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Objective: To examine whether Medicaid versus commercial insurance and reimbursement are associated with uterine artery embolization (UAE) utilization rates for uterine fibroids treatment., Methods: This retrospective (October 2015 to September 2023) study of women aged 30-59 years with procedures for the treatment of uterine fibroids (hysterectomy, myomectomy, or UAE) was based on the Inovalon Insights, LLC, dataset for those with Medicaid or commercial insurance. Differences in the receipt of UAE versus hysterectomy/myomectomy by insurance type and relative reimbursement were assessed with logistic regression controlling for patient characteristics and geographic differences in treatment patterns. For women with either a hysterectomy or myomectomy, differences in the receipt of these procedures laparoscopically were assessed by insurance type and relative reimbursement controlling for patient characteristics and geographic differences in treatment patterns., Results: Medicaid compared with commercial insurance was associated with 38% higher odds of UAE (OR, 1.38; 95% CI: 1.34, 1.42). States with higher Medicaid reimbursement for hysterectomy were associated with lower odds for UAE (OR, 0.95; 95% CI: 0.92, 0.98). For women with a hysterectomy or myomectomy, those with Medicaid versus commercial insurance had 20% lower odds (OR, 0.80; 95% CI: 0.79, 0.82) of receiving it laparoscopically., Discussion: Women insured by Medicaid versus commercial insurance were more likely to undergo the less invasive UAE procedure. Conversely, Medicaid patients who received a hysterectomy or myomectomy were less likely to receive it laparoscopically. Both results are consistent with the notion that insurance status may influence both physician referral patterns and treatment options available to patients., (Copyright © 2025. Published by Elsevier Inc.)

Purpose: To project the future radiologist workforce through 2055 and assess the contributions of residency positions and attrition to radiologist supply., Methods: The CMS National Downloadable Files (2014-2023) were used to assess both the current supply of radiologists and model the attrition based on years of practice. Using a nonlinear regression model, differences in attrition patterns were assessed by gender as well as pre-COVID-19 and post-COVID-19. New entrants to the workforce were modeled via linear regression based on National Residency Matching Program data (2005-2024) for radiology residency positions and filled positions. Attrition and new entrants were combined to generate estimates of radiologist supply through 2055., Results: In 2023, 37,482 radiologists were enrolled to provide care to Medicare patients. If residency positions do not grow after 2024, the projected number of radiologists in 2055 is 47,119 or 25.7% higher than in 2023. If residency positions grow after 2024, these projections are 52,591 radiologists in 2055, 40.3% higher. Based on 2014 to 2023 attrition, average years of practice is 35.7 for male and 34.2 for female radiologists. Attrition rates were substantially higher post-COVID-19 versus pre-COVID-19, which difference is equivalent to 3,116 radiologists in 2055., Conclusions: This study projected that the 2055 radiologist workforce will be 40.3% or 25.7% larger than in 2023 if residency positions, respectively, do or do not grow in the future. The study found that should attrition rates continue to be higher as they have been thus far post-COVID-19, the 2055 radiologist workforce would be substantially smaller., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: To project the future imaging utilization through 2055 and assess the contributions of population growth and aging, insurance type, and utilization trends on it., Methods: The study used claims data from two sources (2018-2022): a CMS 5% sample of Medicare fee-for-service beneficiaries and the Inovalon Insights, LLC, database for individuals with commercial insurance, Medicare Advantage, or Medicaid. Based on sex, age, and insurance type, future utilization was statistically modeled based on US Census Bureau population projections and recent utilization trends by modality., Results: The statistical analysis was based on person-year samples of 348,214,053 insured individuals covering those with Medicare fee-for-service, Medicare Advantage, Medicaid, and commercial insurance. Assuming no continuation of recent utilization trends, projected imaging utilization is 16.9% to 26.9% higher in 2055 compared with 2023 with this range, reflecting differences by modality. If recent utilization trends continue through 2030, this range is 5.6% less to 45.2% more. Population growth accounts for 73% to 88% of utilization increases across modalities; population aging accounts for 12% to 27%. Average utilization differed by insurance type (eg, average CT use was 0.70 for Medicare fee-for-service and 0.40 Medicare Advantage)., Conclusions: Projected imaging utilization in 2055 is 16.9% to 26.9% higher than 2023 levels assuming current per-person utilization will persist into the future, but continuation of recent per-person utilization trends broadens this range. Population growth is the largest driver of increasing future utilization. The continued shift to Medicare Advantage lowers utilization growth given its lower per-person utilization compared with Medicare fee-for-service., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine if relative Medicaid-to-Medicare reimbursement rates are associated with patient imaging utilization., Methods: This cross-sectional study estimated the association of diagnostic imaging utilization with the state-level Medicaid-to-Medicare reimbursement ratio (MMRR) of professional payments. State-specific reimbursement ratios were computed for each imaging modality. Logistic regression was used to estimate the likelihood of having imaging, and gamma regression was used to estimate the average number of imaging studies for those with imaging. These models were performed for each gender-modality combination controlling for patient characteristics., Results: Among 48,835,765 Medicaid patients, 54.3% were women. The median MMRR was 0.82 (interquartile range [IQR]: 0.73-0.94) for CT, 0.87 (IQR: 0.76-1.01) for MR, 0.76 (IQR: 0.69-0.99) for nuclear medicine (NM), 0.85 (IQR: 0.73-1.09) for ultrasound, and 0.82 (IQR: 0.74-0.97) for radiography or fluoroscopy (XR). The probability of having