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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

Doctor-leaders favor physician accountability strongly, Obamacare slightly

A modest majority of physicians working in positions of executive leadership, 55 percent, believe there’s “more good than bad” in the Affordable Care Act. 

Assessing the Affordable Care Act

Since the ACA was passed in 2010, straight talk on the law has been hard to come by. However a few of the top stories from the past month have looked at some trends in the post-ACA world.

Ruling out Alzheimer’s correctly and early could save Medicare millions

The latest diagnostic technologies, including imaging advances such as beta-amyloid PET scans of the brain, hold the promise of helping avoid misdiagnoses of Alzheimer’s disease. A new study shows the resulting savings in more appropriate utilization of resources could help Medicare steer clear of needlessly spending anywhere from $9,500 to more than $14,000 per initially misdiagnosed patient per year.

In search of the Holy Grail: Outcomes metrics

It’s no secret that healthcare in the U.S. provides comparatively poor value. That’s not an opinion. It’s a fact, as costs are high relative to outcomes compared to other Western nations. What can the profession of radiology do to help reduce the former while simultaneously improving the latter?

Seeking radiology in the value aisle: Concede nothing on quality, do more with less

As a broad concept, good consumer value isn’t hard to get a handle on. Varying definitions abound, to be sure, but the phrase is widely understood as shorthand for the best you can get for the least you have to spend without sacrificing too much on quality within a given product or service category.

Unexpectedly robust Medicaid enrollment distresses state budgeters

At least 14 of the 30 states that took up the Affordable Care Act’s offer of federal aid to expand Medicaid are now fretting that they will have to make wrenching budgetary choices in two years, when the dollars from Washington start to diminish. 

Patient response to ACA’s cost-free screenings falls flat

The Affordable Care Act mandated that health insurers pick up the full tab for a number of evidence-based, preventive-care procedures. But for two of the top-targeted procedures, mammography and colonoscopy, patients haven’t exactly rushed doctors’ offices to take advantage of the free screening opportunities. 

In the Garden State, a breast density law is costing plenty and raising concerns about returns

A study in New Jersey, one of a growing number of states to mandate that insurers pay for sonograms of breasts deemed dense in screening mammography exams, may provide additional ammo to detractors who warn that such legislation is misplaced and unproductive. 

Competing on price for chest-port insertion, IR trounces surgery: study

When it comes to inserting chest ports for venous access needed for repeated blood draws and drug administrations, interventional radiologists working in IR suites can do the job at far lower cost—yet with no greater rates of infection or complications—than surgeons in the OR. 

‘SCOTUScare’: 10 quotes from the King v. Burwell opinions

This week, the U.S. Supreme Court’s ruling in King v. Burwell—the case that threatened subsidies offered under the Affordable Care Act—dominated the headlines in healthcare.  Let’s take a look at some of the top quotes from the majority and dissenting opinions.

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