Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

https://www.medpagetoday.com/upload/2011/4/4/Clin%20Infect%20Dis.-2002-O'Grady-1281-307.pdf

Guidelines for the Prevention of Intravascular Catheter-related Infections

https://www.medpagetoday.com/upload/2008/3/6/CRC.pdf

Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

Naomi P. O'Grady, M.D., Mary Alexander, R.N. Lillian A. Burns, M.T., M.P.H., C.I.C. E. Patchen Dellinger, M.D. Jeffery Garland, M.D., S.M. Stephen O. Heard, M.D. Pamela A. Lipsett, M.D. Henry Masur, M.D. Leonard A. Mermel, D.O., Sc.M. Michele L. Pearson, M.D. Issam I. Raad, M.D. Adrienne Randolph, M.D., M.Sc. Mark E. Rupp, M.D. Sanjay Saint, M.D., M.P.H. and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

/pdf/guidelines-for-the-prevention-of-intravascular-catheter-4xarsoczlz.pdf

Guidelines for the prevention of intravascular catheter-related infections, 2011

Cost Effectiveness in Health and Medicine.

Purpose To characterize and compare the performance of radiologists in Medicare's new Physician Compare Initiative with that of other provider groups. Methods CMS Physician Compare data were obtained for all 900,334 health care providers (including 30,614 radiologists) enrolled in Medicare in early 2015. All publicly reported metrics were compared among eight provider categories (radiologists, pathologists, primary care, other medical subspecialists, surgeons, all other physicians, nurse practitioners and physician assistants, and all other nonphysicians). Results Overall radiologist satisfaction of all six Physician Compare Initiative metrics differed significantly from that of nonradiologists (all P ≤ .005): acceptance of Medicare-approved amount as payment in full, 75.8% versus 85.0%; Electronic Prescribing, 11.2% versus 25.1%; Physician Quality Reporting System (PQRS), 60.5% versus 39.4%; electronic health record participation, 15.8% versus 25.4%; receipt of the PQRS Maintenance of Certification Program Incentive, 4.7% versus 0.3%; and Million Hearts initiative participation, 0.007% versus 0.041%. Among provider categories, radiologists and pathologists demonstrated the highest and second-highest performance levels, respectively, for the two metrics (PQRS and MOC) with specialty-specific designs, but they ranked between fifth and eighth in all remaining non–specialty-specific metrics. Conclusions The performance of radiologists and pathologists in Medicare's Physician Compare Initiative may relate to the extent to which metrics are tailored to the distinct aspects of their practices as diagnostic information specialists. If more physician participation in these programs is desired, more meaningful specialty-specific (rather than generic) metrics are encouraged.

How Do Publicly Reported Medicare Quality Metrics for Radiologists Compare With Those of Other Specialty Groups

Purpose The aim of this study was to assess the changing use of emergency department (ED) cervical spine imaging in the Medicare population. Methods Using national aggregate Medicare claims data from 1994 through 2012, all cervical spine radiographic, CT, and MR examinations performed in the ED setting were identified. Shifts in modalities and providers and changes in utilization rates were studied. Results Between 1994 and 2004, ED cervical spine radiography volumes in the Medicare fee-for-service population increased from 203,645 to 306,442 (+50.5%) and then declined to 152,755 (−50.2%) by 2012. CT volumes increased every year, overall by +8,864% from 1994 through 2012 (from 6,360 to 570,121). MR grew by +1,381%, but volumes overall were small (from 944 to 13,979). With these changes, CT overtook radiography as the dominant ED cervical spine imaging modality in 2007. Per 1,000 Medicare beneficiaries, utilization rates of radiography, CT, and MR changed by −27%, +8,682%, and +1,351% from 1994 through 2012 (from 6.3 to 4.6, from 0.2 to 17.3, and from 0.0 to 0.4). For all years, compared with other specialists, radiologists remained by far the dominant providers of radiography, CT, and MR (+91.7%, +93.4%, and +96.0% in 1994 and +96.9%, +99.3%, and +99.0% in 2012) in the ED setting. Conclusions Between 1994 and 2012, the overall utilization rate of cervical spine imaging for Medicare beneficiaries in the ED setting more than tripled. With a small decline in radiography (–27%) but a dramatic increase in CT (+8,864%), CT is now by far the dominant modality for imaging the cervical spine in the ED. Radiologists remain overwhelmingly the dominant providers of these interpretive services.

