Medicare Advantage Payments Increased Federal Spending by $7B in 2019
By Robert King | August 18, 2021
The federal government spent $7 billion more on Medicare Advantage plans in 2019 compared to traditional Medicare, likely due to higher rebates and benchmarks, a new analysis finds.
The Kaiser Family Foundation’s analysis, released Tuesday, comes as the Biden administration is eyeing reforming MA payments to help prevent Medicare’s hospital fund from becoming insolvent.
“This analysis suggests that reducing the difference in payments between Medicare Advantage and traditional Medicare would generate savings, with the potential for reductions in extra benefits for Medicare Advantage enrollees,” the analysis said.
Kaiser found that the federal government spent $321 more per person in 2019 for MA plan enrollees compared to traditional Medicare beneficiaries.
The findings come as spending on MA has increased steadily in recent years and projected to increase to $664 billion by 2029, more than double the $348 billion that is spent now, the analysis said.
Several factors likely contributed to the spending disparity; chief among them are benchmarks which are used to determine payments to MA plans. A benchmark is tied to traditional Medicare spending in an area and can be increased based on the plan’s star ratings and quality bonuses.
“Star ratings increase their benchmarks and allow plans to keep more of the difference between the benchmark and their bid,” said Jeannie Fuglesten Biniek, Ph.D., a senior policy analyst with Kaiser, in an interview with Fierce Healthcare.
More plans have gotten star ratings of four or higher, leaving them eligible for quality bonus payments and another key driver of spending, the analysis found.
“In 2021, 81% of Medicare Advantage enrollees are in plans that receive a bonus payment,” the analysis said.
To read more, go to Fierce Healthcare.
Radiologists’ Share of Catheter-directed Therapy Market Falls as Surgeons, Cardiologists Gain Inroads
By Marty Stempniak | August 18, 2021
Radiologists’ share of the catheter-directed therapy market has fallen over the course of a decade as cardiologists and surgeons gain inroads, according to new research published Monday, Aug. 16.
Popularity of this procedure—using imaging guidance to insert a tube for treatment of blood clots in lower extremities—has grown since 2007, with interventional rads the dominant player. That year, the specialty delivered 72% of such minimally invasive services for deep-vein thrombosis among Medicare beneficiaries, which fell to 57% by 2017, Ohio State experts found in a recent analysis.
Practices should take note of these evolving patient preferences, experts asserted in the Journal of Vascular and Interventional Radiology.
“Despite radiologists performing the majority of procedures each year, it is evident from the results of this study that radiologist market share for these venous interventions [is] declining,” corresponding author Mina Makary, MD, with Ohio State University Wexner Medical Center’s Department of Radiology, and colleagues concluded. “As the continued development of novel techniques allows for minimally invasive treatment of an increasing breadth of pathologies once only amenable to open procedures, it would benefit endovascular specialists to pay close attention to these practice patterns,” they added later.
For their study, Ohio State researchers tapped Centers for Medicare & Medicaid Services databases, seeking all claims associated with chronic, lower-extremity deep-vein thrombosis. They found the number of catheter-directed therapy claims climbed from 4.27 per 100,0000 Medicare beneficiaries up to 13.4 a decade later, a more than 12% increase. Radiologists performed the lion’s share of such procedures every year during the study period, except for 2013. That year rads delivered almost 47% of catheter insertions compared to 53% for surgeons and cardiologists combined.
Meanwhile, catheter-directed therapy also shifted to outpatient providers, jumping from 7% in 2007 up to 29% by the end of the study period, with inpatient still the dominant setting.
To read more, go to Radiology Business.
Breast Imaging Patients See Out-of-Pocket Costs Increase
By Amerigo Allegretto | August 17, 2021
Out-of-pocket costs for additional breast imaging after screening in the U.S. have nearly doubled since 2010, with women facing unexpected financial consequences as a result, according to research published August 17 in JAMA Network Open.
A group of researchers led by Dr. Kathryn Lowry from the University of Washington in Seattle found that higher out-of-pocket costs coincide with the rapid rise in high-deductible healthcare plans.
“These findings are concerning because women who undergo screening may not be anticipating the costs for additional workup,” Lowry told AuntMinnie.com.
The Affordable Care Act (ACA) eliminated out-of-pocket costs for nearly all women who undergo screening mammography. However, the ACA’s rules don’t extend to additional
breast imaging, which occurs after greater than 10% of screening examinations, the study authors said.
Lowry added that it is not surprising that out-of-pocket costs have increased in recent years and that other studies have shown enrollment in high-deductible healthcare plans increasing in recent years, which has “likely” contributed to the rise in costs to patients.
“I think there may be less awareness about the magnitude of these costs, for example, that in recent years over 25% of women who had additional imaging and biopsy had out-of-pocket costs exceeding $400,” she said.
Lowry’s team wanted to look at trends in out-of-pocket costs for commercially insured women who underwent additional breast imaging evaluations or procedures after screening mammography.
To read more, go to Aunt Minnie.
What CMS Can Do to Boost Provider Engagement
By Michael Brady | August 17, 2021
Health systems, accountable care organizations and other operators are largely responsible for engaging providers in value-based care, as CMS policies and programs aren’t especially prescriptive on that front.
The agency could help clinicians buy into value-based care by simplifying its programs, improving information sharing, designing clinician-centric models and holding healthcare organizations more accountable.
