Radiologists Ask Congress for $3B to Offset Looming Cuts in Medicare Physician Fee Schedule
By Marty Stempniak | April 29, 2021
Radiologists and other physicians are asking Congress to inject another $3 billion into the Medicare Physician Fee Schedule to offset looming doc pay cuts slated for 2022.
In a letter to lawmakers, 63 medical groups including the Society of Nuclear Medicine and Molecular Imaging and American College of Radiology said the pandemic continues to hamper physician practices. While Congress provided a lifeline in a 2020 year-end spending bill, they’re asking for this “critical investment in the nation’s healthcare infrastructure” to help make physicians whole.
“By maintaining this level of funding—which equates to a 3.75% increase for all payments across the fee schedule—healthcare providers can continue to focus on addressing patient backlogs and continue to identify effective treatments for patients impacted by ‘long-haul’ COVID-19 symptoms,” SNMMI, ACR and numerous others wrote to House and Senate leadership on April 27. “Our medical practices, therapy clinics, and practitioners must remain viable, so our nation can fully recover from this pandemic,” they added.
The Consolidated Appropriations Act passed by Congress back in December partially mitigated the cuts stemming from Medicare coding changes. Congress provided a one-year infusion of $3B to the fee schedule, which lessened the scheduled reduction to the Medicare conversion factor, and delayed implementation of a new add-on code (G2211) for three years, the groups noted. Absent any action, SNMMI and others predict that America’s seniors could face reduced access to care.
Others signing the letter included the Alliance for Quality Imaging, the Radiology Business Management Association, the American Society of Neuroradiology and the Society of Interventional Radiology.
To read more, go to Radiology Business.
Biden Won’t Pull the Plug on Price Transparency, Experts Say
By Michael Brady | April 28, 2021
Experts said that it’s an easy way for the Biden administration to reduce administrative work for providers without giving up much in price transparency. But it probably doesn’t say much about the Biden administration’s thoughts on price transparency, according to Avalere Health consultant Tom Kornfield.
“I wouldn’t read anything more into this than a push for some administrative simplicity,” Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, said in an email.
Price transparency policies concerning Medicare Advantage rate information wouldn’t do much to affect healthcare costs or spending because Advantage plans pay nearly the same rates as Medicare fee-for-service with little variation within or across metro areas, experts said. According to a 2018 study, the average Advantage price per discharge across all hospital stays was $10,667 or nearly identical to the average Medicare fee-for-service price of $10,716.
Price transparency was central to the Trump administration’s healthcare agenda, as CMS included such requirements throughout its policies. And while there continues to be bipartisan support for greater transparency, many experts thought the Medicare Advantage requirements were misguided from the start.
“This was not a well-thought-out policy in the first place. It was really a waste of everybody’s time in the name of transparency,” Federation of American Hospitals CEO Chip Kahn said.
Hospitals strongly opposed the policy, in part, because Trump’s CMS didn’t do a comprehensive analysis of how a market-based pricing approach would affect the diagnosis-related group payment system or explain why it would be beneficial to the healthcare system as a whole, said Joanna Hiatt Kim, vice president of payment policy and analysis for the American Hospital Association.
“CMS was really conflating market-based prices with costs,” she said.
Dan O’Neil, an independent healthcare consultant, said there was a strong ideological belief inside the Trump administration that Advantage plans must be getting better prices than traditional Medicare because they’re market-based.
“But the empirical data says the markets are not really doing anything different or better than Medicare Advantage. They’re taking the same prices. What’s the point of collecting the data when it’s just going to be the same as the number you already know?” he said.
While Advantage plans may offer improved care coordination and management, there’s little evidence they do better on hospital pricing. That’s mainly because Advantage plans are more tightly regulated than typical commercial health plans, which offer little protection against surprise billing. Medicare fee-for-service providers are more willing to accept similar rates from Advantage plans because there are fewer financial rewards to remaining out-of-network since they can’t effectively balance bill patients.
Hospitals are hopeful that the coming surprise billing regulations from CMS will allow the agency to pull back other price transparency requirements that don’t directly help consumers understand their financial obligations, Kahn and Smith said.
To read more, go to Modern Healthcare.
Humana Agrees to Take Second Look at Panned Payment Change Labeling PET/CT as ‘Investigational’
By Marty Stempniak | April 26, 2021
Humana has agreed to take a second look at a much-criticized recent payment policy update labeling PET/CT imaging as “investigational.”
The Louisville, Kentucky-based insurer first announced the change last year, revealing that plan members would not be eligible for positron emission tomography with concurrently acquired computed tomography in many instances. Those included cardiac, gastric, esophageal or neurologic indications, along with total body screening.
Imaging advocates such as the American Society of Nuclear Cardiology adamantly opposed the decision last fall, asking Humana to reconsider. The insurer appears to be listening, with its medical director agreeing to review the policy following a meeting requested by the nuclear cardiology group.
