HHS to Distribute $9B in COVID-19 Relief Funds to Smaller Providers This Week
By Robert King | December 14, 2021
The Department of Health and Human Services (HHS) announced it has distributed $9 billion in relief payments to providers to plug financial shortfalls caused by the pandemic, with more money going towards smaller providers.
The money is part of a $178 billion Provider Relief Fund and comes as HHS was criticized earlier in the year for not distributing the money fast enough. The agency said payments will reach providers later this week.
“This vital funding will ensure critical healthcare services are delivered to communities across the country—including to those who are disproportionately impacted by the pandemic and medically underserved,” said HHS Secretary Xavier Becerra in a statement.
HHS announced the payment methodology in September in order to give providers more insight into how to qualify for the money.
“Approximately 75% of Phase 4 funding is being distributed based on expenses and decreased revenues from July 1, 2020, to March 31, 2021,” HHS said in a release.
The Health Resources and Services Administration (HRSA) is also reimbursing more losses from smaller providers that were hit especially hard by the financial crisis caused by the pandemic.
HRSA is doling out 25% of the funding as a bonus payment based on the amount and services provided to Medicare, Medicaid or patients with the Children’s Health Insurance Program. “HRSA is using Medicare reimbursement rates in calculating these payments to mitigate disparities due to varying Medicaid reimbursement rates,” the agency said.
HHS announced the application portal for the money back in September, and the $9 billion being distributed this week is part of a $25 billion pot, leaving $16.5 billion left to still give out.
HRSA will make the remaining payments next year.
“While we have made over a half a million relief payments to healthcare providers throughout this pandemic, we know that many continue to face COVID-19 related financial challenges,” said Diana Espinosa, HRSA’s acting administrator, in a statement.
The funding announcement comes less than a month after HHS announced $7.8 billion in relief dollars to rural providers passed as part of the American Rescue Plan Act earlier this year.
Lawmakers have also criticized the slow rollout of the remaining relief funds, especially as providers continue to grapple with surges caused by the virus.
The Trump administration was also criticized last year for doling out the first tranche of relief dollars based on Medicare claims, but advocacy groups criticized the lack of reimbursements to providers reliant on Medicaid. Future tranches of the relief fund made targeted distributions to providers in COVID-19 hot spots and those reliant on other forms of reimbursement.
To read more, go to Fierce Healthcare.
Many More People Avoiding Care Due to Cost This Year, Survey Shows
By Alex Kacik | December 14, 2021
A growing share of U.S. adults has delayed healthcare this year because they couldn’t afford it, a trend that is driving up treatment costs and worsening patient health.
Thirty percent of Americans skipped care this summer due to cost, up from 18% earlier this year, according to a West Health and Gallup survey. About 1 in 5 said they or a member of their family saw their health deteriorate over the past year as a result. The firms polled 6,663 people in September and October.
Low-income families and people of color have been disproportionately burdened by the COVID-19 pandemic, highlighting unyielding health equity issues. High healthcare costs hit those who can least afford it the hardest. About 2 in 5 Medicaid beneficiaries and those without insurance have seen their health conditions—typically chronic—worsen over the past year after forgoing care.
The financial impact is now expanding to households that make at least $120,000 a year, 20% of which have reported delaying care due to cost over the three months prior to the survey.
As healthcare becomes less affordable and families reach increasing levels of desperation, the velocity of change in the survey results this year has been eye-opening, said Tim Lash, chief strategy officer for West Health.
“Delaying care can be deadly,” Lash said. “But save for significant reform both on the drug side and on the provider-payer side, we’re going to see the number of bodies stack up.”
To read more, go to Modern Healthcare.
Staged Cyberattack Altering Mammography Images Deceives Both AI and Radiologists
By Hannah Murphy | December 14, 2021
Researchers are questioning the safety of artificial intelligence models after a staged cyberattack altered the diagnosis-sensitive information on mammograms.
The study, published in Nature Communications this week, brings attention to the vulnerability that exists among AI tools. “Adversarial attacks” pose a risk because of their ability to alter image factors that could cause both AI and human readers to make an incorrect diagnosis.
“Under adversarial attacks, if a medical AI software makes a false diagnosis or prediction, it will lead to harmful consequences to patients, healthcare providers, and health insurances,” corresponding author Shandong Wu, PhD, with the Department of Radiology at the University of Pittsburgh, and co-authors cautioned.
One threat to AI’s reliability is what’s called a generative adversarial network (GAN). Such models manipulate images in a way that might change how humans or AI can interpret them. Sometimes this occurs by inserting or removing portions of cancerous regions on images, which can cause a positive finding to appear negative and vice versa.
The researchers at the University of Pittsburgh used mammograms to build an algorithm for interpreting scans. They then developed their own GAN that proceeded to alter various aspects of the images, creating images that falsely mimicked both positive and negative findings.
They put their AI model, as well as five breast imaging radiologists, to the test after the GAN model manipulated the images. Readers were asked to differentiate between real and fake images. The AI model misinterpreted 69.1% of the images. While the human readers did perform better, their accuracy varied between 29%-71%.
