Radiology Digest: News from the week of April 1, 2022.
Anthem Fined $5M by Georgia Insurance Commissioner
By Mari Devereaux | March 30, 2022 | Included in Radiology Digest – April 1, 2022
The Georgia insurance commissioner is hitting Anthem Blue Cross Blue Shield with a $5 million fine—the largest in agency history— over claims processing errors.
Anthem failed to comply with state laws on a number of occasions between 2015 and 2021, insurance commissioner John King (R) announced Tuesday. Those included improper claims settlement practices, violations of the state Prompt Payment Act, a lack of timely responses to consumer complaints, inaccurate provider directories and provider contract loading delays, according to the regulator.
“My number one priority is protecting Georgia consumers,” King said in a news release. “After numerous complaints made to our office regarding the operations of Blue Cross Blue Shield from individuals, physicians, hospitals and others from around the state, I instructed my staff to conduct an extensive examination into the carrier’s practices.”
Anthem Blue Cross Blue Shield could also incur more penalties if it does not adhere to benchmarks set out in the insurer’s corrective action plan, King said.
In a statement, Anthem Blue Cross Blue Shield said the investigation mainly focused on a database system no longer in use and that the company is working to process and pay claims as quickly and efficiently as possible in accordance with provider agreements and state regulations.
“As the department is aware, we worked diligently to address these challenges,” the company said. “We have since migrated to a new platform with the goal of improving accuracy and transparency. We are dedicated to those we serve and partner with, and we believe the recent enhancements we have made will create an improved overall care provider experience.”
Before the implementation of a replacement provider database system last year, the insurer was out of compliance with timeliness requirements on and off since 2018, according to Georgia.
To read more, go to Modern Healthcare.
Hospitals Hike Prices for Evaluation and Management Services
By Alex Kacik | March 30, 2022 | Included in Radiology Digest – April 1, 2022
Hospital charges for services like emergency department visits and initial hospital care continue to grow faster than other types of care, according to a new study.
Hospitals boosted their median charges for evaluation and management services by 7% and related negotiated rates rose 5%, according to FAIR Health’s analysis of November 2020 to November 2021 high-frequency claims from their database of more than 36 billion claims. Hospital E/M charges and negotiated rates—excluding facility fees—increased the most over that span out of the six categories FAIR Health studied: office E/M services; non-E/M services like psychiatric care, dialysis and immunizations; radiology; surgery; and pathology and laboratory.
Price inflation for hospital E/M services outpaced all other categories the not-for-profit research firm studied for the fifth-consecutive year. Related median charges jumped 6% and negotiated rates ballooned 10% from November 2019 to November 2020.
“It will be interesting to see what extent things will change, like with what we saw with the No Surprises Act,” said Robin Gelburd, president of FAIR Health.
The No Surprises Act aims to curb healthcare costs by protecting patients from surprise bills, like when someone is unexpectedly charged for an out-of-network specialist in an in-network facility. The site-neutral payment policy, where Medicare pays hospital-based outpatient departments and independent physician offices the same rate for E/M services, and the price transparency rule have similar goals. Yet, many hospitals are not complying with the transparency mandate.
In addition to federal law, there have been an array of state-led interventions that look to hold health systems in check through price caps and cost growth benchmarks. But many of these endeavors have yet to meaningfully limit annual price hikes, policy experts said.
To read more, go to Modern Healthcare.
US Senate Passes Bill to Bolster Access to Breast Cancer Screening Services and Related Care
By Marty Stempniak | March 29, 2022 | Included in Radiology Digest – April 1, 2022
The U.S. Senate has unanimously passed a bill to bolster access to breast cancer screening and any related care.
Lawmakers approved the Making Advances in Mammography and Medical Options (MAMMO) for Veterans Act on Thursday, March 24, sending it to the House for consideration. If approved, it would require Veterans Affairs to develop a plan to improve breast imaging services and create a telemammography pilot program for vets in geographies without traditional offerings.
