Another group has weighed on the issue of lung cancer screening, as the American Academy of Chest Physicians (AACP) last week issued guidelines recommending that people with a significant risk of developing lung cancer undergo annual low dose CT scans. It's the latest group to issue screening guidelines based on the results of the National Lung Screening Trial (NLST). While more and more organizations have issued screening guidelines, reimbursement issues remain at play here. Most private insurers and--more importantly--the Centers for Medicare & Medicaid Services, don't cover this type of screening.
If a recent Canadian study about a "culture of isolationism" in radiology is generalizable across the border into the U.S., it could be another sign that the industry may become an increasingly less attractive career choice for young physicians.
Clinical decision support is part of a broader pattern to improve the quality and reporting of imaging procedures, but there has been some resistance to it among radiologists and other physicians. As Keith Dreyer, M.D., vice chairman of radiology informatics at Massachusetts General Hospital said in an interview with Healthcare Informatics last November, "there's a general resistance among all people to change."
But as Dreyer, and others, have pointed out, there also are multiple benefits to imaging CDS.
At least 10 Boston area hospitals treated the more than 170 persons who were injured in last week's bombings, many of them critically wounded. Radiologists were part of the first line team of physicians responding to the emergency.
When President Obama released his 2014 budget last week, one item, in particular, caught the attention of the radiology community: a proposal to close much of the Stark Law loophole. The law prevents self-referrals to facilities for a number of health services--including imaging--for Medicare patients if the referring physician has a financial interest in the facility. But, an in-office ancillary services (IOAS) exception to the law allows physicians to refer to themselves or other physicians in a group practice if the equipment is located in their own offices. Now, the president wants to remove diagnostic imaging, radiation therapy and physical therapy from this exception
A pair of recently published articles look at the radiology industry from two different perspectives.
Last week Sen. Ben Cardin (D-Md.) again introduced legislation (S. 623) that would prevent the Centers for Medicare & Medicaid Services from applying a 25 percent Multiple Procedure Payment Reduction to Medicare reimbursement for interpretation of advanced diagnostic imaging scans performed on the same patient, in the same session. The MPPR of 25 percent on the professional component for CT, MR and ultrasound services is particularly disconcerting for the specialty.
The American Cancer Society endorses virtual colonoscopy as a screening option, and insurance companies like Cigna, UnitedHealthcare and Anthem Blue Cross Blue Shield cover it. Isn't it time for CMS to revisit the issue?
Considering the amount of skepticism that has arisen about the net benefits associated with traditional screening tests like mammography for breast cancer and PSAs for prostate cancer, added evidence about the success of colonoscopy is to be welcomed.