CMS Expanding Coverage for Low-dose CT Lung Cancer Screening
By Marty Stempniak | February 10, 2022
The Centers for Medicare & Medicaid Services is expanding coverage for low-dose CT lung cancer screening, the administration announced Thursday afternoon.
CMS’ final decision will expand eligibility for Medicare beneficiaries to receive such lifesaving screenings by dropping the starting age from 55 down to 50 years old. The agency will also reduce the tobacco smoking history threshold from at least 30 packs per year down to at least 20, according to an announcement.
“Expanding coverage broadens access for lung cancer screening to at-risk populations,” CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality Lee Fleisher, MD, said Feb. 10. “Today’s decision not only expands access to quality care but is also critical to improving health outcomes for people by helping to detect lung cancer earlier.”
The feds first announced they were launching a process to consider expanding coverage for LDCT—the only recommended screening test for the disease, utilizing a specialized computed tomography scanning technique—back in May 2021. In a follow-up announcement last November, CMS hinted at Thursday’s forthcoming decision, indicating that the evidence was sufficient to expand Medicare coverage for LDCT.
In addition, the final decision will also simplify requirements for counseling and shared decision-making as part of screening. Based on feedback from the imaging field, CMS is removing stipulations that the reading radiologist must document participation in continuing medical education, “thereby reducing administrative burden on providers,” according to the announcement. However, the feds added an additional condition to the national coverage determination criteria for imaging facilities, specifying that they must use a standardized lung nodule identification, classification and reporting system (Lung-RADS).
Read the full final decision from the Centers for Medicare & Medicaid Services here.
‘Giveaway for Private Insurers’: ACR Requests Summary Judgment Without Trial in Surprise Billing Suit
By Marty Stempniak | February 10, 2020
The American College of Radiology and other doc groups requested a summary judgment from an Illinois court Wednesday, hoping to avoid a trial in their lawsuit over surprise billing legislation.
ACR, the American College of Emergency Physicians and the American Society of Anesthesiologists are hoping to reach a rapid resolution, with the law already in effect since Jan. 1. Those involved said they support efforts to protect patients from surprise bills but are concerned the current approach is tilted heavily in the favor of payers.
“Without regard for patient impact, insurers are using the federal rule to narrow provider networks, which will deny patients’ access to their chosen providers and inflate already record insurer profits,” Howard Fleishon, MD, chair of the ACR board of chancellors, said in a statement. “Rural and underserved communities may be hit hardest by this overreach that can result in longer wait times for care, delayed diagnosis and higher out of pocket costs to treat more advanced conditions. The court can stop this now by granting our motion for summary judgement.”
Physicians first filed their suit against the federal government in late December. They contend that, under Congress’ original intent, mediators were supposed to consider a host of factors when settling disputes between payers and out of network providers. However, the Biden administration’s implementation of the rule, instead, emphasizes one variable—the health insurer’s median in-network rate. ACR et al. said this gives insurers the power to “strongarm” physicians out of network and drive down rates.
Several other provider groups previously sued the feds over the rule, including the American Medical Association and the Texas Medical Association. Physicians argued that insurer profits have skyrocketed in recent years while costs dropped, with no corresponding reduction in
“There is no indication — nor proof — that insurer profit increases gained via No Surprises Act-related network restrictions would result in lower costs to patients,” ACR, the American College of Emergency Physicians and the American Society of Anesthesiologists said in their statement Wednesday. “Neither the lawsuit nor the filing for summary judgement impact patient protections in the new law nor increase patient healthcare costs,” they added.
To read more, go to Radiology Business.
Congress Members Renew Call to Address Fee Schedule Update that will Stifle Radiologist Pay
By Marty Stempniak | February 9, 2022
Bipartisan members of Congress are renewing calls to address a change in the Medicare fee schedule that will impact radiologist pay.
For the first time in nearly 20 years, the feds are boosting payments to benefit primary care and others who use clinical labor. But because of budget-neutral requirements, this necessitates cuts elsewhere to those who do not—with providers such as interventional radiologists and radiation oncologists bearing the brunt.
