Congress Members Want Screws Tightened on Radiology Providers who Ignore Price Transparency Rule
By Marty Stempniak | April 15, 2021
Lawmakers want Health and Human Services to tighten the screws on providers who are ignoring a new price transparency rule that took effect Jan. 1.
The legislation requires hospitals to provide upfront pricing for certain “shoppable” services — including 13 specified radiology exams — to help patients find the best deal. First finalized in November 2019, officials delayed implementation to give providers more time to prepare.
However, a recent Health Affairs analysis found that 65 of the country’s 100 largest hospitals were “unambiguously noncompliant” with the law. Taking umbrage with the findings, members of the House Committee on Energy & Commerce want HHS Secretary Xavier Becerra to punish laggards.
“We are concerned about troubling reports of some hospitals either acting slowly to comply with the requirements of the final rule, or not taking any action to date to comply,” bipartisan members of the committee wrote April 13. “We urge you to ensure that that the Department of Health and Human Services conducts vigorous oversight and enforces full compliance with the final rule.”
Chairman Frank Pallone Jr., D-N.J., and colleagues want HHS to “revisit its enforcement tools” to boost compliance. Possible responses could include hospital audits and civil monetary penalties, they wrote.
The Hospital Price Transparency Final Rule stipulates that providers must make public a machine-readable file that contains a list of standard costs for its items and services. That includes displaying charges for the hospital’s 300 most shoppable services in a consumer-friendly format, the committee noted. CMS has specified 70 of the services, with more than a dozen in imaging, such as MRI scans of leg joints or X-rays of the lower back. A Wall Street Journal investigation recently found that some hospitals have used special embedded coding to block information from appearing on search engines. Others have buried price details under layers of webpages, House representatives noted.
Committee members are requesting a staff briefing with HHS on the final rule to learn more about how the agency is auditing hospitals.
You can read their full letter to Becerra here.
Coalition Urges CMS to Rethink Medicare Prior Authorization Growth
By Jacqueline LaPointe | April 14, 2021
A broad coalition of healthcare industry groups is calling on CMS to reconsider Medicare prior authorization growth among outpatient services set to go into effect this summer.
The 40 groups representing a range of clinicians and medical technology providers—and including industry heavy-hitters like the American Medical Association (AMA), Healthcare Financial Management Association (HFMA), and American College of Surgeons—sent a letter to Acting CMS Administrator Liz Richter voicing strong opposition to prior authorization expansion recently finalized in Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rules.
First, the calendar year (CY) 2020 final rule established a nationwide prior authorization process for five hospital outpatient department services that have cosmetic purposes in addition to therapeutic indications. The process went into effect on July 1, 2020.
Months later, the CY 2021 final rule expanded prior authorization to two new services categories—cervical fusion with disc removal and implanted spinal neurostimulators. These prior authorization processes are slated to go into effect this July 1st.
“We continue to have serious concerns that beneficiaries will experience significant barriers to access to medically necessary procedures as a direct result of the CY 2021 policy,” the coalition stated in the letter.
“We also worry that future expansions of prior authorization will unnecessarily delay access to care for even more beneficiaries and add administrative and cost burden for providers unless appropriate and transparent regulatory processes are established,” the letter continued.
The prior authorization growth via OPPS/ASC final rules has garnered significant criticism from both healthcare industry groups and lawmakers.
Last year, a group of 50 bipartisan Congress members had written to then-CMS Administrator Seema Verma urging her to not finalize prior authorization growth in the CY 2021 OPPS/ASC final rule.
To read more, go to Revcycle Intelligence.
Who Will Be Liable in The Coming AI Age? 4 Things for Radiologists to Know
By Matt O’Connor | April 13, 2021
Artificial intelligence solutions are gaining steam across imaging practices and radiologists must familiarize themselves with the current legal landscape as the technology continues to evolve.
That’s according to a new perspective piece published by Harvard law and radiology experts April 9 in Skeletal Radiology. As it stands, there is very little legal precedent involving medical imaging AI, and radiologists, their practices and developers all face different risks, the group noted.
Taking both a legal and clinical perspective, the pair outlined key fundamentals of AI liability as they relate to musculoskeletal imaging.
8 Tips to Help Radiologists Communicate with Patients and Physicians
By Matt O’Connor | April 12, 2021
Traditionally, the bulk of radiologists’ interactions have been with referring providers via the written radiology report. But those practicing in today’s healthcare environment must learn to communicate directly with other doctors, patients and radiology team members.
