ACR Stays Neutral on Bill Granting Medicare Coverage for Radiology Assistant Services in All Settings
By Marty Stempniak | August 26, 2021
The American College of Radiology said Wednesday that it plans to remain neutral on recently proposed legislation granting Medicare coverage for radiology assistants’ services in all healthcare settings.
U.S. Rep. Mike Doyle, D-Penn., first unveiled his Medicare Access to Radiology Care Act (MARCA) in June. It drew support at the time from radiologic technologists, who believe the bill could help free up physicians to focus on image interpretation and urgent cases. However, the ACR said it has heard varying opinions from members about the proposal and will neither support nor oppose it at this time.
The college’s board of chancellors plans to hold listening sessions and gather further feedback on the rule, including surveying stakeholders. Following receipt of a report, the American College of Radiology said it will consider lifting its neutral stance and issuing an official policy.
“The ACR continues to actively oppose imaging supervision or interpretation and any independent practice by nonphysician providers,” it said in a statement posted Aug. 25.
Rep. Doyle’s bill proposes to amend the Social Security Act and align federal payment policy for radiology assistants to match state licensure laws. Experts emphasized in June that MARCA would not reimburse radiology assistants independently from a radiologist-led care team, nor could assistants interpret images or practice independently. Its passage would ensure reimbursement for imaging services that include an assistant’s contribution, whether delivered in a hospital, ambulatory surgery center or other facility. Sen. John Boozman, R-Ark., introduced similar legislation in the Senate on Aug. 5.
To read more, go to Radiology Business.
Payers, Patient Advocates Warn Against Overuse of Arbitration in Surprise Billing Disputes
By Jessie Hellmann | August 25, 2021
Patient advocates, unions and business groups are urging President Joe Biden’s administration to make clear that arbitration should only be used as a “last resort” in out-of-network billing disputes.
In a letter to HHS Secretary Xavier Becerra and other cabinet officers, AFL-CIO, the American Benefits Council and dozens of other groups representing large employers, union members and patients expressed concern that providers could abuse the arbitration process under the new surprise billing ban to inflate costs.
HHS is beginning to implement the No Surprises Act Congress passed last year. The department is currently ironing out the independent dispute resolution process that providers and payers can use to resolve disagreements over payments for out-of-network charges.
HHS issued an interim final rule last month banning surprise billing for emergency care, high cost-sharing for out-of-network services, out-of-network charges from ancillary providers such as anesthesiologists or assistant surgeons, and out-of-network charges from providers who don’t notify patients they are not in-network.
“The No Surprises Act was intended to reduce overall healthcare costs by correcting a longstanding market failure,” the groups wrote in the letter to Becerra, Treasury Secretary Janet Yellen and Labor Secretary Martin Walsh on Monday.
“Achieving this goal will require that [independent dispute resolution] is used as a limited, last resort for disputes that cannot be negotiated, rather than an avenue for inflating costs once the patient is taken out of the middle.”
The groups cited “rampant misuse” of the independent dispute resolution process under New Jersey’s, New York’s and Texas’s surprise billing laws, alleging that “out-of-network providers and private equity firms take advantage of [independent dispute resolution] to bolster their bottom lines at patients’ expense.”
To read more, go to Modern Healthcare.
Startup Aiming to Root Out Misdiagnoses in Radiology Raises $25M in New Funding
By Marty Stempniak | August 24, 2021
A New York-based startup aiming to root out misdiagnoses in radiology has raised $25 million in new funding, leaders announced Monday.
Covera Health said the Series C financing comes by way of private equity firm Insight Partners, with additional contributions from existing investors. Founded in 2017, the analytics company has established a Radiology Centers of Excellence Program, working with payers, physicians and employers to steer patients to high-quality imaging. Covera made headlines in 2019 when it partnered with Walmart to help the retail giant’s employees avoid “misguided and unnecessary” treatment stemming from imprecise image interpretation.
“An accurate radiology diagnosis is an essential ingredient in effective downstream medical care across domains as varied as heart disease, cancer, chronic pain and musculoskeletal disorders,” Lonne Jaffe, managing director at New York-based Insight Partners, said in a statement. “We’re excited to continue this journey with Covera as they harness their powerful artificial intelligence platform to transform how healthcare is measured and delivered, with the potential to benefit hundreds of millions of patients across the globe.”
Covera’s quality analytics program utilizes advanced data science and AI to generate “robust” measures of diagnostic accuracy across pathologies and patient types. Data help radiologists to validate their accuracy in relation to peers, and pair patients with members of the specialty who excel at diagnosing a specific concern. Currently, its radiology program touches more than 1 million covered patient lives, according to its website, and is used by some of the largest employers and health plans in the U.S.
The company plans to use its new capital to further scale the radiology program, enhance the platform’s medical error detection technology, and deepen data integration across payers and providers. Covera said it expects to “dramatically” increase the number of users in the coming months.
