|What’s Next for Payer Price Transparency: 5 Things to Know|
By Rylee Wilson | April 19, 2023
Payers have been required to post all of their negotiated rates in publicly available files since July 2022, and most have done so, according to Turquoise Health.
The company, which develops price transparency software, published its first quarter “Payer Transparency Impact Report” on April 18.
Here are five things to know about payers’ price transparency from the report:
1. Chris Severn, CEO of Turquoise Health, told Becker’s the biggest misconception about price transparency data is that it is unusable. Though payer price transparency data files are large, they are usable, according to Turquoise Health’s report. The company gave 159 payers top scores for accessible file sizes in the impact report.
2. Payer data came online quicker than hospital transparency data, according to Turquoise Health. The organization has reviewed data for at least 183 payers, up from 68 in July 2022, when price transparency requirements for insurers first took effect. “In contrast to the hospitals, payers really acted pretty quickly,” Mr. Severn said. “We’re about 10 months in, and in the first quarter of compliance, you saw most of the big payers publish files. I’d say there was a speed to action that was a stark contrast to that of hospitals.”
3. It is more difficult to assess the completeness of payers’ price transparency files than hospitals. It is difficult to know the true size of payers’ networks and every service that should be included, according to Turquoise Health’s report. Some payer files may be missing provider rates, or certain states, but still be valuable overall, Mr. Severn said. “Maybe there are gaps that are artifacts or bugs of the generation process, but let’s not be so quick to dismiss an entire payer’s publication, just because we brought up one rate that doesn’t look right to us,” he said.
4. Turquoise Health’s site that helps consumers compare rates had five times as many visits in 2022 than 2021, according to the impact report. Another indicator more consumers are using data is the proliferation of startup companies creating price transparency tools, Mr. Severn said.
5. Major health systems and payers are using price transparency data for negotiations, and it’s shaking up the process, Mr. Severn said. “It feels a little bit like folks are playing chess in the dark. We’ve just turned the lights on. That’s all that happened,” Mr. Severn said. “I think a lot of the moves, historically, have been a bit aimless. When the lights are turned on, you notice ‘Wait, what are we doing here? This doesn’t make any sense.’ “All the major health systems and payers are using this data for negotiations. The conversations are more data driven now, and also a bit awkward,” he added. “Because, this is the first reckoning of hyper-granular negotiated rates data, so it’s going to have a huge impact. It already is.”
To read more, go to Becker’s Payer Issues.
New Partnership Increases Radiology’s Presence Within the FDA’s Network of Experts
By Hannah Murphy | April 19, 2023
The Radiological Society of North America is joining the U.S. Food and Drug Administration’s Network of Experts.
RSNA made the announcement on Tuesday, April 18, indicating enthusiasm for the opportunity to share the renowned society’s expertise. The Network of Experts is a vetted group consisting of more than 100 organizations and their respective scientists, clinicians and engineers who provide guidance and expertise to the FDA when requested.
RSNA’s involvement in the program will come by way of its Government Relations Committee, which will refer members of its network to the FDA when their expertise is needed. RSNA will be available to consult with the FDA on various matters relative to radiologic science, medical devices and pharmaceuticals under the Center for Devices and Radiological Health and the Center for Drug Evaluation and Research (CDER).
“By joining the FDA Network of Experts, RSNA leaders in technology and innovation will have the opportunity to share their voice, experience and depth of knowledge in ways that are critically important for our patients,” said Pari V. Pandharipande, MD, MPH, RSNA board liaison to the Government Relations Committee. “Equally, the insights gained will further enhance our community’s knowledge of best practices in the successful development and dissemination of cutting-edge imaging technologies at the population level. We are excited and grateful for this important collaborative opportunity.”
RSNA joins other radiology-related organizations in the Network of Experts Program, including the American College of Radiology, American Society of Neuroradiology, American Society of Radiation Oncology, Radiation Research Society, Society of Breast Imaging and the Society of Interventional Radiology.
To view the entire list of organizations participating in the program, click here.
To read more, go to Health Imaging.
4 Policy Levers Politicians Can Pull to Address Private Equity’s Growing Interest in Radiology
By Marty Stempniak | April 18, 2023
As private equity continues to buy up practices in radiology and other specialties, two physicians are offering possible policy solutions to increase scrutiny.
Such investors acquired nearly 7,000 healthcare entities between 2014-2021. But only 0.1% of those firms faced False Claims Acts settlements, editorialists wrote Friday in JAMA . During a time when PE acquisitions in medicine leapt 167%, the number of full-time positions at the Federal Trade Commission climbed only 1%.
