Radiology Digest: News from the week of December 10, 2021.
Senate Finalizes Radiologist Relief from Medicare Cuts, Sending Final Bill to the President
By Marty Stempniak | December 10, 2021 | Included in Radiology Digest – December 10, 2021
The U.S. Senate finalized healthcare legislation Thursday night that gives radiologists and other providers relief from Medicare reimbursement cuts that would have taken effect Jan. 1.
Lawmakers passed the “Protecting Medicare and American Farmers from Sequester Cuts Act” in a 59-34 vote following its approval Tuesday in the House. The bill now heads to the desk of President Joe Biden, who is expected to sign it.
Absent such action, the American College of Radiology said, the cuts would have threatened patients’ access to imaging, deepening disparities in rural and urban areas.
“We are thankful Congress intervened to provide stability within the healthcare system for both patients and healthcare providers,” Howard Fleishon, chair of ACR’s Board of Chancellors, said in a statement. “However, we must begin to look beyond these short-term fixes. The ACR looks forward to working with Congress to address the ongoing structural problems associated with Medicare’s broken payment system.”
“This is an important victory for physicians and patients,” Bob Still, executive director of the Radiology Business Management Association, said Thursday night. “It is a recognition of the critical importance radiologists and other healthcare providers in this time of an ever-present public health emergency. We must now challenge the house of medicine and Congress to resolve these annual reimbursement inequities.”
The Senate’s vote ends months of fierce lobbying to address pay cuts of 10.75% expected to hit diagnostic radiology in 2022. RBMA estimated the reimbursement reduction will now equal about 3% for the specialty, but higher on the interventional side. Providers will now net a one-year, 3% increase in the Medicare Physician Fee Schedule, short of the 3.75% some had sought.
In addition, the legislation will delay 2% Medicare sequester payment reductions for the first three months of 2022, transitioning to a 1% cut in the three months afterward. It will also delay payment reductions tied to the clinical laboratory fee schedule, postpone the radiation oncology payment model and pause the 4% PAYGO cut—all until 2023.
To read more, go to Radiology Business.
Senate Votes to Avert Medicare Cuts to Providers
By Jessie Hellmann | December 9, 2021 | Included in Radiology Digest – December 10, 2021
The Senate on Thursday evening voted 59-34 to avert looming Medicare cuts to providers, sending the legislation to President Biden’s desk for signature.
The highly-anticipated vote comes weeks before the cuts were set to take effect, putting providers on edge as lawmakers hammered out a final deal.
The bill, which passed the House earlier this week, will delay 2% cuts to Medicare rates through March 2022 and punt a separate round of 4% Medicare cuts totaling about $36 billion to 2023.
The 2% cuts derive from the 2011 law that created budget sequestration, requiring spending reductions across the federal government beginning in 2013. Congress paused the cuts last year in response to COVID-19. The bill that passed Thursday would keep that pause in place until April 1, after which providers will see a 1% cut until June 30 and a 2% cut until sequestration expires in 2013.
The 4% Medicare cuts are the consequence a budget law known as PAYGO that requires increases in the deficit be offset by raising revenue or reducing spending. The COVID-19 relief package enacted this year resulted in a larger budget deficit, triggering spending reductions.
To read more, go to Modern Healthcare.
UnitedHealthcare Must Pay TeamHealth $62 Million for Shortchanging Clinicians, Jury Says
By Nona Tepper | December 7, 2021 | Included in Radiology Digest – December 10, 2021
UnitedHealthcare must pay $62.65 in total damages for shortchanging TeamHealth clinicians, a Las Vegas jury decided Tuesday.
The jury unanimously found the nation’s largest insurer guilty of fraud and unjust enrichment, saying it had formed and violated an implied contract with TeamHealth and engaged in unjust and oppressive claims practices. The private equity-backed provider group initially demanded $100 million in punitive damages when it alleged the insurer reimbursed clinicians at unlawfully low rates. The jury awarded the plaintiff $60 million. With the $2.65 million TeamHealth won in compensatory damages last week, UnitedHealthcare’s total obligation reached $62.65 million.
“We will be appealing this decision immediately in order to protect our customers and members from private equity-backed physician staffing companies who demand egregious and anticompetitive rates for their services and drive up the cost of care for everyone,” a UnitedHealthcare spokesperson wrote in an email.
The case, which started last month in Clark County, Nevada, District Court, came on behalf of Fremont Emergency Services, which alleged that UnitedHealthcare responded to the TeamHealth subsidiary’s pledge not to balance bill out-of-network patients by terminating its provider contracts and lowering its reimbursements by up to 80%.
The award closes the book on the first of 10 cases TeamHealth has pending against UnitedHealthcare and sets a precedent for all health insurers, TeamHealth CEO Leif Murphy said in a news release. TeamHealth subsidiaries in Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas are all challenging UnitedHealthcare’s reimbursements.
“We look forward to continuing the fight against United in nine future cases that will be decided on the same set of facts,” Murphy said.