To read more, go to Radiology Business.
Insurers to Get a Break on Price Transparency, Surprise Billing
By Michael Brady | August 24, 2021
Health plans will have more time to get ready for several requirements under the insurer price transparency rule and the ban on surprise billing, according to federal guidance published last week.
The Biden administration won’t crack down on insurers for failing to publish machine-readable files of provider rates until July 1, even though the requirement takes effect at the start of next year. But that doesn’t mean they’re going away.
“The administration and Congress have indicated broad support for policies that provide more transparency into healthcare costs,” said Myra Simon, a consultant at Avalere Health.
The guidance also indefinitely delayed enforcement of a similar requirement for prescription drug pricing. The Biden administration is reconsidering whether the policy still makes sense in light of the new prescription drug reporting requirements that Congress included in its end-of-year spending packing last December.
Health plans were supposed to start reporting that information at the end of the year, but regulators are giving health plans a break. There’s no firm deadline for reporting data on prescription drug prices. But the Biden administration will probably ask for both 2020 and 2021 data in December 2022, McDermott Will & Emery partner Kate McDonald said.
Coordinating the Trump-era transparency rule with the new mandates from Congress would make it easier and less costly for insurers to report the prescription drug pricing information. But it shouldn’t harm transparency, Simon said.
To read more, go to Modern Healthcare.
Hospitals, Insurers Charging ‘Wildly’ Different Amounts for Same Imaging Services
By Matt O’Connor | August 23, 2021
A federal government mandate went into effect this year requiring hospitals to publish prices for imaging and other healthcare services they negotiate with private insurers. But a new investigation reveals why so many trade groups and hospital associations have fought to block the requirement.
Hospitals are charging patients vastly different amounts for the same services, including X-rays, MRI scans, colonoscopies, pregnancy tests and more. The New York Times partnered with two University of Maryland-Baltimore County researchers to review medical costs at 60 major hospitals, releasing their bombshell report on Aug. 22.
In terms of imaging, a patient with UnitedHealthcare’s HMO plan should expect to pay $1,093 for an MRI at Aurora St. Luke’s in Milwaukee. With the same private insurer’s PPO plan, however, the exam runs for more than $4,000.
At Mass General in Boston, a knee MRI costs anywhere from $830-$4,000 depending on an individual’s insurance plan. And if you want to pay in cash, bring around $3,105 for the exam, the Times reported.
The five largest insurers all declined on-the-record interviews. And Vice President for public policy at the American Hospital Association says, “these rate sheets are not helpful to anyone,” adding “… a lot of hospitals are putting in a lot of effort to comply with the rule.”
Six months after these rules went into effect, the Times found the 10 highest-revenue hospitals had posted little to no data on their websites.
The Centers for Medicare & Medicaid Services has said those dodging pricing transparency rules could face fines of up to $2 million.
“It’s not just individual patients who are in the dark,” Martin Gaynor, a Carnegie Mellon economist who studies health pricing, told the news outlet. “Employers are in the dark. Governments are in the dark. It’s just astonishing how deeply ignorant we are about these prices.”
To read more, go to Health Imaging.
ACR Voices ‘Strong Opposition’ to Merit-based Incentive Payment System Changes
By Marty Stempniak | August 20, 2021
The American College of Radiology is voicing “strong opposition” to changes the Centers for Medicare & Medicaid Services is proposing for its Merit-based Incentive Payment System in 2022.
CMS first revealed the updates in July as part of next year’s proposed physician fee schedule. ACR is miffed that MIPS might retire two quality measurements pertaining to radiology, with options already limited for the specialty.
“The pool of measures available to radiologists has been significantly reduced over the last few years of the MIPS program and the ACR intends to push back against the removal of additional radiology measures,” the professional society said in an Aug. 18 update.
Agency officials are angling to retire MIPS measure 195, covering stenosis measurement in carotid imaging reports and 225, related to reminder systems for screening mammography. ACR saved its strongest words for another proposal to remove quality bonus points for additional high-priority measures. Doing so has encouraged the adoption of new non-benchmarked measures, ACR noted, while also giving the specialty a pathway to improve MIPS scores, despite measures being capped or removed from the program.
Advocates also criticized a CMS proposal to raise the data completeness threshold for quality measures up to 80%.
“The ACR believes this is too steep an increase and may prove difficult for small and rural practices. Instead, the ACR encourages CMS to raise this threshold gradually,” the college suggested.
Meanwhile, ACR voiced support for a plan to raise the score ceiling for new measures during the first two years of their existence. But it wants that timeline bumped up to three years, believing it often takes that long for a measure to reach this level of adoption allowing for a MIPS benchmark. The American College of Radiology said it plans to submit detailed comments to the agency by early September.
To read more, go to Radiology Business.