Showing papers by "Richard Duszak published in 2023"

Comparison of Lung Cancer Screening Eligibility and Use between Commercial, Medicare, and Medicare Advantage Enrollees.

Abstract: Lung cancer screening does not require patient cost-sharing for insured people in the U.S. Little is known about whether other factors associated with patient selection into different insurance plans affect screening rates. We examined screening rates for enrollees in commercial, Medicare Fee-for-Service (FFS), and Medicare Advantage plans.County-level smoking rates from the 2017 County Health Rankings were used to estimate the number of enrollees eligible for lung cancer screening in two large retrospective claims databases covering: a 5% national sample of Medicare FFS enrollees; and 100% sample of enrollees associated with large commercial and Medicare Advantage carriers. Screening rates were estimated using observed claims, stratified by payer, before aggregation into national estimates by payer and demographics. Chi-square tests were used to examine differences in screening rates between payers.There were 1,077,142 enrollees estimated to be eligible for screening. The overall estimated screening rate for enrollees by payer was 1.75% for commercial plans, 3.37% for Medicare FFS, and 4.56% for Medicare Advantage plans. Screening rates were estimated to be lowest among females (1.55%-4.02%), those aged 75-77 years (0.63%-2.87%), those residing in rural areas (1.88%-3.56%), and those in the West (1.16%-3.65%). Among Medicare FFS enrollees, screening rates by race/ethnicity were non-Hispanic White (3.71%), non-Hispanic Black (2.17%) and Other (1.68%).Considerable variation exists in lung cancer screening between different payers and across patient characteristics. Efforts targeting historically vulnerable populations could present opportunities to increase screening.

Use and Cost of Skin Biopsy Procedures in the Medicare Part B Fee-for-Service Population, 2017 to 2020

Abstract: The Center for Medicare and Medicaid Services noted skin biopsies have high expenditures and changed biopsy billing codes in 2018 to better align procedure type and associated billings. We examined associations between billing code updates and skin biopsy utilization and reimbursement across provider specialties. While dermatologists perform most skin biopsies, the proportion of skin biopsies performed by dermatologists has continuously decreased, but the proportion of skin biopsies performed by nonphysician clinicians has increased from 2017–2020. After the code update, the non-facility national payment amount decreased for first tangential biopsy but increased for first punch, first incisional, additional tangential, additional punch and additional incisional biopsy compared to the corresponding amount for first and additional biopsy before the code update. The allowable charges and Medicare payment per skin biopsy increased across provider specialties but has increased the most for primary care physicians from 2018–2020.

Are Academic Emergency Radiologists Systematically Disadvantaged Compared with Diagnostic Radiology Subspecialty Counterparts When it Comes to Promotion?

Abstract: To assess academic rank differences between academic emergency vs. other subspecialty diagnostic radiologists.Academic radiology departments likely containing emergency radiology divisions were identified by inclusively merging three lists: Doximity's top 20 radiology programs, the top 20 NIH ranked radiology departments, and all departments offering emergency radiology fellowships. Within departments, emergency radiologists were identified via website review. Each was then career length- and gender-matched to a same-institutional non-emergency diagnostic radiologist (non-ER).Eleven of 36 institutions had no emergency radiologists or insufficient information for analysis. Among 283 emergency radiology faculty from 25 institutions, 112 career length- and gender-matched pairs were included. Average career length was 16 years and 23% were female. Mean h-index for emergency radiologists vs. non-ER was 3.96±5.60 and 12.81±13.55, respectively (p<0.0001). Non-ER were twice as likely as emergency radiologists (0.21 vs. 0.1) of being an associate professor at h-index<5. Men had nearly 3 times the odds of advanced rank compared to women (OR=2.91; [1.02-8.26]; p=0.045). Radiologists with at least one additional degree had nearly 3 times the odds of advancing rank (OR=2.75; [1.02-7.40]; p=0.045). Each additional year of practice increased the odds of advancing rank by 14% (OR=1.14; [1.08-1.21]; p<0.001) CONCLUSION: Academic emergency radiologists are less likely to achieve advanced rank compared to career length- and gender-matched non-ER, and this persists even after adjusting for h-index, suggesting academic emergency radiologists are disadvantaged in current promotions systems. Longer-term implications for staffing and pipeline development merit further attention as do parallels to other non-standard subspecialties like community radiology.