Reimbursement, imaging appropriateness among top radiology issues in 2013

While the medical imaging industry certainly had its share of stories in 2013 that were intriguing--such as February's news that radiologists struggled to identify an image of a gorilla purposely dropped into a CT lung scan--four trends stood out as being vital to imaging professionals, as a whole, throughout the course of the year: imaging appropriateness and the use of clinical decision support; reimbursement; CT and its role in lung cancer screening; and the continuing clinical benefits of breast tomosynthesis.

As the end of 2013 fast approaches, I'd like to take a moment to review each of those four trends in some detail.

Imaging appropriateness and CDS

The issue of imaging appropriateness continues to take center stage as a way of reducing unnecessary imaging while saving healthcare dollars and ensuring that patients receive quality care by receiving the right scan at the right time--or no scan at all, if one isn't necessary.

For example, imaging continues to be well represented in the Choosing Wisely campaign, which is designed to address the problem of patients receiving unnecessary health treatments. Currently, almost half of the Choosing Wisely recommendations concerning tests and procedures are related to imaging.

There also is more evidence that clinical decision support is becoming an important part of the solution to inappropriate imaging. In October, for instance, two Congressional committees issued a draft version of a policy to replace the sustainable growth rate formula that includes language requiring physicians to consult appropriateness criteria for advanced imaging services for Medicare patients. And just this past week, a bill was introduced to Congress that would direct Medicare to require CDS for advanced medical imaging tests performed.


Another year has passed and yet the specialty continues to experience reimbursement challenges.

Late last month, the Centers for Medicare & Medicaid Services released its final rule for the 2014 Medicare Physician Fee Schedule. According to estimates, the rule will have an overall negative-2 percent impact on radiology services (assuming there is a temporary--or even permanent--fix to the sustainable growth rate formula).

One cut, in particular, was worrisome to breast imagers. In setting relative value unit (RVU) assignments for several new Current Procedural Terminology (CPT) codes for breast biopsy procedures, CMS wants to to reduce physician work values for the new breast biopsy codes by 29 to 54 percent, which would result in significant reimbursement cuts for those procedures. The American College of Radiology is warning that those cuts could reduce women's access to those services by making it more difficult for providers to offer them.

CT lung cancer screening

In a landmark decision this past summer, the United States Prevention Services Task Force (USPSTF) issued a draft recommendation supporting the use of CT lung cancer screening for long term smokers.

This action comes two years after the primary research results from the National Lung Screening Trial were published, which found a 20 percent reduction in deaths from lung cancer among current or former heavy smokers who were screened with low-dose helical computed tomography (CT) versus those screened by chest X-ray. What it means is that, like breast and colorectal cancer, CT lung cancer screening likely will become widely accepted and applied.

A number of private insurance carriers already have starting covering this screening exam, and now that the USPSTF has given CT lung screening a B recommendation (which indicated the test provides a moderate/substantial benefit), the road has been paved for Medicare coverage.

Breast Tomosynthesis

Though no longer a new imaging technique, breast tomosynthesis continued to make headlines this past year with the publication of a number of studies demonstrating its clinical benefits.

For example, at the annual meeting of the Radiological Society of North America in Chicago earlier this month, researchers from the Hospital of the University of Pennsylvania presented a study that found that recall rates with tomosynthesis fell from 10.4 percent to 8.8 percent compared to digital mammography, while cancer detection rates increased significantly.

Tomosynthesis is "the most exciting improvement to mammography that I have seen in my career, even more important than the conversion from film-screen mammography to digital mammography," lead researcher Emily Conant, M.D., said at the meeting. "The coming years will be very exciting, as we see further improvements in this technology."

Do you agree with my list, or were there other stories or trends that captured your attention in 2013? Let me know in the comments section below, or on social media via Facebook, LinkedIn or Twitter. - Mike (@FierceHealthIT)


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