The authors caution that the results of their study “pose an imperative need for continuing research on the medical AI model’s safety issues and for developing potential defensive solutions against adversarial attacks.”
You can view the research in Nature Communications.
To read more, go to Health Imaging.
Independent Radiologists, Who Bill Separately for Imaging, Muddying Hospital Price Transparency Efforts
By Marty Stempniak | December 13, 2021
Prices disclosed by hospitals for 13 “shoppable” imaging services may serve little use to patients, as they fail to include charges for independent radiologists not employed by the institution.
That’s according to new research out of Emory University, published Monday in JAMA Network Open. The Centers for Medicare & Medicaid Services started requiring hospitals to share these payer-specific negotiated rates for care on Jan. 1, hoping to steer individuals toward a more cost-conscious selection of providers to drive down spending.
But health policy experts believe these numbers are of little benefit if they do not incorporate total costs. Analyzing more than 4.5 million hospital encounters for shoppable services, researchers found that episodes frequently involved independent providers who account for a substantial portion of costs but were not included in that initial upfront estimate.
In radiology, between 65% to 87% of services included an independent radiologist, adding anywhere from $26 to $210 in additional reimbursement, dependent on the exam type.
“In some encounters, such as most laboratory and pathology services, the undisclosed reimbursements of independent practitioners were relatively low; thus, the disclosed hospital prices could be beneficial to consumers,” Michal Horný, PhD, with Emory University School of Medicine’s Department of Radiology and Imaging Sciences, and co-authors concluded. “In other encounters, such as some evaluation and management services, radiology services, and most medicine and surgery services, the reimbursement of independent practitioners was often nontrivial and could create a substantial financial
burden for patients who may not expect to receive additional bills beyond those from the hospital.”
For their study, Horný and co-authors utilized 2018 information from IBM’s MarketScan Commercial Database, offering a large collection of commercial claims. Alongside the technical payment for an imaging exam many also included the added professional component for an independent rad to read the scan, often not included in the initial estimate. That ranged anywhere from $26 for lower back radiography to $210 for brain MRI. Abdominal ultrasound of a pregnant uterus included more than one additional component not delivered by the hospital about 65% of the time, while mammography screening had one 87% of the time.
In a corresponding editorial, University of Pennsylvania experts argued that patients need better information to make informed decisions. Reference pricing—where payers set a maximum for hospital charges, with all above that the consumer’s responsibility—is one option. “Inclusive shared savings” is another, offering patients a positive incentive to select cheaper facilities.
“Patients would receive financial rewards for selecting less costly treatments, say a $50 bonus card if they selected a lower-cost imaging facility for magnetic resonance imaging or an ambulatory surgical center rather than a hospital for a colonoscopy,” Ezekiel Emanuel, MD, PhD, and Amaya Diana, with the Perelman School of Medicine’s Department of Medical Ethics and Health Policy, wrote Dec. 13. “If we want the information provided on costs to be of any use, we need to properly incentivize the people making care decisions to choose high-quality, lower-cost options.”
To read more, go to Radiology Business.
House Passes Radiologist-backed Bill to Address Burnout Following Physician’s Suicide
By Marty Stempniak | December 13, 2021
U.S. House representatives passed a radiologist-supported bill to address provider burnout on Wednesday, Dec. 8, in response to a physician’s untimely passing last year.
The Dr. Lorna Breen Health Care Provider Protection Act is named after New York Presbyterian Hospital’s 49-year-old former emergency department director, who died by suicide in April 2020. Representatives voted 392-36 to kick the bill back to the Senate for final approval after a few House tweaks.
Measures in the bill include grants for helping train physicians to address mental health issues, along with pinpointing best practices to prevent provider suicide. The American College of Radiology signaled its support for the Lorna Breen Act Friday, adding that there is a good chance the upper chamber will finalize it in short order.
“While the year-end legislative calendar remains in flux, the ACR is cautiously optimistic that the Senate will soon consider the legislation and possibly seek passage via the fast-tracked ‘unanimous consent’ process, which would clear the way for President Biden to sign the bill into law,” the college said in a Dec. 9 news update.
The bill would also create a national initiative urging healthcare professionals to seek support for mental health and substance abuse, and launch an exploration of COVID-19’s impact on such concerns. Some provisions of the legislation are funded by the American Rescue Plan Act, signed into law in March. Other supporters include the American Medical Association, American Academy of Emergency Medicine and similar groups representing family physicians and pediatricians, among others.
Rep. Abigail Spanberger, D-Va., one of the House bill’s supporters, believes there is a strong need for such services amid the public health crisis. She called the death of Breen — a native of Charlottesville, Virginia, and University of Virginia School of Medicine graduate — “absolutely heartbreaking.”
“From the earliest days of the pandemic, she — along with thousands of dedicated healthcare professionals across our country — worked tirelessly to treat patients from overcrowded waiting rooms,” Spanberger said in a statement Friday. “The paralyzing pressures these heroes face day in and day out have been greatly exacerbated by a global pandemic.
To read more, go to Radiology Business.