Temporal and Patient Variations Potentially Impacting New Payment Models.

PURPOSE: To evaluate the impact of an array of nongeographic patient and within-year temporal factors on variation in Medicare imaging utilization. METHODS: Using the CMS Chronic Conditions Data Warehouse, we identified imaging events nationally per 1,000 Medicare beneficiaries from 2008 through 2014 on a quarterly basis. We also stratified imaging utilization by a variety of clinical and sociodemographic patient factors. Data were summarized descriptively. RESULTS: On a quarterly basis from 2008 through 2014, mean and median imaging utilization were highest in the second quarter (878 and 885 imaging events per 1,000 beneficiaries, respectively) and lowest in the fourth quarter (844 and 846, respectively) of each year. Imaging events per 1,000 beneficiaries increased progressively with increasing patient comorbidities (0 conditions, 511 events; 1-3 conditions, 2,033 events; 4-5 conditions, 3,188 events; 6+ conditions, 5,774 events). Imaging utilization was also higher in dual Medicaid eligibility beneficiaries than in others (3,855 versus 3,200 events) and in those eligible for Medicare owing to end-stage renal disease versus age or disability (7,876 versus 3,225 and 3,501, respectively). Imaging utilization showed additional variation with beneficiary age, gender, and ethnic group. CONCLUSIONS: In the Medicare population, the utilization of medical imaging varies greatly in association with a variety of patient and within-year temporal factors that have previously received little attention. As radiologists embark on risk-bearing contracts, the timing and length of such arrangements should be carefully considered, as well as specific features of the patient population attributed to their practices.

Report of the ACR's Economics Committee on Value-Based Payment Models.

A major outcome of the current health care reform process is the move away from unrestricted fee-for-service payment models toward those that are based on the delivery of better patient value and outcomes. The authors' purpose, therefore, is to critically evaluate and define those components of the overall imaging enterprise that deliver meaningful value to both patients and referrers and to determine how these components might be measured and quantified. These metrics might then be used to lobby providers and payers for sustainable payment solutions for radiologists and radiology services. The authors evaluated radiology operations and services using the framework of the imaging value chain, which divides radiology service into a number of discrete value-added activities, which ultimately deliver the primary product, most often the actionable report for diagnostic imaging or an effective outcome for interventional radiology. These value activities include scheduling and imaging appropriateness and stewardship, patient preparation, protocol design, modality operations, reporting, report communication, and clinical follow-up (eg, mammography reminder letters). Two further categories are hospital or health care organization citizenship and examination outcome. Each is discussed in turn, with specific activities highlighted.

The ICD-10 system: a gift that keeps on taking.

The Protecting Access to Medicare Act of 2014 was signed into law on April Fool's Day. Indeed, 2014 saw unprecedented enthusiasm for the possibility of a permanent solution to the sustainable growth rate formula. Congress failed to come together on methods to pay for that fix. Instead, Congress provided another temporary patch on April 1. As part of that law, International Classification of Diseases-10 (ICD-10) adoption was pushed back by at least 1 year until, at the earliest, October 1, 2015. While many physicians support the delay in ICD-10 implementation, there are those that disagree.

Modified stent-supported coil embolization for treatment of a splenic artery pseudoaneurysm.

A patient presented 2 weeks after distal pancreatectomy and splenectomy with increased bloody output from his surgical drain. Catheter angiography found an enlarging splenic artery stump pseudoaneurysm. During the procedure, there was concern that nontarget embolization may occur, given the short splenic artery remnant. Pseudoaneurysm thrombosis was subsequently achieved using a variation of stent-supported coil embolization. At 3-month follow-up, the patient had no recurrent bleeding from the surgical site. Although this technique has been described in the treatment of neurovascular and renal artery aneurysms, it is applicable to, and readily adapted for, use in visceral arterial procedures.