Zotec Partners Radiology Digest | August 14

August 14, 2020

Radiology Digest: News from the week of August 14, 2020.

Senate Leaves Until September without Coronavirus Relief Deal
By Jordain Carney |August 13, 2020 | Included in Radiology Digest – August 14, 2020
The Senate left Washington, D.C., on Thursday until September — the latest sign that a deal on a fifth coronavirus relief package is, at least, weeks away.

Senate Majority Leader Mitch McConnell (R-Ky.) had kept the chamber in session this week, which was technically the first in its August recess, as a last-ditch attempt to create space for the administration and congressional Democrats to get an agreement.

But with talks stalemated, senators argue there is little reason for them to keep holding daily, roughly 1 1/2-hour sessions. The House already left town and isn’t expected to return until Sept. 14.

“We will have our regular pro forma meetings through the end of the state work period. If the Speaker of the House and the minority leader of the Senate decide to finally let another package move forward … it would take bipartisan consent to meet for legislative business sooner than scheduled,” McConnell said as he wrapped up the Senate until next month.
McConnell added that he hoped the Senate would be able to “act sometime soon.”

Senators will get at least 24 hours’ notice to return if congressional Democrats, Treasury Secretary Steven Mnuchin and White House chief of staff Mark Meadows are able to break the impasse and votes are scheduled. Otherwise, the Senate will formally reconvene on Sept. 8.

Sen. Chuck Grassley (R-Iowa) predicted during a conference call on Tuesday that if negotiators didn’t restart by Thursday, the administration’s executive orders would be the only action that takes place until early September.
To read more, go to The Hill.

Practices Can ‘Recover Wisely’ From COVID-19
By Kate Madden Yee | August 13, 2020 | Included in Radiology Digest – August 14, 2020
It’s possible for radiology practices to “recover wisely” to pre-COVID-19 imaging volumes, according to a study published August 10 in Academic Radiology. It comes down to close monitoring of data, researchers believe.

“To [recover wisely], we used a data-driven approach to inform our decisions and strategies,” noted the team, led by Dr. Achala Vagal of the University of Cincinnati. “Provision of a safe environment for patients and staff remained our top priority.”

The COVID-19 pandemic prompted declines in imaging volume of at least 50% as imaging centers and hospitals postponed nonemergency exams. Procedure volume has only slowly started to come back since then.

At the University of Cincinnati, Vagal and colleagues launched an initiative for reinstating nonurgent imaging on May 4. The team used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines — a structure for reporting knowledge about improving healthcare — to assess imaging volumes over a 10-week period (May 4 to July 10) in an effort to restore them to pre-COVID-19 levels, including addressing exam backlogs.

The strategy included establishing a task force that consisted of radiologists, administrators, technologists, and schedulers. The group gathered imaging information by date, time of day, site, modality, and available scanners and used this data to model the recovery program.

“We continuously monitored the backlog of imaging studies and available imaging resources as we gradually opened imaging sites,” Vagal and colleagues wrote. “A thorough and real-time evaluation of our backlog, vis-à-vis resources, ensured ‘equity in prioritization’ for all referring physicians and specialties.”
To read more, go to Aunt Minnie.

CMS Pushes Imaging Appropriate Use Criteria Go-live Date Back a Year Due to Pandemic
By Marty Stempniak | August 12, 2020 | Included in Radiology Digest – August 14, 2020
The Centers for Medicare and Medicaid Services is delaying the go-live date for new imaging appropriate use criteria by a year, the agency announced on Monday.

CMS first kicked off the initial testing period for this program on Jan. 1, with full implementation slated for the same date in 2021. Industry advocates such as the Society of Nuclear Medicine and Molecular Imaging have advocated for a delay because of the pandemic and got their wish this week.

“There was significant concern that referring physicians and sites would not be ready for the implementation phase due to the COVID-19 public health emergency,” SNMMI advised its members on Tuesday. “Therefore, CMS announcing a one-year delay in the implementation phase (until Jan. 1, 2022) provides relief to the referring physicians and gives additional time to prepare for the implementation of this program.”

The appropriate-use requirement was first mandated under the Protecting Medicare and Medicaid Services Act of 2014, with the goal of curbing unnecessary care in the federal payment program. It stipulates that referring providers must consult an electronic clinical decision support system before ordering MRIs, CT scans or other expensive imaging tests for Medicare beneficiaries. And clinicians who over-order radiology services under this system will be labeled as “outliers,” with the feds eventually subjecting them to prior authorization, SNMMI noted.

Following Monday’s announcement, CMS will extend the testing period through Dec. 31, 2021. The agency chose not to address the appropriate-use mandate in its recently released physician fee schedule, which “means that the decision is final and not subject to comment,” the American College of Radiology wrote Tuesday.

CMS emphasized that it will not levy any imaging appropriate-use criteria penalties in calendar 2020 or 2021.

“We encourage stakeholders to use this period to learn, test and prepare for the AUC program,” the agency advised this week.
To read more, go to Radiology Business.

New Trump Unemployment Plan Could Squeeze State Budgets, Medicaid Rates
By Rachel Cohrs | August 11, 2020 | Included in Radiology Digest – August 14, 2020
If President Donald Trump’s plan to extend additional unemployment benefits further squeezes state budgets already ravaged by COVID-19, states could look to Medicaid as a way to cut costs.

