Medicare Administrative Contractors Exploring Coverage of Cerebral Perfusion Analysis Using CT
By Marty Stempniak | July 15, 2020
Three of the seven Medicare Administrative Contractors are exploring local coverage of cerebral perfusion analysis using CT imaging, the American
College of Radiology advised its members Tuesday.
MACs are currently seeking comment from radiologists and other subject matter experts on the “local coverage determination,” as it’s called. ACR
noted that the payment change would mean that clinicians could receive Medicare payment for CT imaging guidance to aid in the removal of a blood
clot under certain conditions.
“The American College of Radiology Contractor Advisory Committee (CAC) representatives will track this topic and submit written comments to the appropriate contractor. If your local MAC does not have [a local coverage determination] on this topic and deems this as a noncovered service, a request should be sent to reverse this decision,” ACR advised in its July 14 news post. “CAC representatives are vital to influence decisions related to reimbursement at the local level, but this cannot be done without the engagement of subject matter experts in neuroradiology.”
ACR said this would be the first proposed local coverage determination for this code category. Along with CT perfusion with contrast, it would also cover post-processing of parametric maps with determination of brain blood flow and volume, and mean transit time. The college expects MACs to allow 45 days for the radiology field to provide testimony through open meetings
and the public comment period.
“…There is an opportunity to make your voice heard,” ACR wrote.
Read more about the coverage determination and how to comment in the ACR post below:
Medicare Administrative Contractors Seek Comments on CT Perfusion Proposed LCD
Providers, Payers Hint They Will Sue CMS Over Proposed IPPS Rule
By Michael Brady | July 13, 2020
Hospitals and insurers are fuming over the Trump administration’s latest idea to lower healthcare costs by changing how CMS calculates Medicare severity DRG payments.
Under the proposed Inpatient Prospective Payment System rule, CMS would force hospitals to report for each MS-DRG the median payer-specific negotiated rates for all Medicare Advantage organizations and third-party payers beginning in 2021. Regulators say hospitals should be able to calculate the charges since they will have to pull together and publish most of the data under the disputed price transparency rule, which is making its way through the courts.
The agency is thinking about using the information to adjust inpatient prospective payments starting in 2024, speculating the change could help rein in healthcare spending.
But in comments on the proposed rule, providers and payers signaled they may sue the federal government if it moves forward with the changes, arguing that regulators don’t have the power to do either.
“CMS lacks any authority to adopt a ‘market-based’ MS-DRG weighting methodology because Congress has explicitly instructed CMS to weight MS-DRGs based on ‘relative hospital resources used with respect to discharges’ for each MS-DRG,” the Federation of American Hospitals wrote in a comment letter.
CMS multiplies a hospital’s payment rate per case by the relative weight of a DRG to determine how much to pay for a specific case. According to the agency, the weighting is currently based on “the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs.” Under the proposal, CMS would base it on
payer-specific negotiated charges.
Hospitals and payers have fought nearly every price transparency effort by the Trump administration, arguing that Congress didn’t give regulators the power to make them disclose their rates. Doing so would be difficult and wouldn’t help consumers, they say. But a number of experts think price transparency could reduce healthcare costs in the long term by increasing
competition among providers, even if there’s a short-term uptick.
Providers also took issue with CMS’ attempt to change and clarify policies related to so-called Medicare bad-debt claims, especially the agency’s desire to apply such changes retroactively. Most notably, CMS emphasized in the proposed rule that providers must put forth a similar effort to collect unpaid debts from non-indigent patients regardless of payer. The agency is
worried that providers won’t try as hard to collect debts from non-indigent Medicare patients if they think the federal government will pay instead.
To read more, go to Modern Healthcare.
IRS: For-profit Providers Have to Pay Taxes on COVID-19 Relief Grants
By Rachel Cohrs | July 13, 2020
The IRS clarified that for-profit healthcare providers will have to pay taxes on the grants they received from the COVID-19 Provider Relief Fund.
The two laws that set aside $175 billion in grants to help providers cover lost revenue and coronavirus-related expenses didn’t explicitly state that the funds would be taxable. However, the IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. The change means that grants to for-profit healthcare providers including
hospitals and independent physician practices will be subject to the 21% corporate tax rate.
“Physicians or hospitals will be asked to give back on average 21 cents of a dollar of relief, while large tax-exempt hospitals will get 100 cents on the dollar when everybody is experiencing the same losses,” said Federation of American Hospitals CEO Chip Kahn. “It’s unfair and will lead to an unlevel playing field.”
Some for-profit providers had hoped that the grants could be classified as a qualified disaster relief payment, but the IRS said the grants have to be included in gross income. Tax-exempt providers won’t be taxed on the grants unless they reimburse the provider for lost revenue for an unrelated trade or business.
“In the beginning there was denial that this could be taxable because it did not seem like it was in line with the spirit of the legislation to create liquidity to help hospitals and medical providers,” said Jennifer Breen, a partner at Morgan, Lewis & Bockius.
The Federation of American Hospitals, American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, and U.S. Chamber of Commerce asked congressional leaders on June 25 to change the policy so that for-profit providers don’t have to pay taxes on the grants.
To read more, go to Modern Healthcare.
Some Hospitals Choose to Continue Providing Elective Procedures
By Shelby Livingston | July 10, 2020
Many hospitals and other providers are continuing to perform nonemergency procedures despite the fact that most states are once again seeing an increasing number of COVID-19 cases.
Hospitals say they don’t need to delay care like they did in the initial months of the crisis. With four months of the pandemic under their belts, providers better understand how to control the spread of COVID-19. They have better protocols in place to conserve and reuse personal protective equipment and other resources needed to care for patients. And they have more access to coronavirus testing, they say.
