Radiology Digest – August 29, 2023

August 24, 2023

Radiology Digest: News from the week of August 29, 2023.

Same Hospital, Same Insurer, but Imaging Prices Twice as High for Commercial vs. Medicare Advantage Plans

By Marty Stempniak | August 23, 2024

Imaging prices at the same hospital are more than twice as high for patients with commercial plans compared to those covered by Medicare Advantage, despite being negotiated by the same insurer.

That’s according to a new analysis by researchers at Johns Hopkins University, published in the latest issue of Health Affairs [1]. Most major insurance companies operate both types of health plans, grappling with different incentives on the commercial side compared to privately managed Medicare.

Health economist Mark Meiselbach, PhD, and colleagues set out to gauge the impact of these dynamics amid rapidly rising costs for commercial insurance. They found that the median commercial-to-Medicare Advantage price ratio was 2.4 for imaging, higher than the figures for surgery and medicine services (1.8) or laboratory tests (2.2).

“The large price gap between commercial and MA prices within an insurer reveals the pricing consequences of differing incentives across markets,” Meiselbach, also an assistant professor at the Johns Hopkins Bloomberg School of Public Health, and co-authors concluded. “Out-of-network price benchmarking through government regulation, competition with Medicare fee-for-service, and the fact that insurers actually bear risk in the MA market may drive down prices in MA. In contrast, in the commercial market, self-insured employers are largely the ones bearing risk and paying the higher prices.”

For the study, researchers utilized 2022 hospital price transparency information, compiled by data firm Turquoise Health. They extracted negotiated commercial and MA prices from general acute care hospitals for 70 shoppable services and five ED visit codes. Meiselbach et al. included 46 services in the final sample, for which hospital disclosure rates were above 50%, and excluded the state of Maryland, where the state sets hospital prices paid by plans.

The final sample spanned 118 total insurers and 2,434 total hospitals. Across all service categories, median commercial prices were between 1.8 and 2.7 times more expensive than Medicare Advantage. When stated in dollar terms, the largest gap was within surgery and medicine (with a median of $1,702 for commercial plans vs. $925 in MA), followed by imaging ($490 vs. $191), lab tests ($32 vs. $12), and ED visits ($519 vs. $262).

Regression-adjusted analysis revealed that commercial prices were between $660 and $707 more expensive than Medicare Advantage (or 2.1 to 2.2 times).

Meanwhile, commercial and MA prices were exactly the same 3.7%-6.6% of the time, including about 5.3% for imaging. Commercial pricing was more than five times higher than MA between 6.5%-27.2% of the time, including 23.1% in imaging. All major health insurers had median price ratios above 2 for most or all services categories, except for Centene, the authors noted. Kaiser Permanente, in particular, had the highest median ratios, including 3.7 for imaging.

To read more, go to Radiology Business.

 

Employer-sponsored Insurance Costs to Rise 8.5% for 2024: Report

By Rylee Wilson | August 22, 2023

Employers will pay more than $15,000 on average for each employee’s healthcare in 2024, according to an analysis from consulting firm Aon. 

Employer-sponsored insurance costs will rise 8.5 percent in 2024, up from an average of $13,906 per employee in 2023, according to Aon’s estimates published Aug. 22. 

Though inflation has spiked in the past two years, employer-sponsored healthcare costs have stayed relatively stable because of multiyear contracts, Debbie Ashford, chief actuary for Health Solutions at Aon, said in a news release. 

“Even though inflation is subsiding, healthcare trend is growing as medical providers push insurers for larger cost increases to cover the higher costs of wages and supplies that they endured during the last couple years but were unable to pass on to payers,” Ms. Ashford said. 

“Other contributing factors adding pressure on healthcare cost trends are the proliferation of newly indicated weight loss drugs, new technologies, severity of catastrophic claims and increasing share of specialty drugs,” she added. 

In a tight labor market, employers will likely absorb most of the rising costs, rather than charging employees higher premiums, according to Aon’s report. 

Read the full report here

 

Medicare Pay for Most Interventional Radiology Procedures has Declined in Recent Years

By Marty Stempniak | August 22, 2023

Medicare reimbursement for most interventional radiology procedures decreased between 2007 to 2020, after adjusting for inflation, according to an analysis published Monday in the medical journal Cureus [1].

Vascular and emergency procedures were the two exceptions, recording adjusted payment increases during that time span. Biliary procedures, in particular, saw the largest average decrease in reimbursement rates at -$21.25, while vascular emergency treatments notched the biggest gain ($3.23).

Researchers involved in the analysis believe this information underlines the “critical need” for advocacy at a national level among IR professionals.

“Decreasing Medicare reimbursements across most procedural classes indicates a necessity for engagement in current and future congressional policy,” Soryan Kumar, an MD candidate with the Warren Alpert Medical School of Brown University, and co-authors wrote Aug. 21.

“While physician and policymaker acknowledgment and understanding of these results are vital, their involvement in creating a sustainable reimbursement model to guarantee continued patient access to IR services must be an even higher priority,” they added later.

For the analysis, researchers selected common IR procedures across multiple classes, including gastrointestinal, urinary, fallopian dilatation, other injection/change/removal and iliac vascular, among others. They queried the Physician Fee Schedule Look-up Tool from CMS for current procedural terminology codes and adjusted figures for inflation using the consumer price index.

Out of the 69 procedures pinpointed in the analysis, 33 (or nearly 48%) experienced a CPT code change between 2007 to 2020. All procedures with reimbursement rate increases had a CPT code change during the study period, while nearly 37% of those with decreases did.

Endovascular repair of infrarenal aorta had the largest increasing annual reimbursement rate ($58.06) during the study period, and placement of bile duct stent for existing access had the largest decreasing rate (-$43.78).

Both had branching CPT codes with large shifts in annual reimbursements. Biliary procedures encompassed many of the individual procedures with large annual drops, and those of the urinary variety contained eight of all increasing procedures, the analysis found.

To read more, go to Radiology Business.

 

House Freedom Caucus Rolls Out Demand to Avoid a Shutdown

By Jordain Carney | August 21, 2023

The conservative House Freedom Caucus on Monday formally drew its red line on the looming government shutdown deadline.

The group of roughly three dozen Republican lawmakers said it would oppose any short-term stopgap unless leadership meets a slew of their demands. Senate Majority Leader Chuck Schumer and Minority Leader Mitch McConnell, earlier this month, publicly said a temporary fix will be necessary to avoid a shutdown at the end of September as Congress takes more time to hash out new spending bills.

“In the eventuality that Congress must consider a short-term extension of government funding through a Continuing Resolution, we refuse to support any such measure that continues Democrats’ bloated COVID-era spending and simultaneously fails to force the Biden Administration to follow the law and fulfill its most basic responsibilities,” the Freedom Caucus said in a statement.

The demands, while not unexpected, underscore the headache awaiting Speaker Kevin McCarthy, who told GOP members during a recent call that they would need a short-term spending fix before October.

In addition to vowing to oppose a so-called clean short-term funding bill, the Freedom Caucus is also planning to vote against any spending legislation that doesn’t meet certain priorities of the party’s right flank. That would mean including, according to the announcement, a sweeping GOP border bill that has stalled in the Senate; addressing “the unprecedented weaponization” of the Justice Department and FBI and ending “woke” Defense Department policies.

An official position from the Freedom Caucus requires the support of at least 80 percent of its members.

To read more, go to Politico.

 
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