Harvard Medical School experts believe regulators need more firepower to begin better understanding the impact of such trends.
“As evidence emerges on the clinical and economic consequences of these buyouts, federal and state policy makers have begun exploring ways to improve oversight and regulation in this space,” Christopher Cai, MD, and Zirui Song, MD, PhD, wrote April 13. “To date, however, a framework for potential policy responses to this growth in private equity ownership remains lacking.”
The two physicians listed three reasons why PE deals in medicine warrant closer examination: (1) The emphasis on rapid returns during a five- to 10-year timeline may lead to price increases and an unnecessary uptick in volume. Among nearly 580 physician groups acquired by PE over a four-year period, prices leapt 11% while volume increased 16%, one study found. (2) PE can introduce new financial risk into medicine, taking on massive amounts of debt and attaching it to the acquired entity rather than the investment firm. Across all sectors including healthcare, companies acquired through a leveraged buyout are 10 times more likely to go bankrupt, another study found. (3) These firms benefit from special tax and regulatory privileges and are subject to less regulatory oversight than their publicly traded counterparts.
Cai and Song suggested four possible policy levers to pull to increase oversight: Expanding regulatory reviewLimiting moral hazardImproving transparencyProtecting providers and patients.
To read more, go to Radiology Business.
Physicians Who Accept Medicare, Medicaid Patients at All-time Low of 65%
By Andrew Cass | April 17, 2023
Reduced Medicare and Medicaid payments are having more physicians considering reducing those patient bases, according to Medscape’s “Physician Compensation Report” for 2023.
Sixty-five percent of physicians surveyed said they would continue treating current Medicare or Medicaid patients and take on new ones, according to the report. Medscape said it is the lowest percentage it has seen in its annual compensation reports. Five years ago, 71 percent of physicians said they would continue treating current Medicare or Medicaid patients and take on new ones.
For the report, Medscape collected responses from 10,011 physicians across more than 29 specialties. The data was collected between Oct. 7, 2022, and Jan. 17, 2023.
Eight percent of physicians surveyed said they would not take on new Medicare patients, and 5 percent said they would not take on new Medicaid patients.
Four percent said they will stop treating some or all of their current Medicare patients and will not take on new ones, and 3 percent said the same about Medicaid patients.
Twenty-two percent said they have not yet decided how they will move forward regarding Medicare and Medicaid patients, according to the report.
To read more, go to Becker’s Payer Issues.
Dangerous Scope-of-Practice Bills Fail, While ACR Joins Puerto Rican Radiologists in Another Fight
By Marty Stempniak | April 17, 2023
Two “dangerous” scope-of-practice bills were recently defeated in one eastern state, while the American College of Radiology has joined Puerto Rican physicians in another battle farther south.
Maryland lawmakers were proposing legislation in the state’s House and Senate to allow physician assistants to “perform X-ray duties” without a license or supervision, ACR reported Friday. However, the proposals—opposed by the Maryland Radiological Society—failed to advance in the latest legislative session, with lawmakers now adjourning for the year.
“The MRS and ACR value the commitment of physician assistants to the team-based model of care and greatly respect the contributions physician assistants make to the healthcare team. However, we do not believe their education and training prepare them to independently oversee patient care,” the two professional associations wrote in a March 14 letter to the head of the Maryland Senate Finance Committee. “The MRS and ACR are deeply concerned that [Senate Bill] 673 eliminates physician-led teams.”
Meanwhile, ACR also has teamed with the Radiological Society of Puerto Rico in another scope-of-practice battle. Lawmakers are proposing to allow general practitioners—with 10 years of uninterrupted full-time service in an emergency department—to be granted certification as radiologists or other medical specialists. The move is meant to help address a shortage of providers on the island.
Such practitioners are not subject to the same rigorous 13 years of training as members of the specialty, the Radiological Society of Puerto Rico and the college noted.
“The SOCRAD and ACR greatly appreciate the contributions and roles that general practitioners make to the entire healthcare system. However, we do not believe that their education and training prepare them to treat patients in Puerto Rico who require specific medical specialties and subspecialty procedures,” leaders of both associations wrote to local lawmakers on April 10. “Patients expect the most qualified person—physician experts with unmatched training, education and experience—to lead and oversee care.”
Earlier this month, ACR also highlighted a third scope-of-practice law change proposed in New Mexico. Senate Bill 412 would have allowed physical therapists to order MRIs to aid them in diagnosis and treatment. But the bill failed to make it past the Senate Judiciary Committee and cannot be considered in New Mexico’s current legislative cycle.
To read more, go to Radiology Business.