Zotec Partners Radiology Digest | August 21

August 21, 2020

Radiology Digest: News from the week of August 21, 2020.

Senate GOP Narrows COVID-19 Relief Asks, Removes Provider Funding
By Rachel Cohrs | August 18, 2020 | Included in Radiology Digest – August 21, 2020
Senate Republicans are considering a new, slimmer COVID-19 relief bill that includes no additional funds for healthcare provider grants.

The proposal comes as negotiations between congressional Democrats and the White House collapsed in recent weeks. The new bill includes liability protections that healthcare providers wanted but doesn’t set aside the additional $100 billion in grants providers had asked for or relax Medicare loan terms, according to draft text of the proposal.

Funding for the federal government expires at the end of September, so there could be a must-pass vehicle for further legislation at that time.

The more modest legislation is scaled back from the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act that Senate Republicans proposed last month. The new bill includes funds for COVID-19 testing, an extension of more modest federal unemployment benefits, a second round of forgivable Paycheck Protection Program loans for hard-hit small businesses, and money for vaccine production and distribution.

Senate Republicans’ initial offering would have added $25 billion to the $175 billion Provider Relief Fund that lawmakers created to help healthcare providers offset lost revenue and coronavirus-related expenses. That funding is excluded from the narrower bill.

Hospitals have also been asking Congress to relax the repayment terms and interest rates on Medicare loans many providers took out at the beginning of the COVID-19 crisis, but the scaled-back Senate GOP proposal doesn’t include that policy either.

An extension of telehealth flexibilities through at least 2021 was also left out of the smaller bill.

McConnell’s liability legislation has drawn criticism from Democrats, who are instead pushing to force the Occupational Safety and Health Administration to issue emergency standards to protect workers.
To read more, go to Modern Healthcare.

60% of Breast Cancer Survivors’ Imaging Care Delayed Due to COVID-19
By Matt O’Connor | August 18, 2020 | Included in Radiology Digest – August 21, 2020
Nearly half of breast cancer survivors in the U.S. experienced care disruptions during the beginnings of the pandemic, according to new research, exposing dangerous cracks in the nation’s healthcare system.

A group from the University of Illinois at Chicago surveyed more than 600 women for their study, published recently in Breast Cancer Research and Treatment. About 44% said they experienced delays in care, with follow-up appointments and diagnostic imaging two of the leading types of postponements.

“Overall, we see that there is a serious gap in disaster preparedness when it comes to providing critical and often time-sensitive care for breast cancer patients,” Elizabeth Papautsky, PhD, assistant professor of biomedical and health information sciences at the UIC College of Applied Health Sciences, said Tuesday.

The investigators sent out their questionnaire to U.S. breast cancer survivor groups via social media and email, asking women who received a cancer diagnosis if their appointments were pushed back and, if so, what type of care was delayed. Between April 2 and 27, they received 609 responses. On average, women were 47 years old.

In total, 63% were receiving cancer care, with most claiming their routine follow-up visits were rescheduled (79%), followed by breast reconstruction surgery (66%), imaging exams (60%), and lab testing (50%).

Additionally, 30% experienced hospital or clinic-based cancer therapy stoppages, which included infusions (32%), radiation (30%), and surgery to remove a tumor (26%).

Papautsky and colleagues were surprised by a number of their findings, including the sweeping impact on all communities and the higher incidence of delays in younger patients. The latter may be attributed to delays in hormone therapy, which is typically administered to younger individuals, they noted.

“We expected the usual racial difference we see in healthcare, with Black patients being disproportionately affected, but our results showed that patients were universally affected by COVID in terms of delays in breast cancer care, likely because in those early weeks, hospitals and health care facilities were postponing visits and procedures across the board as they took on the growing burden of dealing with COVID-19,” Hamlish added in a statement.

The authors pointed out that many women said their treatments were modified, rather than completely canceled.
Read the entire study here.

