HHS Secretary’s Report Calls for Congressional Action to Combat Surprise Billing and Promote Price Transparency
July 29, 2020
The U.S. Department of Health and Human Services released the HHS Secretary’s Report on Addressing Surprise Billing. The report, called for in Section 7 of President Trump’s Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First, outlines critical steps, including Congressional action, to implement the Administration’s principles on surprise billing. Sound surprise billing legislation will not only protect patients but will encourage a fairer, more transparent, patient-centered healthcare system that benefits all Americans.
“Americans have the right to know what a healthcare service is going to cost before they receive it,” said HHS Secretary Alex Azar. “President Trump and his administration have done their part to deliver historic transparency around the prices of many procedures. Now it’s time for Congress to do what we all agree is necessary: combat surprise billing with an approach that puts patients in control and benefits all Americans.”
Surprise medical billing is a widespread and costly problem in the United States, and the need to address it has been highlighted during the Public Health Emergency (PHE) presented by COVID-19. Research shows that 41 percent of insured adults nationwide were surprised by a medical bill in the past two years alone, and that two thirds of adults worry about their ability to afford an unexpected medical bill. At a time when Americans are increasingly seeking medical care, practices such as surprise billing leave many patients vulnerable to the financial burdens presented by a nationwide pandemic.
You can read the full report here.
Major Imaging Groups Launch Campaign Urging Patients to ‘Return to Care’
By Marty Stempniak | July 28, 2020
Several major U.S. radiology industry players are banding together, urging patients to “return to care” that they’ve put off during the COVID-19 pandemic.
Groups such as the RSNA and American College of Radiology are concerned about recent reports of consumers putting off imaging amid fears of contracting the new coronavirus. One recent survey from the American Cancer Society found that 87% of cancer patients and survivors reported a disruption in their care during the pandemic.
“Concerns about COVID-19 have led some patients to delay necessary screens, scans, vaccinations and treatments,” imaging advocates noted on their website. “The #ReturnToCare Coalition is a group of patient advocacy organizations and medical societies working together to encourage patients to seek the care they need in consultation with their healthcare providers.”
The coalition’s webpage offers information and resources to encourage patients to schedule any long-delayed imaging or other care. Fellow group members the American Society of Radiologic Technologists highlighted the effort in an alert to its members Tuesday. Others involved include the American Society for Radiation Oncology, the Academy of Physician Assistants, Society of Hematology, Society of Nuclear Medicine and Molecular Imaging, and the Medical Imaging and Technology Alliance.
To read more, go to Radiology Business.
Shifting Payer Mix Due to COVID-19 Putting Pressure on Radiology Practice Margins
By Marty Stempniak | July 28, 2020
The COVID-19 pandemic and the corresponding economic downturn is shaking up the U.S. payer mix and forcing radiology practices to rethink future revenue projections.
After three years of decline, the crisis has markedly increased the number of individual covered by Medicaid, for instance, up to 72.3 million. And the pandemic stripped an estimated 5.4 million American workers of their insurance through May amid widespread job losses.
The Radiology Business Management Association highlighted these trends on Monday while noting that the uninsured rates could leap even higher, once COBRA and other safety net services expire. According to one Kaiser Family Foundation analysis, if those who lost their jobs during the crisis are not rehired, some 17 million could become eligible for government insurance.
“From a practice leader’s perspective, as Medicaid enrollment increases, a shrinking percentage of people with employer-sponsored and other private health plans that typically reimburse higher than Medicare and Medicaid could spell financial trouble due to a less advantageous mix of payers,” the association advised on July 27.
With this shift, leaders will be forced to take action, including lowering the cost of imaging procedures to “ensure adequate reimbursement” at those modified rates. RBMA also advised its members to chronicle cases carefully “so that money is not left on the table due to downcoding for lack of documentation.”
Joshua Liao, MD, with the University of Washington in Seattle, also recently mentioned this trend in a commentary published July 10 in JACR. He predicted that the “abrupt change in payer mix could adversely affect providers,” prompting them to rewrite financial predictions and their ability to provide certain services.
He suggested participating in new payment models—such as accountable care organizations or capitated outpatient radiology contracts—as one way to counter these trends.
To read more, go to Radiology Business.
Imaging Group Applauds Legislation Granting Tricare Beneficiaries Permanent DBT Coverage
By Matt O’Connor | July 27, 2020
The Medical Imaging & Technology Alliance on Monday applauded federal lawmakers for ensuring veterans, service members and their families have permanent access to top breast screening exams.
U.S. House members included an amendment mandating Tricare beneficiaries receive permanent coverage for digital breast tomosynthesis in a recently passed National Defense Authorization Act for fiscal year 2021. DBT has proven to be more effective than traditional mammography, notably in the millions of women with dense breasts, MITA said in a July 27 statement.
“America’s active duty service members and their families deserve access to the same advanced screening diagnostics as those with private insurance, Medicare, and Medicaid,” said the group’s Executive Director Patrick Hope. “With the inclusion of this amendment in the 2021 NDAA, lawmakers continue the bipartisan practice of putting U.S. service members’ health and wellbeing first.”
This amendment follows numerous Congressional efforts seeking to expand DBT screening to service members. In particular, last November, Senator Martha McSally, R-Ariz., and Representative Chrissy Houlahan, D-Pa., successfully lobbied the Department of Defense to approve provisional coverage for such exams. The vote, however, meant coverage could be yanked at any time and would last only five years.
“Service members and their families sacrifice so much and deserve the best healthcare and technology available,” McSally said in a Nov. 2019 statement. “There is simply no good reason to deny DBT screening, the latest breast cancer imaging technology, to Tricare patients.”
To read more, go to Health Imaging.
Subspecialists Must Maintain General Radiology Skill Set Ahead of Future Crises, Experts Say
By Marty Stempniak | July 27, 2020
Subspecialist radiologists must maintain a jack-of-all-trades skill set to help address future crises, experts argue in a new opinion piece.
In small private practices, that is typically the case, with physicians interpreting all sorts of studies. But in larger academic medical centers, it is common for radiologists to spend entire careers never deviating from their narrow expertise.
However, two imaging experts from UCLA and the University of British Columbia pushed peers to broaden their focus to help out during future crises, as the current pandemic has forced many docs to do. In a commentary published Sunday in Clinical Imaging, they urged all radiologists to equip themselves to interpret general studies in the acute care setting.
“…It is important for healthcare providers to maintain versatility and do some level of cross-training that may allow them to cover for others in times of need,” Arvind Vijayasarathi, MD, MBA, and Faisal Khosa, MD, MBA, with the UCLA Department of Radiology and UBC Faculty of Medicine, respectively, wrote July 26. “For radiologists, at a minimum, we should be ready and able to handle the challenge of interpreting diagnostic imaging outside of our chosen subspecialty.”
The pair offered several suggestions to remedy this situation, including: creating case conferences among different radiology sections, promoting continuing medical education, mentoring, or using machine learning to aid subspecialists operating outside their expertise.
“Perhaps even more importantly, departments should incentivize subspecialty radiologists to maintain their general skillset by offering internal moonlighting opportunities in acute care imaging settings,” the authors concluded. “By providing educational resources, clinical support, and financial incentives, academic radiology departments can help ensure that our workforce is better prepared to meet the needs of a future healthcare crisis.”
You can read more of the commentary in Clinical Imaging here.