Reps. Bobby Rush, D-Ill., and Gus Bilirakis, R-Fla., are spearheading a group of 61 lawmakers, urging House and Senate leaders to address these changes. They believe such pay cuts will prove detrimental to specialists who treat clinical concerns—such as venous ulcers and peripheral artery disease—that disproportionately affect Black and Latino patients.
“These ‘clinical labor’ cuts are the most significant negative impact of the 2022 Physician Fee Schedule by far and are expected to cut reimbursement by more than 20 percent for some specialties,” Rush, Bilirakis and colleagues wrote in a Feb. 8 letter to leaders from both
parties in the House and Senate. “Frankly, these cuts threaten to undermine efforts to address health inequity, accelerate health system consolidation, and weaken our ability to deal with the pandemic.”
The letter writers first introduced their bill back in November, with the feds failing to include its changes in final year-end spending legislation. Instead, the administration will phase-in the clinical labor wage updates over the next four years. Rush et al. said they hope their proposal will be included in upcoming omnibus appropriations legislation.
Late last month, the American College of Radiology identified the clinical labor wage updates as one potential target for its advocacy efforts in early 2022.
To read more, go to Radiology Business.
HHS Running Out of Money to Pay Providers for Treating Uninsured COVID-19 Patients
By Jessie Hellmann | February 8, 2022
A federal program that reimburses healthcare providers that care for uninsured COVID-19 patients is expected to run out of money by spring or summer.
The Provider Relief Fund has paid out more than $17 billion to providers treating, testing and vaccinating the uninsured throughout the pandemic. The Health and Human Services Department program has been a lifeline for providers, especially in states such as Texas and
Florida with high rates of people who don’t have health coverage.
But there’s only $7.6 billion left and the money will run out in the coming months, an HHS spokesperson said. Congress isn’t currently considering making more funding available, meaning providers and patients are likely to soon have to bear the costs themselves.
Hospitals continue to urge Congress to replenish the Provider Relief Fund, which has helped offset providers’ pandemic-related losses.
“One of the most helpful and patient-oriented use of the PRF was to help those people who for whatever reasons are uninsured and suffer from COVID-19,” said Federation of American Hospitals CEO Chip Kahn. “It meant that no one should have any reluctance to go to the hospital if they have COVID but no insurance.”
Amid the omicron variant’s widespread, HHS has been processing about $500 million in claims for uninsured patients, so the fund is quickly depleting, the HHS spokesperson said.
Of the $17 billion HHS has distributed to providers from the uninsured fund, nearly $10 billion paid for testing, more than $6 billion reimbursed for treatment and the remainder covered vaccinations.
Providers in states with high uninsured rates and in states that haven’t expanded Medicaid to low-income adults under the Affordable Care Act are among those receiving the most money, according to a Modern Healthcare analysis of HHS data.
If the Provider Relief Fund runs out of money and Congress doesn’t appropriate more, hospitals could be left footing the bill. Not-for-profit hospitals and many for-profit hospitals must provide financial assistance to people with low incomes, many of whom are uninsured.
To read more, go to Modern Healthcare.
Rural Lung Cancer Screening Program Boosts Engagement, with Nearly 90% of LDCT Orders Completed
By Marty Stempniak | February 8, 2022
A novel rural lung cancer screening program is boosting patient engagement, with nearly 90% of low-dose CT orders completed, according to research published Monday in JACR.
The limited number of imaging facilities and long travel distances can make screening uptake challenging in such settings. Imaging experts in Texas sought to address these challenges, collaborating with community leaders to launch an intervention that included navigation services and tobacco cessation counseling.
In the first year alone, providers referred 570 patients for screening, with 86% eligible for imaging.
“Implementation, uptake and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts,” corresponding author David Gerber, MD, a professor of internal
medicine in the Hematology/Oncology Division at UT Southwestern Medical Center, and coauthors wrote Feb. 7. “Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.”
Providers first implemented their Lung Cancer Screening and Patient Navigation (LSPAN) program in May 2018. It provides support across 18 rural and medically underserved counties in North Texas, targeting 107,000 individuals with an elevated lung cancer risk. The program includes outreach to educate patients on screening; fostering a virtual network of integrated providers; and deploying an algorithm to pinpoint patients who require aid in navigating the process. LSPAN also centralizes reimbursement, so that clinical service costs are supplemented with additional funding for low-income or uninsured patients.
