|National Healthcare Spending Grows 2.7% as COVID-19 Relief Runs Dry|
By Jacqueline LaPointe | December 15, 2022
National healthcare spending is slowing down in the US compared to a significant 10.3 percent increase in 2020. However, healthcare costs remain high as US health expenditures reach $4.3 trillion.
Healthcare spending now accounts for 18.3 percent of the US’ gross domestic product (GDP), a percentage lower than 19.7 percent in 2020 but still higher than 17.6 percent in 2019.
The data released by CMS actuaries earlier this week was part of the National Health Expenditures (NHE) report. The NHE report is published annually and measures total annual spending by the delivery of healthcare goods and services (e.g., hospital, physician, and prescription drugs), type of payer (e.g., commercial health insurance, Medicare, and Medicaid), and type of sponsor (e.g., businesses, households, and federal/state governments).
The 2021 NHE Report showed that healthcare spending in the US grew by 2.7 percent last year as the federal government provided less financial support to healthcare providers to offset losses and added expenses from the COVID-19 pandemic.
The federal government spent 3.5 percent less on healthcare in 2021, as Provider Relief Fund and Paycheck Protection Program (PPP) funds, which assisted businesses with payroll, increased expenses, and lost revenue due to the pandemic, dried up. Federal public health activity also declined while there was slower growth in the federal portion of Medicaid payments, according to the report.
Lower federal spending on healthcare more than offset the impact of greater healthcare utilization and insurance coverage that year, CMS stated.
Spending on hospital and physician services slowed relative to 2020. Hospital care spending increased by 4.4 percent in 2021 compared to 6.2 percent growth in 2020. In total, spending on hospital services reached $1.3 trillion.
To read more, go to Revcycle Intelligence.
Last-minute Senate Bill Seeks to Extend Value-based Care Doc Bonus for Another 2 years
By Robert King | December 14, 2022
A new bipartisan Senate bill aims to extend for two years a 5% bonus to doctors who participate in alternative payment models, with lawmakers having little time to get it through Congress before the holidays.
Sens. Sheldon Whitehouse, D-Rhode Island, and John Barrasso, R-Wyoming, introduced on Wednesday the Preserving Access to Value Based Care Act to save the bonus that goes away in 2023. Provider advocacy groups lauded the bill as a critical tool that will help get more doctors into value-based care.
“We need to encourage more health care innovation—not pull the rug out from under the people who are making the system work better for everyone,” said Whitehouse in a statement. “There is strong bipartisan support for our proposal to allow these providers to continue delivering high-quality coordinated care.”
The 5% bonus went to doctors that sign up to participate in an advanced alternative payment model.
A recent estimate from the Alliance for Value-Based Patient Care, a collection of patient groups, finds approximately 300,000 physicians rely on the incentive and one-third could drop out of the models if it goes away.
“Congress will be playing with fire by not extending these critical incentives, which are important to providing patients and our health system with better outcomes and higher quality care,” Clif Gaus, president and CEO of the National Association of ACOs, in a statement.
Some providers have said the bonus has been a key selling point for physicians to join an accountable care organization and defray some of the infrastructure costs like staffing and care management.
“It really is meeting a lot of the need in terms of making sure value-based care is successful,” said Ashley Ridlon, vice president of health policy for managed care services company Evolent Health, in an interview with Fierce Healthcare. “This incentive is important to encourage providers to escalate up into … advance tracks.”
It remains unclear whether the bill will be able to make it before Congress leaves for the year. It is competing with a slew of other priorities for Congress, including in the healthcare arena as physicians are hoping to get rid of a 4.5% cut to Medicare payments as part of the Physician Fee Schedule.
Lawmakers are currently crafting a must-pass omnibus spending bill in which the legislation could be included. Negotiators in the House and Senate have released a framework on the omnibus but have not announced top-line numbers nor what other legislative riders could be included.
To read more, go to FierceHealthcare.
Find It Early Act Takes Flight on Capitol Hill
By Dave Pearson | December 13, 2022
Women with dense breasts or other heightened risk factors for breast cancer may be on the cusp of receiving 100% coverage for additional imaging beyond standard mammography.
The push comes from bipartisan legislation introduced for initial consideration in the U.S. House Dec. 13 by Reps. Rosa DeLauro (D-CT) and Brian Fitzpatrick (R-PA).
Called the Find It Early Act, the law would require all healthcare payers to pony up for breast ultrasound, breast MRI or other follow-up tests deemed clinically necessary for due diligence against hard-to-find breast cancers.
The introduction took place at a live-streamed press conference featuring broadcaster Katie Couric and DenseBreast-Info.org executive director JoAnn Pushkin.
“I’m here in part because my own cancer was missed an estimated five years in a row,” Pushkin said from the podium. “I had a mammogram every one of those five years. And every one of those five years, my doctor told me my mammogram was normal. But in fact a tumor was growing, hidden in dense tissue.”