Deep Dive Finds More for Radiologists to Dislike in 2021 Medicare Physician Fee Schedule
By Marty Stempniak | August 14, 2020 | Included in Radiology Digest – August 21, 2020
A new analysis of the 2021 Medicare Physician Fee Schedule is unearthing more for radiologists to dislike about the proposal.

Consulting firm Healthcare Administrative Partners shared its deep dive on Friday, highlighting sizable slashes to doc pay when the calendar flips. Those include a 11% hit to diagnostic radiology, 9% on the interventional side, and 8% for nuclear medicine.

While those numbers have already been circulated, Pennsylvania-based HAP also drilled down to the impact on high-volume radiology procedures and noted drops as high as 18% in 2021. The cuts follow the inclusion of a pay boost for evaluation and management services, which necessitates budget balancing elsewhere that advocates say will come out of the pockets of rads and other physicians.

“Many specialties, including radiology, will see a significant cut in Medicare reimbursement in 2021 if the MPFS Proposed Rule is applied without a change to the budget neutrality requirement in the law,” Sandy Coffta, VP of client services for HAP, wrote in the analysis. “The proposed rule is subject to comment from the public and interested organizations that will potentially modify its proposals,” she added later.

Coffta and colleagues made their determinations using their payment database and calculating the impact on the most popular procedures. She noted that the hospital professional component of payment would drop by at least 10% for an extracranial bilateral study, using a duplex doppler, to as high as 18% for CT of the thorax without dye. Most cuts would fall into the 11%-12% range.

Meanwhile, the range of reductions is much greater for providers operating in freestanding imaging centers, with cuts as low as 1% for some x-rays and 15% for CT. MRI would drop 8% while ultrasound would fall by as much as 7%, and the overall drop may be lower than CMS’ 11% estimate, Coffta wrote.

You can read much more of the 2021 MPFS—including its impact on the Quality Payment Program and appropriate use criteria—here. A bipartisan group of House members is also advocating against these cuts, calling them “reckless” and “devastating for providers.”
To read more, go to Radiology Business.

Insurers Should Get Unpaid ACA Subsidies, Appeals Court Rules
By Shelby Livingston | August 14, 2020 | Included in Radiology Digest – August 21, 2020
A federal appeals court ruled on Friday that the Trump administration violated the law when it abruptly stopped paying for subsidies intended to reduce healthcare costs for low-income individuals who buy coverage on the Affordable Care Act exchanges.

In a separate decision also issued Friday, the same court said health insurers should not collect a windfall from the decision. While the U.S. Federal Circuit Court of Appeals said insurers are entitled to the full amount of unpaid cost-sharing reduction subsidies for 2017, the amount owed for 2018 should be reduced because insurers were able to raise premiums to make up for the loss of subsidies.

“We hold that the claims court must reduce the insurers’ damages by the amount of additional premium tax credit payments that each insurer received as a result of the government’s termination of cost-sharing reduction payments,” the opinion in Maine Community Health Options v. United States states.

The Federal Circuit remanded that case to the lower court to figure out the amount by which the insurers’ damages should be reduced. It noted that determining the damages will be “a fact-intensive task,” and may require new summary judgment motions or a trial.

The ACA established cost-sharing reduction subsidies for individuals whose incomes were below 250% of the federal poverty level. The Trump administration ended those subsidies in late 2017, claiming that it lacked an appropriation. But the law still required insurers to reduce copayments and other cost-sharing for eligible individuals.

Insurers in 2018 increased premiums for silver plans on the exchanges to make up for the lack of CSR payments. Because of the way ACA premium tax credits are structured, the federal government ended up paying substantially higher premium tax credits as a result.

Numerous health insurers have sued the federal government over the past few years to recoup unpaid subsidies. Several more filed lawsuits in recent weeks in the wake of an insurer victory in a U.S. Supreme Court challenge over another ACA program known as risk-corridors. That victory suggested insurers may also prevail in their efforts to recoup cost-sharing reduction subsidies.
To read more, go to Modern Healthcare.

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