imaging was 25.9% for CT, 25.9% for MR, 21.4% for ultrasound, and 31.8% for XR higher at 75th percentile of the MMRR distribution compared with the 25th percentile (P < .001). For those with imaging, the mean number of imaging studies received was associated with 5.7% fewer studies for NM at the 75th percentile compared with the 25th percentile (P < .001), although there was no difference for other modalities., Conclusions: Medicaid payments are related to imaging utilization. A higher MMRR is associated with a substantially increased likelihood of Medicaid patients receiving CT, MR, ultrasound, and XR imaging but no difference in the amount of imaging studies received for those with imaging for these modalities., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: Given the financial hardships of surprise billing for patients, the aim of this study was to assess the degree to which radiologists effectively participate in commercial insurance networks by examining the trend in the share of radiologists' imaging claims that are out of network (OON)., Methods: A retrospective study over a 15-year period (2007-2021) was conducted using claims from Optum's deidentified Clinformatics Data Mart Database to assess the share of radiologists' imaging claims that are OON. Radiologists' annual OON rate was assessed overall as well as for claims associated with inpatient stays and emergency department (ED) visits. Rates were assessed for all imaging studies as well as by modality. Linear regression was conducted to assess OON rate time trends., Results: From 2007 to 2021, 5,039,142 of radiologists' imaging claims (6.3%) were OON. This rate declined from 12.6% in 2007 to 1.1% in 2021. Over the study period, the OON rate was 5.0% during an inpatient stay and 2.1% on the same day as an ED visit that did not lead to an inpatient admission. The linear trend in the overall OON rate declined 0.74 percentage points annually (95% confidence interval [CI], -0.90 to -0.58 percentage points) over the study period. Likewise, the annual declines were 0.54 percentage points (95% CI, -0.71 to -0.36) and 0.26 percentage points (95% CI, -0.33 to -0.20 percentage points) for imaging claims associated with inpatient stays and ED visits, respectively., Conclusions: Radiologists' imaging claims that are OON has significantly declined from 2007 to a minimal level in 2021. This may indicate effective negotiations between radiologists and commercial payers and new state-level surprise billing laws., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Macrophage cytokine production is regulated by neural signals, for example in the inflammatory reflex. Signals in the vagus and splenic nerves are relayed by choline acetyltransferase + T cells that release acetylcholine, the cognate ligand for alpha7 nicotinic acetylcholine subunit-containing receptors (α7nAChR), and suppress TNF release in macrophages. Here, we observed that electrical vagus nerve stimulation with a duration of 0.1-60 s significantly reduced systemic TNF release in experimental endotoxemia. This suppression of TNF was sustained for more than 24 h, but abolished in mice deficient in the α7nAChR subunit. Exposure of primary human macrophages and murine RAW 264.7 macrophage-like cells to selective ligands for α7nAChR for 1 h in vitro attenuated TNF production for up to 24 h in response to endotoxin. Pharmacological inhibition of adenylyl cyclase (AC) and knockdown of adenylyl cyclase 6 (AC6) or c-FOS abolished cholinergic suppression of endotoxin-induced TNF release. These findings indicate that action potentials in the inflammatory reflex trigger a change in macrophage behavior that requires AC and phosphorylation of the cAMP response element binding protein (CREB). These observations further our mechanistic understanding of neural regulation of inflammation and may have implications for development of bioelectronic medicine treatment of inflammatory diseases.

Purpose: The purpose of this study was to determine whether intrasac spectral Doppler flow velocities can predict whether or not a type II endoleak will spontaneously seal and to relate intrasac flow to preoperative branch vessel anatomy., Methods: Between October 1996 and June 2002, 265 patients with abdominal aortic aneurysms underwent endovascular repair. Patients with less than 24 months of follow-up and type I endoleaks were excluded. Type II endoleaks were confirmed with duplex scan and computed tomographic angiography. Two groups were identified: 14 patients with sealed endoleaks (<6 months) without intervention and 16 patients with persistent endoleaks greater than 6 months and without resolution. Spectral Doppler flow velocities were recorded from endoleaks within the aneurysm sac., Results: The two groups were similar in age, demographics, and aneurysm morphology. The mean follow-up times were 29.9 +/- 7.9 months for sealed endoleaks and 30.2 +/- 8.6 months for persistent endoleaks (P = not significant). Spectral Doppler velocities were significantly lower in patients with sealed endoleaks compared with persistent endoleaks (75.5 +/- 78.8 cm/s versus 138.2 +/- 36.2 cm/s; P <.01). Patients with sealed endoleaks and low (<100 cm/s) intrasac Doppler velocities had significantly fewer patent inferior mesenteric arteries (43% versus 81%; P <.01), a smaller inferior mesenteric artery (5.6 +/- 1.8 mm versus 7.2 +/- 1.3 mm; P <.01), and fewer paired lumbar arteries (1.3 +/- 0.8 versus 2.4 +/- 0.6; P <.0001) compared with those with persistent endoleaks and high (>100 cm/s) intrasac flow velocities. Three patients with sealed endoleaks had Doppler velocities of 200 cm/s or greater. However, the diameter of the inferior mesenteric artery in these patients was 4 mm or less with no visualized lumbar arteries before surgery. Aneurysm diameter(-4.6 +/- 5.6 mm) and volume (-0.9 +/- 45.2 mL) decreased in patients with sealed endoleaks. Aneurysm diameter (1.8 +/- 4.9 mm) and volume (18.5 +/- 33.9 mL) increased slightly in patients with persistent endoleaks (P <.05). No ruptures or conversions occurred in any patient. Secondary interventions to treat type II endoleaks were unsuccessful in six of 16 patients (38%) with persistent endoleaks., Conclusion: Intrasac Doppler velocities can be used to predict whether a type II endoleak will spontaneously seal. High-velocity type II endoleaks are related to preoperative large branch vessel diameter and number and are resistant to endovascular treatment.