Changing Utilization Patterns of Cervical Spine Imaging in the Emergency Department: Perspectives From Two Decades of National Medicare Claims

Purpose As federal legislation increasingly influences health care delivery, the impact of election funding has grown. We aimed to characterize US radiologist federal political contributions over recent years. Methods After obtaining 2003 to 2016 finance data from the Federal Election Commission (FEC), we extracted contribution data for all self-identified radiologists. Contributions were classified by recipient group and FEC-designated political party and then analyzed temporally and geographically, in aggregate, and by individual radiologist. Results Between 2003 and 2016, the FEC reported 35,408,584 political contributions. Of these, 36,474 (totaling $16,255,099) were from 7,515 unique self-identified radiologists. Total annual radiologist contributions ranged from $480,565 in 2005 to $1,867,120 in 2012. On average, 1,697 radiologists made political contributions each year (range 903 in 2005 to 2,496 in 2016). On average, contributing radiologists gave $2,163 ± $4,053 (range $10-$121,836) over this time, but amounts varied considerably by state (range $865 in Utah to $4,325 in Arkansas). Of all radiologist dollars, 76.3% were nonpartisan, with only 14.8% to Republicans, 8.5% to Democrats, and 0.4% to others. Most radiologist dollars went to political action committees (PACs) rather than candidates (74.6% versus 25.4%). Those PAC dollars were overwhelmingly (92.5%) directed to the Radiology Political Action Committee (RADPAC), which saw self-identified radiologist contributions grow from $351,251 in 2003 to $1,113,966 in 2016. Conclusion Radiologist federal political contributions have increased over 3-fold in recent years. That growth overwhelmingly represents contributions to RADPAC. Despite national political polarization, the overwhelming majority of radiologist political contributions are specialty-focused and nonpartisan.

Characteristics of Federal Political Contributions of Self-Identified Radiologists Across the United States.

Purpose Commonly called "double scans" by the media, combined pre- and postcontrast thoracic and abdominal CT examinations have been the focus of recent CMS policy initiatives. The aim of this study was to examine trends in the relative utilization of double-scan CT before and after 2006 legislation mandating relevant Medicare reporting initiatives. Methods Medicare Physician Supplier Procedure Summary Master Files from 2001 through 2012 were used to identify claims for thoracic and abdominal CT examinations. Double-scan rates by billing physician specialty and place of service were analyzed over time. Rates of double-scan CT between radiologists and nonradiologists were compared using t tests. Results From 2001 to 2006, double-scan rates for thoracic and abdominal CT examinations declined by 1.7% and 7.5% for radiologists, respectively (from 6.0% to 5.9% and from 22.6% to 20.9%) but increased by 15.8% and 23.6% for nonradiologists (from 5.7% to 6.6% and from 28.8% to 35.6%). From 2006 through 2012, double-scan rates declined by 42.3% and 35.2% (from 5.9% to 3.4% and from 20.9% to 13.5%) for radiologists but only by 31.8% and 8.1% (from 6.6% to 4.5% and from 35.6% to 32.7%) for nonradiologists. Double-scan rates were significantly lower for radiologists than nonradiologists for all years for abdominal CT ( P P Conclusions Reductions in thoracic and abdominal CT double-scan rates followed legislation mandating CMS initiatives designed to reduce costs and radiation. For nonradiologists, double-scan rates were consistently higher and declined more slowly than those for radiologists. Medicare policy initiatives directed toward imaging utilization seem to influence behavior differently for radiologists compared with nonradiologists.

Richard Duszak

Papers

How Do Publicly Reported Medicare Quality Metrics for Radiologists Compare With Those of Other Specialty Groups

Changing Utilization Patterns of Cervical Spine Imaging in the Emergency Department: Perspectives From Two Decades of National Medicare Claims

Characteristics of Federal Political Contributions of Self-Identified Radiologists Across the United States.

Medicare Policy Initiatives and the Relative Utilization of “Double-Scan” CT

Deauthorization: the insidious new payer trick.