Gerber and co-authors sought to study the impact of the program, collecting data on referrals, orders and completions. In the first year ending in June 2019, providers ordered 381 LDCTs, with 88% completed. Out of those who were referred but ineligible, the most common reasons were age (43%) and insufficient tobacco history (20%). Among the screened patient population, 61% were current smokers and 36% had insurance coverage, with an average program cost per patient of $430.
About one-fourth of eligible referrals didn’t complete their screening, and failure to contact the patient after three attempts accounted for half of such cases.
“Reasons for active and passive refusals to undergo LDCT after referral merit further investigation, because it is unclear whether this behavior reflects patient health beliefs, logistical considerations or other concerns,” the authors advised. “Notably, once an LDCT order was placed, adherence was almost 90%, suggesting such a procedure is feasible despite the distance needed to travel.”
Read more about the program in the Journal of the American College of Radiology here.
To read more, go to Radiology Business.
Senators Introduce Bipartisan Bill to Extend Patient Access to Telehealth Through 2024
By Heather Landi | February 8, 2022
Two U.S. senators introduced bipartisan legislation Monday to extend current Medicare telehealth reimbursement waivers an additional two years following the end of the public health emergency.
If passed, the bill, the Telehealth Extension and Evaluation Act (PDF), would also extend current Drug Enforcement Administration telehealth prescribing waivers for two years after the COVID-19 PHE period.
U.S. Sens. Catherine Cortez Masto, D-Nevada, and Todd Young, R-Indiana, introduced the bill.
“Seniors across Nevada have benefited immensely from having access to a wide range of telehealth services throughout the pandemic, and we need to make sure they continue to have access to quality care from their homes” said Cortez Masto in a statement. “We’re still feeling the impacts of coronavirus, especially in older and more vulnerable populations, which is why these telehealth services must be extended.”
The legislation would allow the Centers for Medicare & Medicaid Services to extend Medicare payments for a broad range of telehealth services, including substance abuse treatment, for an additional two years. The bill would also commission a study on the impact of the pandemic telehealth flexibilities extended in the bill in order to better inform Congress’ work to make telehealth flexibilities permanent.
Cortez Masto also introduced bipartisan legislation to permanently expand access to telehealth services for Americans with high-deductible health plans and legislation to ensure Medicare Advantage enrollees can access affordable to telehealth during the pandemic, even if they can only make an audio connection to providers.
“The telehealth flexibilities put in place by Congress during the early days of the COVID pandemic played a critical role in allowing the most vulnerable Hoosiers to access care safely. As Congress evaluates which changes to make permanent, many of these flexibilities are set to expire. We should act now to ensure seniors continue to benefit from these important remote health care services,” said Young in a statement.
Many healthcare groups applauded the legislation as a way to expand access to virtual care.
“By extending the current telehealth waivers by two years after the end of the COVID-19 PHE, the Telehealth Expansion and Evaluation Act would provide much-needed certainty to providers and patients who have come to rely on telehealth as a critical tool to deliver and access high-quality care,” said Jen Covich Bordenick, CEO of Executives for Health Innovation (EHI), in a statement. “We urge Congress to quickly act to pass this bipartisan legislation as an important step toward permanent reform.”
Last week, more than 330 organizations, including EHI, the Alliance for Connected Care and the American Telemedicine Association, sent a letter to congressional leaders calling for temporary extension of telehealth waivers as a pathway toward permanent telehealth policies.
To read more, go to Fierce Healthcare.
House Punts Sequester Relief, Telehealth Reform in Short-term Spending Bill
By Robert King | February 7, 2022
(This bill was passed on 2/8)
House appropriators bypassed addressing major health priorities on telehealth and sequester relief in a short-term spending bill introduced Monday that funds the federal government through March 11.
The House Appropriations Committee released legislation Monday for the short-term continuing resolution to avert a government shutdown by Feb. 18. Health groups have been pressing for additional relief from a 2% cut to Medicare payments expected to go back into effect this summer.
