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Physician Payment Source May Affect Evaluation for Black Lung Disease

WEDNESDAY, March 31, 2021 -- Source of payment is strongly associated with radiograph classification of black lung disease, according to a study published online March 29 in the Annals of the American Thoracic Society.

Lee S. Friedman, Ph.D., from the University of Illinois Chicago, and colleagues examined the direction and magnitude of association between financial conflict of interest of physicians participating in the Federal Black Lung Program (FBLP) and international standards for the classification of radiographs of pneumoconiosis. Physician classification of radiographs was determined using an epidemiologic assessment of black lung claims filed to the FBLP for 2000 to 2013.

The researchers found that 31.4 and 3.6 percent of the 63,780 radiograph classifications made by 264 physicians were read positive for simple pneumoconiosis and having progressive massive fibrosis (PMF), respectively. Fifty-two and 18 physicians classified chest X-rays as having no evidence of pneumoconiosis in 99+ percent of their readings and as positive for simple pneumoconiosis in 99+ percent of their readings, respectively. Per 10 percent increase in the proportion of court records demonstrating that a physician was hired by the employer, the adjusted odds of a negative classification of pneumoconiosis was 1.46. The adjusted odds ratios for classifying simple pneumoconiosis and finding PMF were 1.51 and 1.28, respectively, per 10 percent increase in court records indicating that a physician was hired by the miner-claimant.

"There remains a need for empirical analyses specific to the workers' compensation system, which is wholly lacking," the authors write. "All parties involved deserve a compensation system that is objective and expeditious."

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