Radiology Digest – September 15, 2021

September 29, 2021

Radiology Digest: News from the week of September 15, 2021.

Over Half of States Have Rolled Back Public Health Powers in Pandemic
By Lauren Weber & Anna Maria Barry-Jester | September 15, 2021 | Included in Radiology Digest – September 15, 2021

Republican legislators in more than half of U.S. states, spurred on by voters angry about lockdowns and mask mandates, are taking away the powers state and local officials use to protect the public against infectious diseases.

A KHN review of hundreds of pieces of legislation found that, in all 50 states, legislators have proposed bills to curb such public health powers since the covid-19 pandemic began. While some governors vetoed bills that passed, at least 26 states pushed through laws that permanently weaken government authority to protect public health. In three additional states, an executive order, ballot initiative or state Supreme Court ruling limited long-held public health powers. More bills are pending in a handful of states whose legislatures are still in session.

In Arkansas, legislators banned mask mandates except in private businesses or state-run health care settings, calling them “a burden on the public peace, health, and safety of the citizens of this state.” In Idaho, county commissioners, who typically have no public health expertise, can veto countywide public health orders. And in Kansas and Tennessee, school boards, rather than health officials, have the power to close schools.

President Joe Biden last Thursday announced sweeping vaccination mandates and other Covid measures, saying he was forced to act partly because of such legislation: “My plan also takes on elected officials in states that are undermining you and these lifesaving actions.” All told:

  • In at least 16 states, legislators have limited the power of public health officials to order mask mandates, or quarantines or isolation. In some cases, they gave themselves or local elected politicians the authority to prevent the spread of infectious disease.
  • At least 17 states passed laws banning Covid vaccine mandates or passports, or made it easier to get around vaccine requirements.
  • At least nine states have new laws banning or limiting mask mandates. Executive orders or a court ruling limit mask requirements in five more.

To read more, go to Kaiser Health News.

New Data Show ‘Unequivocal Support’ for LDCT Screening Patients at Risk of Lung Cancer
By Matt O’Connor | September 14, 2021 | Included in Radiology Digest – September 15, 2021

Newly released data on low-dose CT screening shows the practice can significantly reduce lung cancer mortality, researchers underscored recently.

U.K. experts performed a meta-analysis of nine international randomized controlled trials, including the National Lung Screening Trial and the NELSON trial. Both have shown LDCT screening for lung cancer can reduce deaths by 20% and 24%, respectively.

Adding their data from more than 4,000 patients at high risk of developing cancer over the next five years, the team found screening could reduce mortality by up to 16%. And a majority were diagnosed at stage 1, meaning many patients could have undergone potentially successful treatment.

John K. Field, PhD, with the University of Liverpool’s Department of Molecular and Clinical Cancer Medicine, and co-authors shared their findings Sept. 11 in The Lancet Regional Health-Europe.

“The added value of this manuscript has been to enhance our knowledge of lung cancer CT screening, including effects on mortality (lung cancer mortality and all-cause mortality), as well as on [the] stage of the disease and on pulmonary nodule classification,” Field et al. noted. “The associated meta-analysis, which includes the UKLS trial, provides the most up to date international view of lung cancer mortality in lung cancer CT screening studies.”

The team enrolled 4,055 patients with a single LDCT screening visit or usual care (no screening) between October 2011 to February 2013. In total, 3,968 participants were eligible, and the primary outcome was cancer mortality.

After a median follow-up of 7.3 years, 30 of 1,987 participants in the LDCT group died of lung cancer compared to 46 of the 1,981 in the non-screened cohort. Additionally, 61% of cases were found at stage 1, and surgery to remove the disease could have been scheduled in 83% of cases.

Fields and co-investigators noted risk model-based screening programs are “well underway” in the U.K., reaching participation levels near 40%-53%. But despite Medicare funding LDCT programs in the U.S., uptake remains low, at around 4%.

To read more, go to Health Imaging.

Biden to Toss Medicare Coverage for “Breakthrough” Technology
By Michael Brady | September 13, 2021 | Included in Radiology Digest – September 15, 2021

The Centers for Medicare & Medicaid Services wants to repeal a Trump-era rule allowing Medicare to cover medical devices designated as “breakthrough” technology by the Food and
Drug Administration, according to a proposed rule on Monday.

Former President Donald Trump’s administration had said the original rule was necessary because the existing Medicare coverage determination process is too slow and could delay beneficiaries’ access to the latest medical technology.

Medical device companies lauded the plan when CMS first announced it last year. But patient-safety groups like ECRI worried it could threaten the safety of Medicare patients. Other experts agreed, and now CMS does too.

“While the rule tried to address stakeholder concerns about accelerating coverage of new devices, significant concerns persist about the availability of clinical evidence on breakthrough devices when used in the Medicare population as well as the benefit or risks of these devices with respect to use in the Medicare population upon receipt of coverage,” the proposed rule says.

The Biden administration hinted that it could decide to cover breakthrough devices in the future but that it must ensure the safety of Medicare beneficiaries.