But the short-term spending bill will give congressional negotiators more time to work on a larger omnibus package.
“We are close to reaching a framework government funding agreement, but we will need additional time to complete the legislation in full,” said House Appropriations Committee Chairwoman Rep. Rosa DeLauro, D-Connecticut, in a statement Monday.
The legislation does extend the enhanced federal matching rate for Medicaid funding for certain territories through March 11.
However, it does not include any policies that provider groups have been lobbying for, as groups have another month to make their case to lawmakers.
Several hospital groups are hoping to get relief from a 2% cut to Medicare payments made under sequestration. The payment cuts were suspended by Congress in 2020 at the onset of the pandemic to help providers facing massive revenue shortfalls.
Congress reached a deal late last year to keep the 2% moratorium through April, when it then declines to 1% through June and then resumes the full cut after that month.
But hospital groups say that the landscape has dramatically changed since that deal was made in early December, as the omicron-fueled surge of the virus and crippling labor shortages has caused massive strain on facility finances. Groups are hoping to use the must pass spending bill as a vehicle for policy changes.
Some groups, such as the American Hospital Association, want the 2% moratorium to be extended through the duration of the COVID-19 public health emergency, which was extended into April by the Biden administration and could be extended again.
Other groups have wanted key flexibilities for telehealth use to be made permanent for another year or two to give the federal government more time to study the use of telehealth. The Centers for Medicare & Medicaid Services removed many barriers to Medicare reimbursement for telehealth, but those flexibilities go away after the public health emergency ends.
To read more, go to Fierce Healthcare.
Presidential Call to Action on Cancer Screening Draws Praise from Radiology Community
By Marty Stempniak | February 7, 2022
A recent presidential call to action on cancer screening is drawing praise from the radiology community.
The White House announced its relaunch of Joe Biden’s Cancer Moonshot initiative on Feb. 2, hoping to cut deaths from the disease by 50% over the next 25 years. Imaging will be a key component of the revived effort, with more than 9.5 million missed cancer screenings in the U.S. resulting from the pandemic, the White House said Wednesday.
Federal officials hope to catch up by offering new access points and utilizing at-home and mobile cancer screening options, according to a fact sheet. Coinciding with the announcement, the three-person panel reporting on the nation’s progress fighting the disease issued a new report: Closing Gaps in Cancer Screening, detailing recommendations on this issue.
“We could not be more pleased with the direction that this has taken and firmly believe that there is a real opportunity here for radiology to play an increasing role in three of the four cancers (lung, breast, colon) studied by the President’s Cancer Panel,” William Thorwarth Jr., MD, CEO of the American College of Radiology, said in a Friday news update.
Other recommendations include creating communications campaigns, deploying community health workers to reach individuals, and modifying requirements to allow nonphysician providers to consult patients on lung cancer screening (as part of doc-led teams). ACR noted that radiologists played a part in investigating this issue and helping the President’s Cancer Panel compile its list of goals and guidance.
Others in the radiology community also applauded the administration’s efforts. The Medical Imaging & Technology Alliance, which represents device manufacturers, called reductions in screenings during the pandemic a “ticking time bomb for too many Americans.”
The American Society for Radiation Oncology pointed to its own data, which found that 66% of docs surveyed said patients were presenting with more advanced-stage cancers amid the pandemic. Another 73% of radiation oncologists said they’ve noticed missed cancer screenings among their patients.
“These rates may be even higher for racial and ethnic minority groups, who face disproportionate burdens regarding both COVID-19 and cancer,” Laura Dawson, MD, chair of ASTRO’s board of directors, said Feb. 2. “Multiple studies show that inequitable access is driving disparate outcomes. Today’s [White House] announcement highlights the critical need for multidisciplinary collaboration and prioritization of cancer research and screening to reverse these alarming trends.”
As part of its push, ASTRO and other cancer care advocates recently sent a letter to Congress, urging it to swiftly pass a 2022 spending package. Such action should include “strong support” for the National Institutes of Health and National Cancer Institute, the society and others urged.
To read more, go to Radiology Business.