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The mission of the Harvey L. Neiman Health Policy Institute® is to establish foundational evidence for health policy and radiology practice that promotes the effective and efficient use of health care resources and improves patient care.

Health Policy

November 29, 2020

The Neiman Institute COVID-19 Studies

To understand the impact of COVID-19 on radiology in a variety of care-delivery settings, the Harvey L. Neiman Health Policy Institute (HPI®) initiated a series of studies from an integrated healthcare system in New York and community radiology practices, and analyzed data from a national survey of radiology practices. View the infographic to see how COVID-19 affected imaging volumes and radiology practices. View Infographic

Radiologist-Practice Separation: Recent Trends and Characteristics

The purpose of this study is to assess recent trends and characteristics in radiologist-practice separation across the United States. Using the Medicare Physician Compare and Medicare Physician and Other Supplier Public Use File data sets, the researchers linked all radiologists to associated group practices annually between 2014 and 2018 and assessed radiologist-practice separation over a variety of physician and group characteristics. Multivariate logistic regression modeling was used to estimate the likelihood of radiologist-practice separation. Full Article

Stefan Santavicca, MS , Danny R. Hughes, PhD, Howard B. Fleishon, MD, MMM, Frank Lexa, MD, MBA Eric Rubin, MD, Andrew B. Rosenkrantz, MD, MPA, Richard Duszak, MD. 2020. "Radiologist-Practice Separation: Recent Trends and Characteristics," Journal of American College of Radiology (JACR)

Patient-reported financial toxicity in multiple sclerosis: Predictors and association with care non-adherence

Multiple sclerosis (MS) results in considerable financial burdens due to expensive treatment and high rates of disability, which could both impact care non-adherence. Full Article

Gelareh Sadigh, Ruth Carlos, Carolyn Meltzer, Jeffrey M. Switchenko, Neil Lava, Rich Duszak, Danny Hughes, Elizabeth Anne Krupinski. 2020. "Patient-reported financial toxicity in multiple sclerosis: Predictors and association with care non-adherence," Multiple Sclerosis

Associations Over Time Between Paid Medical Malpractice Claims and Imaging Utilization in the United States

The aim of this study was to explore state-level relationships between the incidence and payout amounts for medical malpractice claims and Medicare imaging utilization and spending across the United States. Full Article

Alexander Villalobos, MD, Michal Horný, PhD, Danny R. Hughes, PhD, Richard Duszak, MD. 2020. "Associations Over Time Between Paid Medical Malpractice Claims and Imaging Utilization in the United States," Journal of American College of Radiology (JACR)

National Trends in Oncologic Diagnostic Imaging

This study characterize national trends in oncologic imaging (OI) utilization. This retrospective cross-sectional study used 2004 and 2016 CMS 5% Carrier Claims Research Identifiable Files. Radiologist-performed, primary noninvasive diagnostic imaging examinations were identified from billed Current Procedural Terminology codes; CT, MRI, and PET/CT examinations were categorized as “advanced” imaging. OI examinations were identified from imaging claims’ primary International Classification of Diseases-9 and International Classification of Diseases-10 codes. Imaging services were stratified by academic practice status and place of service. State-level correlations of oncologic advanced imaging utilization (examinations per 1,000 beneficiaries) with cancer prevalence and radiologist supply were assessed by Spearman correlation coefficient.OI usage varied between practice settings. Although the percentage of advanced OI done in academic settings nearly doubled from 2004 to 2016, the majority remained in nonacademic practices. Full Article

Andrew B. Rosenkrantz, MD, Laura Chaves Cerdas, MS, Danny R. Hughes, PhD, Michael P. Recht, MD, Sharyl J. Nass, PhD, Hedvig Hricak, MD, PhD. 2020. "National Trends in Oncologic Diagnostic Imaging," Journal of American College of Radiology (JACR): 1116 - 1122.

Characteristics of Coronavirus Disease 2019 (COVID-19) Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines. The authors used imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, and mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Full Article

Richard Duszak Jr, MD, Jeff Maze, MB, Candice Sessa, MS, Howard B. Fleishon, MD, Lauren P. Golding, MD, Gregory N. Nicola, MD, Danny R. Hughes, Ph. 2020. "Characteristics of Coronavirus Disease 2019 (COVID-19) Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work," Journal of American College of Radiology (JACR)

Digital Breast Tomosynthesis Implementation: Considerations for Emerging Breast Cancer Screening Bundled Payment Models

Bundled payments have been touted as mechanisms to optimize quality and costs. A recent feasibility study evaluating bundled payments for screening mammography episodes predated widespread adoption of digital breast tomosynthesis (DBT). We explore a similar model reflecting emerging acceptance of DBT in breast cancer screening. Methods: Using 4-year data for 59,094 screening episodes from two large facilities within a large academic health system, we utilized published methodology to calibrate Medicare national allowable reference prices for women undergoing screening mammography before and after practice-wide implementation of DBT. Full Article

Margaret M. Fleming, MD, MS, Danny R. Hughes, PhD, Lauren P. Golding, MD, Geraldine B. McGinty, MD, MBA, Dan MacFarlane, BS, CPA, Richard Duszak Jr, MD. 2019. "Digital Breast Tomosynthesis Implementation: Considerations for Emerging Breast Cancer Screening Bundled Payment Models," Journal of American College of Radiology (JACR), 16(7)

Survey Measures Burnout Among Neurointerventionalists

The toll of burnout on healthcare is significant and associated with physician depression and medical errors. The objective of this study it to assess the prevalence and risk factors for burnout among neurointerventionalists. Full Article

Kyle M Fargen, Adam S Arthur, Thabele Leslie-Mazwi, Rebecca M Garner, Carol A Aschenbrenner, Stacey Q Wolfe, Sameer A Ansari, Guilherme Dabus, Alejandro Spiotta, Maxim Mokin, Italo Linfante, J Mocco, Joshua A Hirsch. 2019. "Survey Measures Burnout Among Neurointerventionalists," Journal of NeuroInterventional Surgery

Radiologist Professional Payments After Mitigation of CMS’s Multiple-Procedure Payment Reduction Initiatives

The aim of this study was to assess the potential impact of ACR evidence-based advocacy on radiologist professional reimbursement from individual-provider CMS multiple-procedure payment reduction (MPPR) initiatives. Full Article

Sadigh, G., Hughes, D.R., Wang, W., Allen, B., McGinty, G., Silva, E., Duszak, R. 2017. "Radiologist Professional Payments After Mitigation of CMS’s Multiple-Procedure Payment Reduction Initiatives," Journal of the American College of Radiology

MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology

This paper suggests that patient-focused physician models provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, and may foster greater radiologist participation in APMs under MACRA. Full Article

Rosenkrantz, A.B., Nicola G.N., Allen, B., Hughes, D.R., and Hirsch, J.A. 2017. "MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology," Journal of the American College of Radiology