Bill co-sponsor Sen. Mazie Hirono, D-Hawaii, said Congress has an obligation to keep service members safe and healthy.
“As the share of veterans who are women continues to rise, fulfilling that duty means strengthening the VA’s ability to identify, treat and defeat breast cancer,” she said in a statement. “The MAMMO for Veterans Act takes important steps toward that goal by increasing access to testing for individuals in rural areas, making upgrades to VA’s infrastructure, and fundamentally changing the department’s approach to breast cancer testing and treatment.”
To read more, go to Radiology Business.
Accelerated Health Spending Expected Through 2030 as COVID Impacts Lessen
By Anastassia Gliadkovskoskaya | March 28, 2022 | Included in Radiology Digest – April 1, 2022
National health spending is expected to grow 4.9% annually over the next three years and 5.3% from 2025 to 2030, according to the latest estimates from the Centers for Medicare & Medicaid Services (CMS).
This is expected to be driven in part by higher drug price growth and new pharmaceutical launches.
National health spending growth is expected to be more than 4% for 2021, at $4.3 trillion. That figure compares to nearly 10% growth in 2020, driven by large inflows of government funding related to the pandemic. Healthcare utilization is expected to rebound in 2021 and normalize through 2024, by which time the government share of health spending is expected to fall to 46%. (It was at a record-high 51% in 2020.)
Economic growth is expected to outpace health spending growth in the next few years but reverse between 2025 and 2030. This will result in healthcare’s share of the economy being nearly identical to that in 2020, at 19.6%.
“As far as understanding directional changes—it’s really a matter of context,” said Andrea Sisko, an economist at the CMS Office of the Actuary, in a webinar for media Monday. Though growth is expected to slow in 2023 and 2024, she added, “that’s relative to the pandemic effects and certainly growth is actually higher than what you see in 2019.”
“While there is still considerable uncertainty around the COVID-19 pandemic, its related health and economic impacts are projected to lessen in the next few years,” John Poisal, deputy director for the National Health Statistics Group in CMS, said in an announcement. “From 2025 onward, we expect economic and demographic factors to reemerge as the most influential drivers of health sector spending trends.”
Declining federal COVID-19 funding in 2021 is expected to have contributed to slower hospital and physician and clinical services spending growth. These rates, however, are expected to accelerate significantly in 2022 as demand for services picks back up. Hospital price growth is also expected to accelerate amid rising labor and other costs. Growth rates are expected to stabilize between 2025 and 2030.
To read more, go to Fierce Healthcare.
‘Dramatic’ Rise in Image-guided Procedures Performed by NPs and PAs Rather Than Radiologists
By Marty Stempniak | March 28, 2022 | Included in Radiology Digest – April 1, 2022
There has been a dramatic rise in nurse practitioners and physician assistants performing certain image-guided procedures, according to an analysis published Thursday. In particular, NPs and PAs have grabbed a growing share of Medicare reimbursement for the removal of fluid or gas from the lungs (thoracentesis) and abdomen (paracentesis).
Radiologists performed the majority of ultrasound-guided thoracentesis at nearly 74% in 2013. But their total share fell to 66% by 2018, during a time when advanced practice providers saw their share rise leap from 8% up to nearly 13%.
“The most striking trend in this study is the dramatic increase in volume of these procedures performed by APPs, which approximately doubled over the study period,” Rajoo Dhangana MD, a professor and interventional radiologist with the University of Pittsburgh Medical Center, and co-authors wrote March 24. “The great acceleration of this trend in the past decade, demonstrated in the present study, follows a national trend of increasing participation of APPs in clinical care, specifically in minimally invasive procedures,” they added later.
Researchers gathered their data from 2012-2018 Medicare claims for procedures performed with and without imaging guidance. Such “blind” delivery of thoracentesis decreased nearly 44% during the study period, down to 15,000 procedures in 2018. Meanwhile, the volume of imaging-guided needle insertion into the pleural space around the lungs climbed 19%, up to almost 223,000 during the same time.