In this case and others, UnitedHealthcare counters that TeamHealth’s unreasonably high charges led to its removal from the insurer’s provider networks. The company’s private equity owners are bent on generating additional profits, which contribute to rising healthcare costs, the insurer argues.
Private equity firm Blackstone Group purchased TeamHealth for $6.1 billion in 2017.
The trial started days after UnitedHealthcare filed a separate complaint against the provider group in the U.S. District Court for the Eastern District of Tennessee. The insurer alleges TeamHealth intentionally misled the insurer into paying more than $100 million in fraudulent claims. TeamHealth has said this case represents an attempt to distract from its complaint, and includes evidence from the insurer that the jury was not allowed to hear in the Nevada suit.
To read more, go to Modern Healthcare.
House Votes to Avert Looming Medicare Cuts
By Jessie Hellmann | December 7, 2021 | Included in Radiology Digest – December 10, 2021
Providers are poised to get relief from pending Medicare cuts under legislation the U.S. House of Representatives passed Tuesday night on a party line vote, 222-212. It now heads to the Senate where it is expected to pass as soon as this week.
The bill falls short of what providers advocated but hospitals are relieved that Congress is taking steps to block tens of millions of dollars in reimbursement reductions slated to take effect next year, American Hospital Association President and CEO Rick Pollack said.
“The AHA is pleased that the House has recognized that now is not the time to make cuts to hospitals and physicians under the Medicare program,” Pollack said in a news release. “Providers on the front lines of the fight against COVID-19 will not face additional imminent financial jeopardy as they continue to care for patients and communities.”
The legislation, released by the House Rules Committee Tuesday, would delay 2% cuts to Medicare rates through March 2022 and punt a separate round of 4% Medicare cuts totaling about $36 billion to 2023.
The 2% Medicare cuts derive from the 2011 law that created budget sequestration requiring spending reductions across the federal government beginning in 2013. Congress and President Donald Trump delayed the cuts last year as part of the federal pandemic response. The bill would keep that pause in place until April 1, after which providers would see a 1% cut until June 30 and a 2% cut until the budget sequestration expires in 2031.
The 4% Medicare cuts are the consequence a budget law known as PAYGO that requires increases in the deficit be offset by raising revenue or reducing spending. The COVID-19 relief package enacted this year resulted in a larger budget deficit, triggering spending reductions.
To read more, go to Modern Healthcare.
ACR Seeking Changes to CMS Proposal that Would Expand Eligibility for CT Lung Cancer Screening
By Matt O’Connor | December 6, 2021 | Included in Radiology Digest – December 10, 2021
The American College of Radiology is seeking changes to a recent federal proposal that would expand Medicare eligibility criteria for CT-based lung cancer screenings.
On Nov. 17, the Centers for Medicare & Medicaid Services said it found evidence to cover low-dose CT exams for Medicare beneficiaries between the ages of 50 to 77 instead of a starting age of 55. CMS also indicated it intends to expand its high-risk population from those with a 30 pack-year smoking history down to 20. The decision mirrors recently updated recommendations from the U.S. Preventative Services Task Force.
While the ACR and other groups have praised these updates, many of its recommendations have not been incorporated into CMS’ national coverage determination proposal, the college noted.
For example, the ACR recommends CMS “reconsider” its decision to remove the radiology imaging facility criteria and instead modify the language. The college specifically pointed to independent testing facilities.
“We affirm that LDCT lung cancer screening is a covered benefit in all facilities, including independent diagnostic testing facilities where the LDCT CT exam is performed and interpreted,” the college said Dec. 2. “However, the ACR believes CMS’ proposed coverage updates could lead to unintended consequences and poor quality as this benefit is expanded.”
CMS revealed its decision to explore expanded reimbursement for LDCT lung cancer screening back in May. A study published in September predicted that the new recommendations may lead to a 54% jump in eligible patients.
The ACR said it’s working to ensure quality is central to any new lung cancer screening updates and is currently preparing comments for CMS that it will submit by the Dec. 17 deadline. CMS is expected to finalize its coverage decision by Feb. 15, according to the college.
To read more, go to Health Imaging.
Medicare Saw Telehealth Use Grow More Than 6,000% During Pandemic
By Tim Broderick & Maya Goldman | December 3, 2021 | Included in Radiology Digest – December 10, 2021
The Health and Human Services Department found that Medicare visits held via telehealth increased 63-fold from 2019 to 2020 as a result of flexibilities put into place due to the COVID-19 public health emergency, according to a new HHS study released Friday.
The Centers for Medicare and Medicaid Services will use the report’s results to inform future Medicare telehealth policy, CMS Administrator Chiquita Brooks-LaSure said in a news release.
Providers have been eager to see how lawmakers and policymakers will regulate telehealth once the PHE ends. Medicare payment advisors have suggested a temporary extension of flexibilities to allow time to study telehealth’s impacts.
CMS already expanded reimbursement for telehealth to treat mental health issues in the hospital outpatient payment rule last month. Beneficiaries were more likely to use telehealth for mental health services in 2020. Employers also increased access to telehealth in 2020.
To read more, go to Modern Healthcare.
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