“We must strengthen breast cancer awareness, specifically for women with dense breasts like me,” said Couric, who received her diagnosis this past spring. “Breast cancer is treatable, and 99% of women who are diagnosed early survive. The Find It Early Act is a critical step toward bettering access to … life-saving screenings.”
In a news release posted by DeLauro’s office, event organizers state that, when follow-up and additional screenings are needed “because of breast density, family history or for any other reason, depending on their health insurance, the majority of women are forced to pay out of pocket for these additional screenings, which can cost more than $1,000.”
As a result, many who cannot afford this cost will choose to delay or forego these additional tests, and that decision to delay screening can lead to later stage diagnosis. The Find It Early Act would ensure all health insurance plans cover screening and diagnostic mammograms and breast ultrasounds and MRIs with no cost-sharing.”
News release here, press conference here.
To read more, go Radiology Business.
AMA, Medical Societies Decry Pending Medicare Cuts
By Jeff Lagasse | December 12, 2022
In a letter to congressional leaders, the American Medical Association and every state medical society are telling Congress that any cut to Medicare payments will “undermine Medicare’s ability to deliver on its promises to seniors.”
What the groups want from Congress is action that would avert the entire 4.5% reduction to Medicare payment rates from being implemented on January 1, 2023. This relief, the AMA said, will help provide short-term financial stability for practices until permanent, bipartisan payment reforms are enacted.
Congress has until January 1 to avoid the cuts, which the medical groups stressed would prove harmful to seniors seeking healthcare.
“We cannot overstate the importance of Congress stopping the entirety of the upcoming 4.5% reduction,” according to the letter, which was signed by all 50 state medical societies, as well as Washington, D.C.
WHAT’S THE IMPACT?
The impending 4.5% Medicare Physician Fee Schedule (MPFS) payment cut comes as medical practices throughout the country are experiencing pressures stemming from rising rates of inflation, according to the letter.
While all healthcare stakeholders struggle with steep annual payment reductions, they’re exacerbated by the fact that physicians are the only providers whose Medicare payments do not automatically receive an annual inflationary update, the AMA said. This statutory flaw that characterizes the MPFS consistently leads to financial uncertainty and budgetary challenges for all physicians, according to the group.
“The stark reality is that, adjusted for inflation in practice costs, Medicare physician pay has declined 22% from 2001 to 2021,” the letter read. “Allowing cuts to Medicare payments is simply unacceptable during this time of record inflation and coming on the heels of a highly disruptive pandemic.”
The group contended that this contributes to burnout, stress, workload and the cumulative impact of the COVID-19 pandemic, which has one in five physicians considering leaving their practice within the next two years. The payment cuts, the AMA said, will only accelerate this trend unless the reduction is stopped in full; otherwise, it’s likely that Medicare patients will struggle to access healthcare services.
“Put simply, the cost of congressional inaction is an across-the-board cut that will further amplify the financial hardship physician practices are already facing while inhibiting Medicare from delivering on its promises to seniors and future generations,” according to the letter.
THE LARGER TREND
The 2023 Medicare Physician Fee Schedule final rule reflects the end of the temporary 3% supplemental increase from 2022. Physician groups are pressing for Congress to intervene to stop the cuts. Many are pushing for Congress to pass the Supporting Medicare Providers Act, H.R. 8800. Combined with a 4% Medicare cut stemming from the Statutory Pay-As-You-Go Act, physicians said they are looking at a nearly 8.5% Medicare cut on January 1.
To read more, go to Healthcare Finance.
Price Transparency a Hot Topic, But Many Patients Still Caught Off Guard by Imaging Bills
By Hannah Murphy | December 12, 2022
Although well-intentioned, price transparency initiatives pertaining to shoppable imaging services might not provide reliable or useful information to patients. A new paper published in the Journal of the American College of Radiology recently offered explanations as to why this is sometimes the case.
Co-authors Mohinee Mukherjee of Emory University Rollins School of Public Health and Michal Horný of Emory University School of Medicine explained that there are two aspects of billing complexity that make providing reliable price estimates to patients difficult: the number of parties involved in providing care, and billing for fees and ancillary services outside of the actual imaging exam itself.
“A key issue is the complexity of health care products. A single health care encounter from the patient’s perspective often consists of several complementary services. What services will comprise a health care encounter—and, ultimately, appear on a patient’s medical bill—varies across providers based on contractual agreements with payers,” the authors explained.
The authors’ recent analysis of more than 5 million outpatient imaging encounters revealed just how frequently patients are billed by multiple entities for what amounts to just one imaging exam. They found that 70.9% of hospital-based encounters resulted in multiple bills for a single exam. These rates were markedly lower for office-based encounters and exams completed at imaging centers, at 4.5% and 7.6%
The use of iodinated contrast was also found to play a role in bill complexity, with more than half of encounters utilizing the image agent resulting in separate bills across all three care delivery settings.