To read more, go to Radiology Business.
4 Healthcare Items to Watch in Biden’s Budget Proposal
By Paige Minemyer | March 28, 2022 | Included in Radiology Digest – April 1, 2022
The White House has released its proposed budget for fiscal year 2023, and it highlights multiple healthcare priorities for the administration.
During a briefing with reporters Monday, Department of Health and Human Services (HHS) Secretary Xavier Becerra said the budget reflects the agency’s willingness to take on the industry’s most difficult challenges.
“Done right, [budgets] turn hardship into hope, opportunity into inclusion,” Becerra said.
Here’s a look at a few of the healthcare focuses included in the budget proposal:
Investment in pandemic preparedness
The budget calls for $81.7 billion in investment over the course of five years to plan ahead for any future pandemics in the wake of COVID-19. The funding would “catalyze advances in science, technology and core capabilities” to leave the country better prepared for a future biological threat, according to the request.
The funding request includes $12.1 billion for the National Institutes of Health to research vaccines and therapies for high priority biological threats as well as research to prevent biological incidents. The budget would also allocate $40 billion to the Office of Assistant Secretary for Preparedness and Response for similar initiatives.
The Food and Drug Administration would receive $1.6 billion for enhanced capacity to address potential biological threats under the proposed budget.
To read more, go to Fierce Healthcare.
Hospitals Urge HHS to Renew Public Health Emergency
By Kelly Gooch | March 28, 2022 | Included in Radiology Digest – April 1, 2022
Hospitals are calling for a renewal of COVID-19 as a public health emergency.
In a March 28 letter to HHS Secretary Xavier Becerra, national healthcare associations cited ongoing concerns about vulnerable populations, including children younger than 5 and the immunocompromised, who cannot be vaccinated, as well as the potential for additional surges. The groups also cited challenges hospitals continue to face.
“Our members continue to face challenges related to workforce shortages and staff burnout, continuing disruptions in the supply chain leading to shortages of supplies and a need for further clinical guidance regarding the symptoms of and best course of treatment for long COVID-19 patients,” the letter said. “In addition, our hospitals and health systems are increasingly caring for patients with a variety of health needs for which care had to be delayed due to the pandemic.”
The letter urged HHS to renew the COVID-19 public health emergency because the groups said it provides flexibility and resources to hospitals to respond to COVID-19, while best serving patients. The current public health emergency is set to expire April 15.
The letter is signed by America’s Essential Hospitals; the American Hospital Association; the Association of American Medical Colleges; the Catholic Health Association of the United States; the Children’s Hospital Association; the Federation of American Hospitals; the National Association for Behavioral Healthcare; Premier healthcare alliance; and Vizient.
In February, more than 70 House Republican lawmakers signed a letter calling for an end to the public health emergency.
To read more, go to Beckers Hospital Review.
DBT Coverage Mandates Increase Use But Have No Impact on Patients’ Out-of-pocket Costs
By Marty Stempniak | March 28, 2022 | Included in Radiology Digest – April 1, 2022
Digital breast tomosynthesis coverage mandates appear to increase use of the technology but have little impact on out-of-pocket costs, according to research published Friday in JAMA Network Open.
DBT has supplanted standard, two-dimensional mammography as the standard of care during the past decade, given its higher sensitivity and impact on breast cancer screening callbacks. However, without a federal requirement to reimburse for the exam, some private payers have been slow to cover DBT, instead labeling it as elective.
Seventeen states have enacted their own mandates to address this. Yale School of Medicine experts recently set out to examine the impact of such laws, with their analysis unearthing mixed results.
“State-level mandates requiring coverage for screening DBT were associated with meaningful increases in DBT use and relative reductions in DBT price,” Ilana Richman, MD, a professor and general internist with the New Haven, Connecticut institution, and co-authors concluded. “Our findings overall suggest that mandates may encourage DBT use but also may have more complex implications for the associations among technology adoption, price and value.”
To read more, go to Radiology Business.
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