But that could be easier said than done. “Culturally, it’s hard for CMS because the agency has a real aversion to getting in between provider relationships,” said Dr. Mai Pham, a consultant who formerly served as CMS’ chief innovation officer.
Healthcare executives have complained for years that it’s difficult for them to redesign care delivery around CMS’ countless payment policies and programs, each with their own quality measures, reporting requirements and financial rewards and penalties.
“The incentives are often counterproductive and conflicting with each other. It makes it hard to manage and know how to enter into value,” said Dr. Robert Fields, chief medical officer for population health at Mount Sinai Health System in New York.
Not only has that created problems for the C-suite, it’s also made it tougher for clinicians to understand how their actions affect their organizations’ performance in value-based contracts.
CMS could alleviate some of those issues by adopting simpler, more cohesive payment policies across original Medicare, Medicare Advantage, Medicaid and other programs. It could also align its value-based payments with commercial insurers to get more providers on board and accelerate the transition from volume to value.
The agency’s leadership seems keenly aware of the issue and is likely to address it.
To read more, go to Modern Healthcare.
‘Grave Concern’: Radiologist Reimbursement Expected to Plummet After CMS Clinical Labor Wage Update
By Marty Stempniak | August 16, 2021
Radiologists and other providers are expressing “grave concern” around plans to boost pay for clinical labor staff, a move advocates say will result in drastically reduced reimbursement for the specialty.
The proposal is part of the 2022 Medicare Physician Fee Schedule, released in July. CMS wants to update wages for clinical labor, but these practice expense components are subject to budget neutrality. As such, interventional radiology, radiation oncology and other specialties with high medical supply costs and low clinical labor tallies 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, the Society of Interventional Radiology warned Friday.
“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,” SIR said in a statement.
The Society of Interventional Radiology is working alongside the American College of Radiology, American Medical Association and the CardioVascular Coalition to fight these changes. In its own update issued Aug. 12, ACR said the groups are exploring “all regulatory and legislative options to protect radiology practices and access to quality care.”
CMS estimates cuts attributed to periodic labor pricing updates would land at 5% in interventional radiology and 1% for radiology. That’s in addition to a 9% cut for IR and 2% in radiology because of adjustments in the conversion factor used to calculate reimbursement, mandated sequestration and cuts to practice expense values. SIR said the proposed cuts represent a “perfect storm,” resulting from the feds’ failure to keep labor rates and product tables current with inflation.
The CardioVascular Coalition—a group representing physicians, other providers, advocates and manufacturers—expressed “grave concern” tied to anticipated 20% payment cuts to revascularization services in 2022. Updating clinical labor data in the CMS database “makes sense,” the group said, and every specialty should see increases to resources based on this change. However, these gains should not come at the expense of access to such services to treat peripheral artery disease.
“These impacts will have profoundly negative effects on health equity,” the coalition said in a statement. “The decrease in access to revascularization services could lead to higher amputation rates and exacerbate inequities that already exist, particularly in America’s communities of color.”
The Society of Interventional Radiology and others are urging Congress and CMS to reverse the cuts, suspend sequestration, and maintain the COVID-related increase to the conversion factor. SIR said this would ensure that rad reimbursement “better reflects the real cost of healthcare in a pandemic world.”
To read more, go to Radiology Business.
Radiologists-in-training Saddled with 162% Increase in Neuroimaging Work Over Recent Years
Matt O’Connor | August 13, 2021
Radiologists’ brain imaging workloads have drastically increased over recent years, but the uptick has been particularly heavy for imaging trainees.
In fact, Medicare claims for neuroimaging rose by 86% for radiologists but jumped 162.5% for trainees between 2002 and 2018. This disparity also extended to workloads, with work relative value units (wRVUs) jumping nearly 80% for all services compared to 162.3% for radiology interns, residents and fellows, researchers reported Friday in Academic Radiology.
This swell may be due to institutional-specific needs, trainee requirements or broader population-driven trends, the authors hypothesized. The growth in emergency imaging use, they noted, is also a factor.
“One potential explanation for the greater rise among trainees may be the overall increased utilization of advanced neuroimaging in the emergency department, an environment often covered predominately by trainees after-hours and weekends,” Richard Duszak Jr., MD, with Emory University School of Medicine’s Department of Radiology and Imaging Sciences, and co-authors added.
A study published just last week, led by Emory researchers including Duszak, found neuroimaging use rates per 1,000 ED visits increased 72% between 2007-2017, driven primarily by head and neck CT angiography. And a similar investigation, undertaken by Emory Medicine and Mass General, found the increasing use of CT for patients with minor injuries is increasing spine imaging utilization across emergency departments.
For their current study, the group analyzed CT and MRI claims for brain, head and neck, and spine exams spanning Medicare fee-for-service beneficiaries.
Trainees were saddled with more CT claims compared to radiologists overall (196.8% vs.102.9%), along with MRI claims (106.6% vs. 59.9%), the authors reported. In terms of workloads, wRVUs for trainees in neuroradiology subspecialties jumped by 120.3% over the 16-year study period, particularly for head and neck CT (470%), and spine CT imaging (394.2%).
As it stands, radiology training programs design their educational programming based on institutional needs and priorities, Duszak et al. noted, with no national guidelines to lean on.
To read more, go to Health Imaging.