And the specialty’s move toward value- and patient-centered care only emphasizes the need for more effective communication, a group of five radiologists explained April 10 in Academic Radiology. Top imaging advocates and educational groups have also emphasized these skills, but many rads still lack the necessary exposure.
“Despite the importance given to communication by the Accreditation Council for Graduate Medical Education, the American Board of Radiology and the ACR, trainees may not receive formal education to develop and/or improve their communication skills,” Judah Burns, MD, with Montefiore Medical Center’s Department of Radiology, and colleagues added.
Below are tips for radiologists to help develop their gift of gab:
Microsoft to Acquire Radiology Vendor Nuance in $19.7B Deal
By Marty Stempniak | April 12, 2021
Microsoft has reached an agreement to purchase radiology vendor Nuance Communications in a deal valued at $19.7 billion, the two announced Monday morning.
The Redmond, Washington-based tech giant was reportedly the highest bidder for Nuance, which sells solutions for sharing medical images and processing radiology reports using artificial intelligence.
Microsoft officials said the latter was a key part of its decision to acquire the Burlington, Massachusetts-based company.
“Nuance provides the AI layer at the healthcare point of delivery and is a pioneer in the real-world application of enterprise AI,” CEO Satya Nadella said April 12. “AI is technology’s most important priority, and healthcare is its most urgent application. Together, with our partner ecosystem, we will put advanced AI solutions into the hands of professionals everywhere to drive better decision-making and create more meaningful connections, as we accelerate growth of Microsoft Cloud for Healthcare and Nuance.”
Mark Benjamin will remain chief executive of Nuance following the deal, reporting to Scott Guthrie, executive VP of cloud and AI at Microsoft. Nuance also makes solutions outside of healthcare, including virtual assistants and biometric solutions. Its technology is currently used by 55% of all physicians in the country, 75% of radiologists, and 77% of all U.S.
Hospitals. Acquiring the company will double Microsoft’s total addressable market in the healthcare provider space, climbing to nearly $500 billion, officials said.
The two said they hope to close the transaction by the end of 2021, subject to regulatory approval and a vote by Nuance’s shareholders. Microsoft’s board of directors, meanwhile, already gave its unanimous blessing.
Bloomberg first reported news of the transaction over the weekend.
To read more, go to Radiology Business.
Many Women Willing to Pay More for Screening MRI, Particularly Those with Dense Breasts
By Matt O’Connor | April 9, 2021
Most women are not satisfied with only undergoing mammography to screen for breast cancer and many are willing to pay more out of pocket for other imaging exams, according to survey results published Friday.
In fact, out of nearly 1,000 patients scheduled for a mammogram, only 34.7% were content with their breast screening plan. And more than half were willing to shell out at least $250-$500 for an MRI exam, particularly those with dense breasts, researchers reported April 9 in Academic Radiology.
Breast MRI and contrast-enhanced mammography (CEM) are primarily used in high-risk women due to their enhanced sensitivity, yet adverse contrast reactions, false positives and unnecessary biopsies are all known downsides to using these techniques.
But it appears women, at least at this single institution, aren’t concerned with these risks.
“Prior to our study, little was known whether asymptomatic patients in the general screening population would accept the associated downsides and risks related to contrast-enhanced imaging despite improved cancer detection compared to conventional mammography,” Daniel Son, MD, and co-authors with the Division of Breast Imaging at Beth Israel Deaconess Medical Center and Harvard Medical School explained.
To reach their conclusions, Son et al. surveyed all patients undergoing screening mammography at their institution between December 27, 2019, and March 6, 2020. In total, 1,011 of the 1,349 individuals completed the questionnaire.
More than half reported having dense breasts and of those, 49.6% had been called back, 29% had a benign biopsy and 13.7% a prior CEM/MRI.
Below are additional findings.
• A majority of women were neutral or not concerned with the risks and downsides of contrast-enhanced imaging, including radiation exposure (70.3%), contrast reaction (75.4%), IV line placement (82.2%), claustrophobia (67.4%), and false positives (70.7%).
• Patients were even less concerned with an allergic reaction, IV, and claustrophobia if they had undergone a prior breast MRI or CEM exam.
• Those who had a previous benign biopsy or MRI/CEM exam weren’t as worried about false positives as much as others.
• Patients with dense breasts were less satisfied with mammography screening and more willing to pay out of pocket for MRI. Furthermore, 10.3% said they would pay $500-$1,000.
To read more, go to Health Imaging.