“ASNC expects an update in May after Humana conducts an internal review of the policy. Stay tuned for updates,” it said in a Monday afternoon update to members.
Both the American College of Radiology and Society of Nuclear Medicine and Molecular Imaging have also criticized Humana’s update, which took effect Feb. 4. The insurer supported its revision by asserting that PET/CT is “not identified as widely used or generally accepted” in peer-reviewed, English-language medical literature. Industry advocates have debunked this argument, as other insurers and the American Medical Association have widely accepted recommendations on the use of PET/CT published by SNMMI and others.
“ASNC opposes this decision because these procedures are unequivocally NOT experimental and are indeed widely performed. The majority of PET scanners manufactured today are PET-CT machines,” the society said in a recent blog post.
To read more, go to Radiology Business.
Should Radiologists Discuss Results with Patients?
By Amerigo Allegretto | April 26, 2021
Both patients and primary care physicians (PCPs) reported an increase in how well patients understood their medical conditions following virtual visits with radiologists in a study presented April 22 at the virtual American Roentgen Ray Society (ARRS) meeting.
Researchers from Massachusetts General Hospital said the findings indicate that collaboration between radiologists, primary care physicians, and patients can result in better patient care.
Initiatives led by the RSNA and American College of Radiology have emphasized the role of radiologists in patient-centered care. But most patients discuss radiology exam findings with their referring provider and do not communicate directly with radiologists for their imaging results.
“We believe this is a missed opportunity,” said J.C. Panagides, an undergraduate researcher from Massachusetts General Hospital. “The radiology report is a principal form of communication between the radiologist and PCP, but there is significant variability in their interpretations, with radiologists attributing a higher likelihood of disease based on certain report terminology than PCPs.”
The researchers cited cardiovascular disease as an example in their study, saying risk is “consistently” underestimated by providers and patients. In addition, knowledge of their medical images can lead to patients taking steps to reduce their risk factors.
Massachusetts General Hospital previously piloted a point-of-care virtual radiology consult model where radiologists review imaging with patients and PCPs in real-time during patient visits. However, the researchers wanted to assess the attitudes of patients and their physicians regarding the perceived value of radiologists reviewing images with patients during primary care visits.
In the study of video-based radiology consultations between September 2019 and February 2020, patients and PCPs completed a survey after patients reviewed their medical images with a radiologist via a third-party video interface platform.
Out of the 30 patients who completed the survey, 18 said that it had a great impact on their understanding and the remaining 12 said that it had some impact. The patients had an average age of 67.1 years.
To read more, go to Aunt Minnie.
American College of Radiology Updates Imaging Appropriateness Criteria with 13 New Topics
By Marty Stempniak | April 26, 2021
The American College of Radiology has added more than a dozen new topics to its imaging appropriateness criteria while revising several more, officials announced on Monday.
ACR’s update covers several clinical scenarios, such as breast imaging in transgender patients, or staging and follow-up for primary vaginal cancer. The college additionally revised five other topics, with all including a narrative, evidence table and summary of relevant scientific literature.
“ACR Appropriateness Criteria creates consistent behaviors for medical imaging and interventional radiology procedures for all patients,” Mark Lockhart, MD, chair of the committee that oversees the criteria, said in a statement. “By employing these guidelines, providers enhance quality of care and contribute to the most efficacious use of radiology.”
These criteria were first introduced back in 1993 and determined by a panel of experts in diagnostic imaging and interventional radiology. Today, the ACR now covers 211 topics and more than 1,900 clinical scenarios.
Providers can consult the ACR Appropriateness Criteria to meet requirements from the Protecting Access to Medicare Act, which mandates that clinicians consult medical guidelines before ordering advanced imaging. The Centers for Medicare & Medicaid Services has already designated ACR as a qualified provider-led entity, the college noted.
You can find the full list of new and revised topics here. ACR issued its last update back in October.
To read more, go to Radiology Business.
The Spectacular Failure of Amazon’s Haven Healthcare and 4 Key Takeaways for Radiology
By Marty Stempniak | April 23, 2021
The recent failure of Amazon’s Haven Healthcare venture may offer some key lessons for radiologists, experts charged on Thursday.
The Seattle-based tech giant first announced the endeavor in 2018 to much fanfare, with some dubbing Haven as a “disruptive force that will drive widespread change throughout the industry.” Yet a few years later, Haven ceased operations for complex reasons that weren’t easy for outsiders to discern.
Indiana University imaging experts see an opportunity for the specialty to learn from Haven’s downfall, they wrote in Academic Radiology.
“Failure is a rich but often underutilized source of insight, whose lessons should not be lost on radiology learners,” Richard Gunderman, MD, PhD, and Joseph Acchiardo, both with the Indianapolis institution’s Department of Radiology, explained April 22. “How could a widely touted organization with such an impressive pedigree and resources collapse in the space of three years?”
The two authors broke down Haven’s demise into four lessons for radiology learners: