The Reading Room

Our latest update on all things imaging

How Medicare's final rules affect imaging in 2019

by Erin Lane, Catherine Kosse, and Ty Aderhold November 12, 2018

Last week, CMS released final rules governing hospital outpatient facility and provider payments  for calendar year (CY) 2019. The rules outline major payment and regulatory updates for radiology, including changes to site-neutral payments and clinical decision support policies.

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How a new study on inappropriate imaging orders should inform your strategy to curb unnecessary testing

by Matt Morrill and Ty Aderhold November 6, 2018

One billion dollars per year—that's how much one study estimates is spent on neuroimaging for headaches in the United States, an exam that is considered low value by Choosing Wisely. Considering that imaging for headache is just one of many Choosing Wisely targets related to imaging, it's clear that reducing unnecessary imaging could significantly affect overall health care spending. However, although the Choosing Wisely campaign launched over six years ago to help reduce unnecessary, low-value medical services, studies have found it's had only limited impact on imaging utilization to date.

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Scrutiny over hospital imaging prices continues: How you should respond to UHC's new policy

by Lea Halim, Matt Morrill, and Catherine Kosse October 23, 2018

UnitedHealthcare (UHC)*, the ­­­­­largest commercial insurance company in the United States, announced a new site-of-care policy for MR and CT procedures conducted in hospital outpatient departments (HOPD). Effective January 1, 2019, the payer will conduct site-of-care reviews for these exams during the prior authorization process. UHC explained this policy furthers their commitment to the Triple Aim of reducing health care prices, improving services, and generating quality outcomes.

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Lung cancer screening works. But how can we increase compliance?

by Matt Morrill and Ty Aderhold October 16, 2018

Lung cancer screening has a significant impact on mortality rates for high-risk individuals, according to the results of a large randomized trial, NELSON, presented at the World Conference on Lung Cancer. The 10-year study found that low-dose CT screening decreased lung cancer mortality by as much as 61% in at-risk women, with a smaller—yet still significant—decrease of 26% for high-risk men.

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We asked, you answered: Imaging leaders' top priorities

by Matt Morrill and Catherine Kosse September 25, 2018

Each year, we survey our membership of imaging leaders and private radiology groups to identify top-of-mind issues to guide our research. This year, over 85 organizations from standalone hospitals, multi-hospital health systems, and independent physician groups provided feedback on six potential research topics. Below are the overall results and the top three takeaways on imaging leaders' priorities.

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How radiology will fare under 2019 Medicare proposals

by Erin Lane, Ty Aderhold, and Catherine Kosse September 11, 2018

This July, CMS released proposed rules governing hospital outpatient facility and provider payments for calendar year (CY) 2019. Included in the rules are payment and regulatory updates important for imaging program leaders to understand as they consider their outlook for 2019 and beyond.

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What imaging leaders should know about changing stroke guidelines

by Matt Morrill and Ty Aderhold August 28, 2018

This past January, the American Heart Association and American Stroke Association expanded the window for which clot removal was an option for ischemic stroke patients based on the results of two major clinical trials: DAWN and DEFUSE 3.

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CMS proposes to expand site-neutral payments. Here's how that affects imaging

by Erin Lane, Catherine Kosse, and Ty Aderhold August 6, 2018

In 2017, CMS implemented a site-neutral payment provision to reduce payment discrepancies between services performed at hospital outpatient departments (HOPDs) and provider-based sites, e.g. physician offices and freestanding clinics. The policy mandates that newer off-campus HOPDs receive reimbursement at a site-specific Medicare Physician Fee Schedule (MPFS) rate. Currently, this rate equals 40% of the hospital rate.

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