Volume declines alone do not paint the full picture of radiology practices’ struggles during the pandemic, with imaging providers also seeing fewer complex cases, according to a new analysis.
Alongside a roughly 57% drop in visits at the peak, Mount Sinai Hospital in New York also saw work relative value units plummet 69% when compared to the pre-COVID baseline. Categories that recorded the greatest average decline in complexity included radiography (14.7%), community hospitals (15.9%) and cardiothoracic imaging (16.2%), researchers detailed Monday in Academic Radiology.
“Reliance on case volume alone underestimates the financial impact of the COVID-19 pandemic as there was a disproportionate loss in high-RVU procedures,” Timothy Carlon, MD, MBA, with the Department of Diagnostic, Molecular, and Interventional Radiology at Mount Sinai, and colleagues wrote Jan. 18. “However, increased complexity of outpatient procedures has stabilized overall losses during the recovery.”
For the study, Carlon and colleagues analyzed billing information from the first 33 weeks of 2020 across academic and community hospitals and standalone outpatient imaging centers. Researchers broke the data down into three separate periods: pre-surge (weeks 1-9), surge (10-19), and recovery (20-33).
They found that the average wRVU per study fell from 1.13 before the surge down to 1.03 at the peak, rebounding back up to 1.19 in the after-phase. Certain categories have actually seen complexity gains during that time, including breast imaging (6.5%), interventional procedures (5.5%) and outpatient services (12.1%). Meanwhile, a handful of others tallied significant increases in complexity after the peak at outpatient centers, such as cardiothoracic care (up from 0.46 to 0.49), abdominal imaging (1.8 to 1.91) and neuroradiology (2.46 to 2.56). Community hospitals witnessed similar gains, while academic locations only recorded upticks in breast imaging complexity, from 1.17 up to 1.32.
Carlon et al. noted that such changes could possibly be attributed to COVID-19 patients seeking follow-up heart, stomach and brain imaging. Or it could additionally reflect consumers’ “persistent reticence to seek all but the most time-sensitive imaging,” such as cancer staging studies, that generate higher wRVUs.
Both breast and cardiac care witnessed increased complexity during the recovery phase, but volume numbers still lagged, the authors added. They believe this may signal hesitance to return for regular screenings such as mammograms, cardiac calcium scoring and chest CT, and serve as a key piece of information when budgeting and allocating department resources in the future.
“These indicate important potential patient outreach avenues when working to restore normal services,” Carlon and co-authors advised. “Additionally, in any future outbreaks, oncology screening will require early focus, as these services are generally high volume and time-sensitive, although nonemergent.”
You can read much more about their investigation in Academic Radiology here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.