Radiology Digest: News from the week of April 29, 2022.
Medical Debt Challenges Common Among Consumer Complaints
By Victoria Bailey | April 26, 2022 | Included in Radiology Digest – April 29, 2022
Americans continued to face medical debt challenges, with consumers reporting instances of debt collectors attempting to collect medical debt that was already paid or does not belong to them, according to data from the Consumer Financial Protection Bureau (CFPB).
The report analyzed consumer complaints submitted to CFPB.
In 2021, CFPB sent more than 750,000 consumer complaints to companies for review and response. Medical debt was a common topic in complaints about debt collection and credit or consumer reporting. According to CFPB, 15 percent of debt collection complaints were about attempts to collect a medical bill.
Past data has shown that including medical debt on consumer credit reports can hinder access to secure housing and employment opportunities. The complaints submitted to CFPB revealed additional challenges consumers face regarding medical debt collection.
Nearly a third of medical debt collection complaints were about receiving written notification about debt. Consumers frequently reported that they did not recognize the company sending them collection notices or the notices did not contain sufficient information to verify the alleged debt.
Consumers also stated that collection notices often included personal medical information that they felt violated the Health Insurance Portability and Accountability Act (HIPAA), such as detailed bills listing procedures, tests, and medications.
Receiving collection notices for incorrect bills was a common trend among consumer complaints. For example, individuals submitted complaints about being contacted for bills they had already paid, were covered by insurance, and or had been resolved through charity care.
Consumers also reported receiving collection notices for medical bills that did not belong to them.
To read more, go to Revcycle Intelligence.
RBMA Radiology Administrator Compensation Survey Expands Insights During the Great Resignation
By Dave Fornell | April 26, 2022 | Included in Radiology Digest – April 29, 2022
The results of the Radiology Business Managers Association (RBMA) 2022 compensation study is discussed by Tony Werner, co-chair, RBMA Data Committee and a principal at Clifton-Larson-Allen, and Jeff Maze, CEO and founder of Quinsite. They presented an overview session on the survey at the RBMA 2022 annual meeting.
The survey includes compensation for radiology department administrators, including management staff such as marketing directors. The data can be broken down using an online form to pull data specific to regions of the country, hospital or health system size, and other parameters to find salary ranges.
“With the great resignation, it is influencing radiology across the board,” Werner explained. “It is pretty consistent out there that radiology groups are struggling to be able to maintain their staffing levels and to bring people in.”
He said this business intelligence data can be used to find what the average pay is for radiology department managers based on region, size of a hospital or healthcare system, duties, and other parameters using the interactive online platform. Werner said this has grown in importance in the past year, as retaining quality staff and attracting new talent has become a major issue in radiology, healthcare and across all other segments of the economy in the era of the great resignation.
To read more, go to Radiology Business.
HHS Appealing Texas Judge’s Surprise Billing Ruling
By Andrew Cass | April 25, 2022 | Included in Radiology Digest – April 29, 2022
HHS April 22 filed a notice of appeal regarding a Texas federal judge’s ruling that sided with providers in a lawsuit over the No Surprises Act.
The Texas Medical Association sued the Biden Administration in October 2021 over the surprise billing resolution process. Providers took issue with a portion of the process that assumes the qualifying payment qualifying payment amount, which is the median in-network rate set by health insurers, is the appropriate out-of-network rate.
The association claimed the reliance on the qualifying payment amount does not allow arbitrators to exercise discretion and weigh other relevant factors. Presiding Judge Jeremy Kernodle ruled in the association’s favor in February, saying the rule “places its thumb on the scale” for the qualifying payment amount.
The judge also ruled that HHS erroneously failed to issue notices and comment periods on the rule.
The Justice Department is appealing the decision to the 5th Circuit Court of Appeals, according to its filing.
To read more, go to Becker’s Hospital Review.
Physicians’ Private Payer Problem
By Patsy Newitt | April 25, 2022 | Included in Radiology Digest – April 29, 2022
More regulation and declining reimbursements from private payers are impeding many physicians’ ability to provide care.
“The patient care path is complicated, but one antagonist bears mention: private payers,” Cory Calendine, MD, orthopedic surgeon at the Bone and Joint Institute of Tennessee in Franklin, told Becker’s. “Insurance companies are essentially financial vehicles. They provide no actual patient care.”
Insurance companies are seeing huge profits, but physicians are seeing a narrowing list of covered services and increasing denials, Dr. Calendine said.
“This produces, at worst, less care for the patient and, at best, more burden to those delivering the care,” he added.
Commercial payers’ policies and protocols are also leading to more denials. Payers are tightening their policies to approve fewer patients for surgery and denying patients who previously would have been approved.