“We believe it is important to evaluate how a device works for Medicare patients. This includes a potential decision to cover a device under Medicare in the context of collecting additional evidence (e.g., by requiring clinical trials or outcome registries) before broadly covering the device in the Medicare program,” CMS said in a news release. “Seniors and people with disabilities who make up the Medicare population often have complex medical needs and unique health considerations compared to other patient populations. This can change the potential risks and benefits of a new device for Medicare patients, specifically.”

The Trump administration claimed the original rule would encourage more innovation by streamlining Medicare coverage of new devices. Under the current system, Medicare Administrative Contractors—16 in total—decide whether to cover a device within their region. Device makers must apply separately to each contractor to get coverage approval.

Trump’s CMS approved the original rule in January, shortly before President Joe Biden took office. It was slated to take effect in March, but the agency delayed its implementation until December 15 to give the president’s team more time to review it.

Comments on the Biden administration’s proposal to withdraw the Trump-era regulation are due October 15.

To read more, go to Modern Healthcare.

50 Lawmakers Join ‘Overwhelming’ Opposition Against Wage Update that Will Gash Radiologist Pay
By Marty Stempniak | September 10, 2021 | Included in Radiology Digest – September 15, 2021

Fifty U.S. lawmakers have now joined building opposition against a policy change advocates say will lead to plummeting pay for radiologists and radiation oncologists.

Reps. Bobby Rush, D-Ill., and Gus Bilirakis, R-Fla., recently started circulating a “dear colleague” letter in opposition to planned wage increases for clinical labor staffers. Weeks later, the campaign has garnered growing support from dozens of bipartisan representatives in the U.S. House.

Meanwhile, a coalition of medical-related organizations has formed to fight the change. Participants include the American College of Radiology, Society of Interventional Radiology and American College of Radiation Oncology. The United Specialists for Patient Access also has joined the coalition, announcing its involvement in a Sept. 9 update.

“Successive, cumulative cuts to specialists under the [physician fee schedule] are resulting in reimbursement ever more out of touch with actual resource needs as well as increased healthcare consolidation and healthcare costs, greater health inequities, and a healthcare system unable to meet the challenges of an ongoing pandemic,” the 16 groups said in a Sept. 7 letter to the Centers for Medicare & Medicaid Services.

CMS first revealed the change as part of its 2022 Medicare fee schedule released in July. The agency is aiming to update wages for clinical labor staffers such as mammography
technologists or angiography techs. But these practice expense components are subject to budget neutrality, meaning increased spending in one place requires cuts elsewhere. As such,
interventional radiology, radiation oncology and other specialties with high medical supply costs and lower spending on clinical labor positions could face significant reimbursement reductions next year, experts predict.

The services most impacted by this decision are used to treat diseases that disproportionately impact patients of color, advocates warned. Treatments such as uterine fibroid embolization and endovenous radiofrequency ablation face reductions north of 20%. In their own separate letters, both the Society of Interventional Radiology and the American College of Radiation Oncology predicted these wage updates would lead to practice closures in 2022.

To read more, go to Radiology Business.

Providers Predict Radiology Practice Closures If CMS Fails to Fix Medicare Fee Schedule
By Marty Stempniak | September 9, 2021 | Included in Radiology Digest – September 15, 2021

Providers are predicting possible practice closures if the Centers for Medicare & Medicaid Services fails to address looming cuts in the 2022 physician fee schedule.

With the calendar flipping in less than four months, CMS is set to increase wages for clinical labor staffers such as mammography technologists. But under balanced-budget requirements, rising spending in one place necessitates cuts elsewhere. Interventional radiologists and radiation oncologists—with high medical supply costs and lower spending on clinical labor positions—are slated to bear the brunt, and they’re not happy about it.

In a Wednesday letter to the federal agency, the Society of Interventional Radiologists highlighted 13% aggregate pay reductions across all IR treatments. Some services in office based settings will sustain decreases of more than 20%.

“As a result, the profound cuts will negatively affect health equity in communities who have already been particularly hard hit by the COVID-19 pandemic,” society President Matthew Johnson, MD, a professor of radiology research at Indiana University’s School of Medicine, said in a statement. “We must protect patients’ access to that crucial care and prevent private practices from closing down, especially in underserved areas,” he added later.

In its own letter to CMS, the American Society for Radiation Oncology estimated the specialty will absorb $300 million in Medicare cuts Jan. 1, if the feds fail to act. Radiation oncologists
are facing a double whammy of $140 million in reductions from the fee schedule, along with $160 million more from the controversial mandatory bundled payment model. Rates for certain breast and prostate cancer treatments would fall 13%, while advanced lung cancer offerings are expected to dip 22%.

“This double hit will be devastating to our patients and radiation oncology teams, endanger patient access to lifesaving treatment and threaten the viability of clinics still reeling from the COVID-19 pandemic,” ASTRO said Sept. 9. “We are confused and disappointed that these proposed policies stand in such sharp contrast to President Biden’s goals to ‘end cancer as we know it’ and advance health equity,” it added.

SIR and others are urging CMS and Congress to “reverse the cuts,” suspend sequestration, extend a 3.75% pay bump enacted in late 2020, and either avoid labor pricing changes (or phase them in over four years). You can read the full interventional society letter here and ASTRO’s here.

To read more, go to Radiology Business.

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