There is also a financial need to resume elective procedures and keep them going. Hospitals and physician practices want to reschedule deferred care to fill the holes in their bottom lines sustained when procedures had to be delayed and patients canceled routine appointments for fear of becoming infected.
But more importantly, providers say continuing to put off non-urgent procedures—which often aren’t things that can be postponed indefinitely—are causing harm to patients. “We stopped operating on patients during the first increase (in cases) because we knew so little, and because we were nervous about ‘was it possible to give these infections to other people?'” said Dr. Catherine O’Neal, Chief medical officer and an infectious disease specialist at not-for-profit healthcare ministry Our Lady of the Lake in Baton Rouge, La.
“And because at that time we were also very, very nervous about our PPE supply. We are trying not to do that again because we saw that that harmed a lot of people. Putting off things is definitely harmful while people are waiting for very needed surgeries,” O’Neal said.
When the COVID-19 crisis first took shape in the United States, hospitals deferred non-urgent procedures, largely to conserve bed capacity, personal protective equipment and other resources.
The CMS in March urged hospitals to delay elective or non-essential medical and surgical procedures until the COVID-19 pandemic ended. Later in April, the agency unveiled guidance to help providers in areas that had already experienced a peak in COVID-19 cases resume elective procedures. It said hospitals shouldn’t start that process until their regions had experienced a decrease in COVID-19 cases for at least 14 days. Guidance from the American Hospital Association and other groups also included that 14-day rule.
Healthcare providers soon began to reschedule procedures that had been postponed after the initial outbreak of COVID-19 cases had subsided and states began lifting stay-at-home orders and social distancing restrictions. But coronavirus cases are again rising in most states, according to a database maintained by Johns Hopkins University. Confirmed U.S. cases have now blown past 3 million while deaths have reached 128,000, Johns Hopkins data shows.
To read more, go to Modern Healthcare.
Pandemic Sharply Impacted Imaging Volume, Operations
By Erik Ridley | July 10, 2020
The COVID-19 pandemic drastically impacted imaging volume for radiology practices throughout the country and necessitated a variety of challenging operational adjustments. And some of these changes may be long-lasting, according to research published online July 9 in the Journal of the American College of Radiology.
A multi-institutional team of researchers led by Dr. Alexander Norbash of the University of California, San Diego (UCSD) assessed the impact of the pandemic on the imaging volume of a large national private practice coalition, as well as three academic medical systems in high COVID-surge regions and three in low-surge areas. After comparing volumes with the same weeks in 2019, they found total declines of imaging volume ranging from 40% to 70%, with the biggest declines in high-surge areas.
Overall, the researchers found that large drops in imaging volume began in week 11 of 2020, with recovery beginning in week 17. The largest academic medical system in the study had the highest drop (70%), while the smallest system had the least amount of decline (40%).
On a modality basis, the greatest volume decreases were experienced with screening mammography and dual-energy x-ray absorptiometry (DEXA) scans, while the smallest drops were found in PET/CT, x-ray, and interventional radiology.
“The lowest drops in volume were seen with modalities where delays in imaging had greater perceived adverse consequences,” the authors wrote.
Meanwhile, imaging volume drops in the private practice coalition –Strategic Radiology — tracked with the trends shown by the low-surge academic medical systems, according to the authors.
“The modalities with greatest initial drops, such as breast screening mammography and DEXA scanning, also showed the greatest delays in trending towards volume recovery,” they wrote. “Similarly, earliest recovery trends were seen with modalities demonstrating lower drops.”
Inpatient imaging was also much less impacted than outpatient or emergency imaging. One high-surge academic medical system even reported an increase in inpatient volume during the pandemic.
In addition to analyzing imaging volumes, the authors also explored the adaptations made by practices, the risks of those changes, and the lessons learned. Reacting to the decline in volume and the operational requirements during the pandemic, the academic medical systems implemented a variety of strategies. These included adopting a wide range of frugality measures,
shifting clinical and nonclinical staff offsite, and maximizing operational efficiency, according to the researchers.
These decisions come with their own challenges, however, including the risk of fragmenting teams, as well as the need to ensure fairness when frugality and financial adjustments were required, according to the authors.
The researchers believe that a host of operational, architectural, and strategic changes could wind up being durable adaptations even after the pandemic.
To read more, go to Aunt Minnie.
ACR: Congress Should Include Delay of ‘Controversial’ USPSTF Breast Cancer Screening in Final Funding Bill
By Matt O’Connor | July 9, 2020
The American College of Radiology is urging Congress to pass a draft bill that includes a delay of U.S. Preventive Services Task Force breast cancer
screening mammography recommendations.
A House subcommittee recently approved the fiscal year 2021 funding bill by a nine to six vote. It extends the current delay in instituting 2009 USPSTF screening guidelines through 2025. The “controversial” guidance pushes for biennial screening beginning at age 50; language in the current bill retains insurance coverage of annual mammograms for women 40 years and older.
“ACR supports the extension of the moratorium against the most recent USPSTF breast cancer screening recommendations,” Dana Smetherman, MD, chair of the ACR Breast Imaging Commission, said in a statement provided to Health Imaging. “The ACR, Society of Breast Imaging, American Cancer Society and even the USPSTF all agree that the most lives are saved when women begin screening at age 40 and are screened annually.”
Smetherman added that moving away from this approach allows insurers to strip women of coverage and may cause “thousands of unnecessary breast cancer deaths each year. “Congress should include the moratorium in the final funding bill,” she added.
The House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies legislation also boosts funding for the National Institutes of Health by $5.25 billion, including $2.9 billion for Alzheimer’s disease and related dementias research.
It will be sent to the full House Appropriates Committee for markup.
Read the American College of Radiology’s breakdown of the legislation here.