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Healthcare Economics & Policy

 

In its fourth annual update on medical overuse, JAMA Internal Medicine names 10 procedures and practices that are ripe for the curtailing. In the category of “overtesting,” the klieg lights fall on four exams—and all are based in imaging.

Anthem’s recent decision to no longer pay for outpatient CT and MR exams performed in hospitals didn’t come from nowhere—and, going forward, the move is not likely to be an outlier among private payers’ business stratagems.

In Harris County, Texas, three outpatient family-medicine affiliates of Baylor College of Medicine have slashed their unnecessary orders of lumbar-spine MRIs—and improved the appropriateness ratings of those they did order—by attending educational sessions and using the American College of Radiology’s R-SCAN program.

Offering first-year medical students an elective introduction to interventional radiology (IR), researchers at the University of Pennsylvania and its Perelman School of Medicine have found considerable receptivity to the learning opportunity and heightened interest in the specialty.

It’s no secret that radiology ranks among the medical specialties with the highest mean markups on list prices. However, a new review of Medicare data on prices listed and payments made shows that, far from being arbitrarily set—as is often assumed if not alleged—many of radiology’s highest prices reflect real-world, case-by-case factors involving heightened risk, greater clinical complexity and increased need for subspecialized expertise.

 

Recent Headlines

Q&A: Fujifilm helps providers prepare for reimbursement reductions and transition to digital radiography

When the Consolidated Appropriations Act of 2016, or Omnibus Bill, was passed late last year, it included text that requires imaging providers to start using DR. 

Radiology subinternships can play key role in radiologist recruitment

If the curricula effectively incorporate hands-on experience with quality instruction and team integration, radiology subinternships can be an effective means of prompting medical students to choose radiology for their final-year clinical elective.  

Chart review tougher than claims analysis in utilization analysis of lumbar MRI

Utilization reviewers seeking to ascertain whether MRI was inappropriately ordered for low-back pain might assume that direct review of patients’ charts would tilt toward patient empathy while aloof analysis of claims data would reflect a higher bar to clear. They would be wrong.

3 insights gleaned as team builds framework for breast-screening bundled payments

Healthcare-economics innovators looking for a model after which to fashion an episodic bundled-payment package for cancer care would do well to consider radiologist-led breast cancer screening.

Gunderman: Beware the advance of the hospitalist

Hospitals cannot function without physicians, but physicians can function without hospitals. Those are plain facts—the latter is demonstrated daily in war-torn parts of the world—and the observation ought to give pause to those looking to quicken the rise of the hospitalist specialty in U.S. healthcare.

Johns Hopkins study challenges efficacy of hormone receptor test for breast cancer patients

Hospitals nationwide are wasting time and money on unnecessary hormone receptor tests for breast cancer patients, according to the results of a Johns Hopkins study.

Daunted by dollars? Many docs self-report rationing MRI

If more than 2,500 physicians responding to a national survey reflect the changing state of clinical decision-making, MRI is frequently getting rationed due to doctors’ concerns about cost. In fact, only drug prescriptions are curtailed more—and not by much. 

Neiman Institute’s Hughes: Post-MACRA, ‘where else can radiology take a leadership role in driving care quality and adding value?’

When it comes to adapting to U.S. healthcare’s transition from volume- to value-based reimbursement, radiology is “leading the charge for non-patient-facing providers in a world that’s geared almost entirely around the direct patient-facing experience.”

RSNA foundation awards a record $4 million to up-and-coming researchers, scholars

By the time 2016 is in the books, RSNA’s Research & Education Foundation will have supported 101 young researchers in 54 academic medical institutions to the tune of $4 million in grants. 

ACR preliminarily pleased with 2017 physician fee schedule

Last Thursday, CMS proposed changes in the Medicare Physician Fee Schedule (MPFS). The American College of Radiology quickly said it would be reviewing the details in the coming weeks and—in advance of that activity as well as of the September 6 comment deadline—noted its overall approval of the proposed rule as released. 

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