The Reading Room

Our latest update on all things imaging

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The ACR's top concerns with the 2016 MPFS final rule

by Solomon Banjo January 11, 2016

As my colleague Erin Lane noted in her analysis of the 2016 MPFS final rule, CMS’s changes to reimbursement for this year left imaging largely unaffected. This was welcomed news for providers accustomed to the sharp cuts of recent years.

However, aspects of the CY 2016 final rule related to clinical decision support (CDS) and lung cancer screening have raised concerns among radiology programs. The American College of Radiology (ACR) sent an 18-page letter to CMS last week commenting on these concerns. Here are the four big issues the ACR believes CMS should address in the future.

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7 things imaging leaders need to know about the MPFS final rule

by Erin Lane November 9, 2015

This blog has been updated to reflect the correction in Medicare Lung Cancer Screening RVUs and reimbursement.

Last Friday, October 30, CMS released its final rule for the calendar year (CY) 2016 Medicare Physician Fee Schedule (MPFS), which governs payment policy for independent physician practices, professional payments, and select other health care services.

This year’s rule is somewhat unique in that CMS needed to incorporate elements of newly passed legislation, including the 2014 Protecting Access to Medicare Act (PAMA), particularly relevant to imaging, and the recent 2015 Medicare Access and CHIP Reauthorization Act (MACRA), which permanently repealed the sustainable growth rate (SGR) formula.

We’ve analyzed the final rule and identified the seven key takeaways imaging leaders need to know.

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In case you missed it: Why patient price sensitivity is really an access issue

by Sarah Hostetter June 1, 2015

Our colleague, Rivka Friedman, recently wrote about her experience at an urgent care center, which led her to the realization that price and access issues in health care are really one in the same.

Medical groups and radiology practices alike are used to thinking about access in terms of proximity and appointment availability, but affordability is increasingly a barrier for patients trying to access care.

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Preparing for CDS: Help physicians make better decisions

by Solomon Banjo March 30, 2015

The Daily Briefing recently covered a Medscape Medical News article discussing the challenge of differentiating between "careful" and "defensive" medicine. This challenge is most acutely felt in the ED where doctors often don’t have relationships with patients and therefore lack the clinical information necessary for optimal care.

According to the U.S. Congress of Technology Assessment, "defensive medicine" is defined as physicians ordering tests, procedures, or visits, or avoiding high-risk patients or procedures "primarily (but not necessarily solely) to reduce their exposure to malpractice liability.” Unsurprisingly, defensive medicine is expensive and has contributed significantly to the rise in health care spending—but experts say it’s hard to draw a line between being appropriately cautious and overly aggressive.

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In case you missed it: New evidence of head CT scan overuse in the ED

Michael Koppenheffer March 9, 2015

The nation’s emergency rooms have not been consistently “choosing wisely” when it comes to CT scans of the head, according to the Physician Executive Council's latest analysis of Crimson data.

For several common conditions that lead patients to visit the emergency room—headache, syncope (fainting), or minor head trauma—more than four out of five head CT scans performed in 2013 didn’t meet specialty society recommendations for appropriate use. In other words, most of these scans—which are costly—were administered even though patients didn’t need them, the results didn’t inform the course of care, and each scan exposed the patient to radiation unnecessarily.

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Poll results: Should radiologists talk to patients?

by Ben Lauing January 20, 2015

In my blog post last month, I discussed the pros and cons of having radiologists consult directly with patients. I also posed a question: do yours?

77 people responded to my quick poll, from a wide array of institutions. Keep reading to find out what they said.

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Why you should think twice about the Medicare Imaging Demonstration

by Erin Lane January 13, 2015

Recently there has been a lot of buzz about the effectiveness of using clinical decision support (CDS) to promote appropriate ordering of advanced imaging exams—especially since RAND released the results of the Medicare Imaging Demonstration (MID) late last year. The demonstration was a CDS pilot program designed by CMS—and the results weren’t encouraging.

But we need to understand more about the study before we jump to conclusions based on what’s been the news. Significant flaws in the design and limitations in methodology impact how we should interpret these results.

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Who orders the most imaging?

by Erin Lane December 22, 2014

A recent study published in JAMA Internal Medicine by the ACR’s Neiman Health Policy Institute examines the diagnostic imaging ordering patterns of primary care physicians and non-physician primary care providers, such as nurse practitioners and physician assistants (sometimes referred to as advanced practitioners or APs).

Examining a sample of Medicare claims from 2010-2011, the authors found that APs ordered imaging for 2.8% episodes of care compared to physicians’ 1.9%, controlling for geographic variation and patient demographics. With the well-known concern about a shortage of primary care physicians across the country, many health systems are turning to APs to expand patient access. It is worth noting that this data is a few years old, and with recent increased attention on appropriate utilization this gap may have narrowed since 2011. Regardless, discrepancy in ordering patterns brings up some legitimate questions about patient safety and cost of care.

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