“I see payers as opportunistic,” said Joe O’Brien, MD, a spine surgeon with OrthoBethesda in Maryland, and medical director of minimally invasive orthopedic spine surgery at Virginia Hospital Center in Arlington, Va. “They will deny care when they can, they will deny payment when they can, and they will provide poor contracts when they can. I’d love to see a future model where the payers were true partners with the patients and doctors.”
Physicians’ problems with insurers are compounded by the increasing number of prior authorizations they need to get approval for procedures before moving forward with care. Seventy-nine percent of medical groups said that payer prior authorization requirements increased in the last year, according to a poll conducted by the Medical Group Management Association March 1.
While these bureaucratic burdens are “totally understandable in our profit-driven, fee-for service, capitalistic healthcare system,” according to Jeff Clode, MD, an internal medicine specialist in Spokane, Wash., they result in “a horrible time sink because the process is so inefficient, cumbersome.”
Physicians, particularly independent ones, often don’t have the resources to conduct the massive administrative work required to secure reimbursements for all procedures. For some, this dilemma is creating a quota-based mindset to maintain profitability.
To read more, go to Becker’s ASC Review.
Physician Practice Acquisitions by Hospitals, Corporations Grew
By Victoria Bailey | April 22, 2022 | Included in Radiology Digest – April 29, 2022
Physician practice acquisitions increased during the COVID-19 pandemic, resulting in nearly three-quarters of physicians being employed by hospitals, health systems, or other corporate entities, according to data from Avalere.
Avalere gathered physician data from the IQVIA OneKey database between January 2019 and January 2022. The information was presented in a study sponsored by the Physicians Advocacy Institute (PAI).
Researchers found that the number of acquisitions of physician practices and employed physicians grew in 2021 as the pandemic continued.
Nationally, hospitals and other corporations acquired 36,200 additional physician practices between 2019 and 2021, leading to a 38 percent increase in the percentage of corporate owned practices.
More than 108,000 physicians became employees of hospitals or other corporate entities throughout the study period, representing a 19 percent increase in the percentage of employed physicians since. More than 75 percent of those employees (83,000) made the shift after the start of the pandemic.
The employee growth was split almost evenly between hospitals and other corporate entities. Just over 58,000 of those newly employed physicians became hospital employees, resulting in an 11 percent increase in hospital-employed physicians. The majority of the shift occurred during the pandemic (51,000 employees), signaling a 9.7 percent hike following COVID-19.
Hospitals acquired 4,800 physician practices over the three years, increasing the number of hospital-owned practices by nine percent, the report found.
Meanwhile, 32,000 physicians became employed by corporate entities during the pandemic, with a total of 50,500 throughout the study period. This represents a 5.5 percent increase in the number of physicians employed by corporations during the pandemic and a 43 percent boost over the last three years.
The number of corporate-owned physician practices increased by 86 percent, as corporate entities acquired 31,300 practices between 2019 and 2021.
The growing rate of physician practice acquisitions led to 74 percent of physicians working for a hospital or a corporate entity as of January 2022, the report revealed. The percentage of hospital or corporate-owned physicians grew by 19 percent from 62.2 percent in January 2019.
To read more, go to Revcycle Intelligence.
Imaging Societies Ask Congress to Repeal Appropriate Use Decision Support Mandate
By Dave Fornell | April 21, 2022 | Included in Radiology Digest – April 29, 2022
Randall Thompson, MD, immediate past president of the American Society of Nuclear Cardiology (ASNC), attending cardiologist at St. Luke’s Mid-American Heart Institute, and professor of medicine, University of Missouri, Kansas City School of Medicine, explains the current ASNC lobbying efforts. ASNC is asking Congressional leaders to take action on improving the prior authorization system and is looking for lawmakers to repeal the Medicare Appropriate Use Criteria (AUC) mandate.
The ASNC says the Medicare Appropriate Use Criteria (AUC) mandate would take away resources from efforts in quality improvement by requiring additional administrative burden.
“It’s not the appropriate use criteria we have an issue with, it is the decision support mandate, because it is overly prescriptive and there is a hassle factor and a time factor involved,” Thompson explained.
The legislation would require electronic prior authorization, improve transparency for beneficiaries and providers, and increase oversight from the Centers for Medicare and Medicaid Services (CMS) on how imaging is used vis prior authorization. The ASNC said the act recognizes that physicians should be focused on patient care, not on navigating the prior authorization process to get patients their recommended tests, procedures and treatments.
It is scheduled to go into effect on Jan. 1, 2023, or the January 1 that follows the declared end of the public health emergency for COVID-19. The mandate implementation has already been delayed for several years, originally having been slated for 2016. Thompson said CMS has run into several technical issues with the rule and vendors did not have clear guidance from CMS early on as to what they needed CDS software to do to be certified.
For more details read the full article American Society of Nuclear Cardiology urges Congress to speed prior authorizations, repeal AUC mandate.
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