This, the authors explained, can make obtaining an accurate price estimate for imaging services difficult for patients, as they would have to seek out multiple entities separately to gather billing and fee information.
Additionally, many patients are unaware of factors that would influence how they are billed, such as ancillary fees and organizational setups that use parties offsite to interpret imaging studies. In turn, the pricing information patients receive prior to exams is often incomplete.
“These findings may be apparent to health care professionals, but they may not be obvious to patients,” they wrote.
To read more, got to Health Imaging.
ACR Rolls Out Quick Guide to LDCT Incidental Findings
By Dave Pearson | December 9, 2022
Clinicians who routinely manage patients screened for lung cancer with low-dose CT have a new 1-page printout to illuminate evidence-based care pathways when faced with significant but questionably urgent incidental findings.
The resource was commissioned by the American College of Radiology’s steering committee on lung cancer screening and is laid out in a paper posted Dec. 9 in JACR .
Lead author Debra Dyer of National Jewish Health in Denver, senior author Ella Kazerooni of the University of Michigan and colleagues drafted the paper and comprised the ACR’s subcommittee on LCS incidental findings.
For the most part, the guide’s insights and recommendations amplify those from previous research.
For example, Dyer and co-authors found that incidental findings turn up in almost 20% of patients undergoing lung cancer screening with low-dose CT, but most of these “incidentalomas” call for no urgent diagnostic or therapeutic action.
Still, the authors report, some 95% of participating end-users representing 49 screening programs rated the guide as useful or extremely so during a pilot rollout.
Further, Dyer and colleagues state theirs is the first report in the literature that “defines the commonly encountered incidental findings in lung cancer screening and provides recommendations for those that are actionable.”
The team developed the guide after analyzing data in the ACR Lung Cancer Screening Registry, reviewing 12 relevant ACR white papers and other published literature and soliciting input from various medical subspecialists.
Co-authors and reviewers of the guide included cardiothoracic radiologists, a pulmonologist and two primary care providers.
The resulting guide contains 45 case-specific recommendations involving 15 separate organs across seven anatomic regions: abdominal, cardiovascular, breast, esophagus, lung/pleura, mediastinum and thyroid.
Major recommendations include:
In reporting significant or potentially significant incidental findings on lung cancer screening with low-dose CT, radiologists should use the Lung-RADS S modifier to indicate that these findings are actionable.Ordering providers have the responsibility to address actionable incidental findings identified and ensure that the findings are appropriately and adequately managed.To read more, go to Radiology Business.
VIDEO: Impact of the 2023 Medicare Cuts on Radiology
By Dave Fornell | December 8, 2022
Ed Gaines, JD, CCP, vice president of regulatory affairs and industry liaison, Zotec Partners, discusses the impact of the 2023 Medicare Fee Schedule on medical imaging at the Radiological Society of North America (RSNA) 2022 meeting. Gaines works with RSNA on billing and Medicare issues and spoke in sessions at the RSNA 2022 meeting.
RSNA and several other medical societies are calling for serious, national discussions on Medicare cuts planned for 2023, which the groups say are not sustainable and will negatively impact care.
“Once again, radiology is looking at disproportionate cuts for diagnostic, interventional and radiation oncology,” Gaines explained. “There are several components, [including] the RVU changes where radiology was negatively impacted.”
The Centers for Medicare and Medicaid Services (CMS) has a fixed amount of money in its budget, so if CMS wants to offer incentives to one area of medicine, money must be taken away from another in a sort of robbing Peter to pay Paul strategy. Gaines said CMS is trying to put more money into primary care because of the growing shortage of physicians in that field. However, the shift impacts radiology and other specialties in the form of lower reimbursements from the changes in relative value units (RVUs).
“You also have the sequestration cuts, which have been around for years but were suspended during COVID,” Gaines said, adding this amounts to a 2% cut for radiology.
Another big impact on CMS payments is the PAYGO cut, a federally mandated plan to make cuts elsewhere to balance the budget. Gaines said this reduction in reimbursements is paying for the American Rescue Plan during COVID. This amounts to a 4% hit in the 2023 fee schedule.
Overall, depending on the subspecialty, CMS cuts amount to a 10 to 12% reduction in payments ins 2023. Gaines said this might be offset possibly by 3 to 4% with legislation pending in Congress in December 2022, but the net results even with Congressional relief would still be overall reduction in reimbursements. This would come, he points out, at a time when inflation and increased supply chain costs are impacting the bottom line in healthcare.
“There is a cost vs. quality equation, and the argument we have to have in Washington now is that the physician fee schedule does not have some component that captures inflation,” Gaines explained. “The Physician Fee Schedule in real dollar terms is down over 60% since its creation in 1992. It has never been indexed to inflation. That is the next bar for us to really try and go for in terms of advocacy.”
Further cuts will come in 2024 when the CMS quality payment program MIPS will be eliminated, Gaines said.
Contact your Senators NOW!Contact your Representatives NOW!To read more, go to Radiology Business.