

To read more, go to Aunt Minnie.

Radiology Among 74 Medical Groups Pressing Politicians to Protect Providers From ‘Devastating’ Pay Cuts

Marty Stempniak | November 12, 2020 | Included in Radiology Digest – November 20, 2020

Seventy-four medical associations this week implored Congress to enact legislation, providing radiologists and other docs with pay bumps to offset “devastating” Medicare cuts set to take hold on Jan. 1.

Those signing the letter included the Radiology Business Management Association, American College of Radiology, and SNMMI among many others. They’re asking House members to pass the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act,” introduced by physician lawmakers last week.

“This critical legislation recognizes the importance of allowing significant scheduled pay increases to primary care and others who primarily provide [evaluation and management] services to take effect while also avoiding the devastating corresponding cuts for physician and nonphysician providers that will occur because of Medicare’s budget neutrality requirements,” doc groups wrote to Reps. Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind., and others who sponsored the bill, on Nov. 11. “Given the ongoing COVID-19 pandemic, it is more important than ever to halt the implementation of any payment reductions that could inadvertently limit patient access to care as well as further exacerbate the financial instability of healthcare provider practices.”

HR 8702, as it’s called for short, would provide clinicians with temporary additional payments covering the difference between 2020 and 2021 reimbursement for two years. The feds have long planned to significantly boost pay for outpatient E/M care beginning next year. But that requires roughly 10% reductions to others who do not bill for such services, in order to balance the budget.

A recent survey from RBMA found that 50% of radiology practices plan to reduce staffing if the changes move forward. And imaging giant RadNet estimated over the summer that it stands to lose $11 million in 2021 revenue if Congress fails to take action.

“Any Medicare payment cuts can only worsen the financial instability of healthcare provider practices already reeling from the pandemic and limit patient access to potentially lifesaving care,” Howard Fleishon, MD, chairman of the ACR’s board of chancellors, said in a statement issued Thursday.

Others signing the letter included the American Society of Neuroradiology, Society of Interventional Radiology, the American Society for Radiation Oncology and the Association for Quality Imaging.

You can read the letter in its entirety here.

Learn more about what Zotec Partners can do for your radiology practice here.