Trump’s plan via executive order appears to be a double whammy for states. States may now be on the hook for unemployment benefits that until now had been paid by the federal government, and the orders put a screeching halt to negotiations over a congressional deal that could have included more funding or flexibility for states. If things don’t improve, states may have to look to Medicaid to close gaps. Prior restrictions mean some of the only options states are left with to balance Medicaid budgets are cutting provider rates or increasing provider taxes.

Manatt Health counsel Allison Orris said that Medicaid provider rate cuts could be especially harmful in a public health emergency because they would target safety-net providers serving the most vulnerable.

“The administration is throwing states a big curveball and adding another budget item as they are struggling to prioritize spending on healthcare and other needs,” Orris said.

After negotiations between Democratic congressional leaders and administration officials fell apart last week, Trump signed an executive order authorizing up to $44 billion from the Federal Emergency Management Agency’s Disaster Relief Fund to provide a $400 per week supplemental unemployment benefits, but states would be on the hook for 25% of the bill.

Many details of the program remain unclear including its feasibility for states to administer, what happens when federal funds run out, whether states could opt out of the program, and whether states could request to have their portion of fees waived.
To read more, go to Modern Healthcare.

Quash ‘Reckless’ Medicare Cuts that Could Cost Radiology Billions, Lawmakers Urge Congress
By Marty Stempniak | August 11, 2020 | Included in Radiology Digest – August 14, 2020
A bipartisan group of U.S. House members are asking congressional leaders to quash a Medicare payment change that could cost radiology billions in the years to come.

Spearheaded by Rep. Bobby Rush, D-Ill., the 92 lawmakers want Congress to waive budget-neutrality requirements stemming from a proposed pay increase for office-based evaluation and management services in 2021. Absent such a decision, the imaging industry stands to lose some $10 billion over the next decade, advocates estimate.

The American College of Radiology and numerous other specialty groups have lobbied hard against the change, set to take effect on Jan. 1. And imaging provider RadNet estimated Monday that it will lose $11 million in reimbursement next year if Congress does not take action.

“It has come to our attention that many specialists are being targeted for ill-conceived and sizeable cuts that simply no longer make sense to implement,” Rush and colleagues wrote to Speaker Nancy Pelosi, D-Calif., and Minority Leader Kevin McCarthy, R-Calif., on Tuesday.

“If these cuts go into effect, they will be devastating for providers and will ultimately result in decreased access to care for patients,” the letter writers added later. “Our healthcare system is already under tremendous financial strain, as it continues to grapple with both the economic and health consequences of the coronavirus. Now is not the time to implement these reckless cuts.”

Rush et al., instead, want the House to waive budget-neutrality requirements related to E/M codes for both the 2021 and 2022 calendar years. The signatories also asked the Centers for Medicare and Medicaid Services to study how failing to counter these cuts could impact providers, along with access to specialty care in underserved communities.

The CardioVascular Coalition—which represents physicians, other providers and industry manufacturers—applauded the letter on Monday. It estimated that interventional radiologists alone will face a 9% Medicare pay decrease next year, absent congressional action.
To read more, go to Radiology Business.

Imaging Groups Urge USPSTF to Remove ‘Arbitrary’ Cutoffs, Expand Lung Cancer Screening Eligibility
By Matt O’Connor | August 10, 2020 | Included in Radiology Digest – August 14, 2020
Top imaging organizations have commended new recommendations to expand the lung cancer screening-eligible population but remain concerned the changes do not go far enough.
The American College of Radiology and Medical Imaging & Technology Alliance both shared this apprehension in recent comments submitted to a United States Preventive Services Task Force draft recommendation statement.

Each group said it “strongly support[s]” USPSTF’s proposal to lower the starting age for low-dose CT screening from 55 to 50, along with loosening smoking history requirements from 30 pack-years to 20. Both, however, urged the federal guidelines to go further and remove additional “arbitrary” roadblocks, ACR and MITA said recently.

“The USPSTF continues to recommend a 15-year smoking cessation quit date and an upper age limit of 80 years,” MITA Executive Director Patrick Hope, said in an Aug. 3 letter. “We strongly recommend that the smoking cessation quit date and the upper age limit cut-off be removed,” he added later, noting such decisions should be left up to the patient and their physician.

USPSTF published its draft statement early last month, noting the new guidelines would help spot cancer in women and African Americans. Both groups tend to smoke less than white men, with Black individuals shown to face a higher risk of lung cancer.

The ACR came out in strong support of the changes, but urged for a broader quit-smoking requirement, from 15 to 20 years.

In its Aug. 3 letter, the group representing some 40,000 professionals reiterated this stance.
To read more, go to Health Imaging.

Health Insurers Strike Gold with COVID-19
By Shelby Livingston | August 7, 2020 | Included in Radiology Digest – August 14, 2020
The largest U.S. health insurers posted enormous profits in the second quarter as hospitals and physician practices postponed elective services and patients put off routine medical care during the COVID-19 pandemic.

Insurers paid billions of dollars less in medical claims for care unrelated to the novel coronavirus, producing savings that vastly outweighed any costs for coronavirus testing, hospitalizations and treatment. As a result, the seven biggest publicly traded insurers reported combined profits of $17 billion in the three months ended June 30, an increase of roughly 79% over the same quarter in 2019.

Some of the insurers, including national companies Anthem, Humana and UnitedHealth Group, nearly doubled their profits. Centene Corp., a prominent Medicaid managed care company, grew profit 144%, aided in part by its acquisition of a rival health plan.
To read more, go to Modern Healthcare.

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