Radiology Digest – February 18, 2021

February 22, 2021

Radiology Digest: News from the week of February 18, 2021.

Data Cast Doubt on Controversial CMS Reimbursement Restriction for MR Imaging

Marty Stempniak | February 18, 2021 | Included in Radiology Digest – February 18, 2021

New research is casting doubt on a controversial Centers for Medicare & Medicaid Services decision to restrict coverage for MR imaging among certain patients, experts wrote Wednesday.

It was a few years ago that the agency kept in place roadblocks to limit such exams for patients with abandoned leads for their cardiac implantable devices amid anxieties around safety. But a new analysis in JAMA Cardiology recorded no adverse events when imaging 139 patients with such concerns.

“In this study of patients with abandoned [cardiac implantable electronic device] leads undergoing MRI, including those who underwent MRI of the thorax, a low rate of arrhythmia, patient symptoms, or change in device settings was observed,” concluded Robert Schaller, DO, with the University of Pennsylvania medical school’s Division of Cardiovascular Medicine, and colleagues. “The growing aggregate of data calls into question current institutional and CMS reimbursement policies concerning MRI in patients with abandoned CIED leads,” they added.

The investigation included patients with at least one abandoned lead (243 total across all patients) who underwent 1.5-Tesla MR imaging between 2013-2020 at the Hospital of the University of Pennsylvania. Such pacing leads—whether capped, uncapped or fragmented—are no longer in electrical continuity with a pacemaker or defibrillator generator. Researchers monitored heart vitals through the process and maintained live contact with each individual via visual and voice connections.

Schaller and co-authors witnessed no abnormal vital signs or sustained arrythmias during the analysis. Nor did they see any changes in battery voltage, power-on reset events, or pacing. One patient with an abandoned subcutaneous array experienced sternal heating, but that subsided after prematurely stopping the exam.

In a corresponding editorial, cardiologist Robert Russo, MD, PhD, said this latest analysis is further proof that coverage should not be denied for clinically indicated MRI in this patient population.

To read more, go to Radiology Business.

5 Tips for Radiology Practices Eliminating Report Embargoes Under New Info-blocking Rules

By Matt O’Connor | February 16, 2021 | Included in Radiology Digest – February 18, 2021

The information-blocking provision of the 21st Century Cures Act is designed to spearhead interoperability and enhance patients’ access to health information. To prepare for this upcoming change, many provider groups are considering eliminating the typical delayed release of radiology reports via online portals.

The idea is that a few days or a week allows referring providers to coordinate care for patients before they fret over potentially abnormal imaging findings. As part of the Office of the National Coordinator for Health IT’s new regulations, however, delaying access to personal health information is subject to penalties of up to $1 million per offense. Organizations must comply with new mandates by April 5, but enforcement of such rules is still pending.

Importantly, there hasn’t been a concrete ruling on whether this imaging embargo period will constitute information-blocking, Massachusetts General Hospital radiologists wrote Tuesday in JACR.
The American College of Radiology in October reached out to the ONC for guidance, with the latter noting providers aren’t required to proactively release rad reports to patients who haven’t requested it. But in practice, the ONC said this could mean a patient gains access “in parallel” to when the ordering clinician has results.

“With respect to patient-level … access, many hospitals plan to respond to the information-blocking provision in part by eliminating radiology report embargoes, among other strategies for promoting data accessibility,” William A. Mehan Jr. MD, MBA, and colleagues with MGH-affiliated Harvard Medical School, explained on Feb. 16. “Radiologists may struggle to understand and prepare for the impact of immediate patient report access via online portals on their practices, referring providers, and patients.”
To read more, go to Health Imaging.

CMS Should Consider Cutting Pay for Low-value Imaging to Curb Misuse, RAND Corp. Says

By Marty Stempniak | February 16, 2021 | Included in Radiology Digest – February 18, 2021

Medicare recipients continue to receive low-value imaging services, despite efforts to curb misuse, and the trust fund should consider cutting pay to find further gains.

That’s according to a new RAND Corp. analysis of 2014-2018 fee-for-service claims data, published Tuesday in JAMA Network Open. Tracking 32 different unnecessary care practices—such as imaging for an uncomplicated headache or CT of the head tied to sudden hearing loss—experts found related spending only dropped modestly.

All told, the proportion study subjects who received low-value care declined from 36.3% in 2014 down to 33.6% a few years later. Annual spending per 1,000 individuals, meanwhile, fell from $52,766 to $46,922, a small dip that occurred despite national campaigns and payment revisions to address wasteful care, authors noted.

“While educational efforts, such as the Choosing Wisely campaign, are important for raising awareness of the problem among clinicians and patients, additional efforts will be needed to significantly curb low-value care use and spending in light of our findings,” lead author John Mafi, MD, a RAND policy researcher and UCLA professor of medicine, and colleagues wrote Feb. 16. “Specifically, we found that increases in the price of services, such as certain diagnostic imaging tests and invasive procedures, were also associated with increases in low-value care spending and addressing price increases may represent an important strategy in reducing wasteful spending,” the team added, citing interventional radiologist-inserted PICC lines as one example.

To read more, go to Radiology Business.

USPSTF Must Operate Transparently in Review of Breast Imaging Guidelines, Radiologists Charge

By Marty Stempniak | February 16, 2021 | Included in Radiology Digest – February 18, 2021

The United States Preventive Services Task Force must operate transparently and consult breast imaging specialists as the group considers modifying its influential screening guidelines, experts charged on Wednesday.

USPSTF just recently began this periodic review, detailing the process it will use to determine new imaging recommendations for the world’s most-diagnosed form of cancer. The volunteer, independent group is accepting feedback through Wednesday, Feb. 17, and the American College of Radiology just weighed in.

ACR believes that with so much at stake, the group must operate openly and take cues from one of the specialties most impacted by its recommendations.

“With millions of lives affected, it is imperative that critical decisions affecting citizens’ access to preventive healthcare services not be made behind closed doors without the benefit and protection of well-established federal agency transparency requirements,” ACR chief executive William Thorwarth Jr. wrote Feb. 10.

Among its asks, the college is urging USPSTF to share details about its methodologies, along with the input received during public comment periods. ACR also wants to hear about how the task force analyzes—and decides to accept or reject—such input.

The USPSTF is not bound by the transparency rules that come with being a formal federal advisory committee. However, the ACR believes that the Affordable Care Act has granted the task force a “prominent role” in dictating both public and private coverage of imaging services. Thorwarth and colleagues urged the group to seek feedback from the field before making changes that could reshape Medicare, Medicaid and commercial radiology reimbursement.

“Breast imaging experts have a high degree of familiarity with the relevant research and the downstream scientific literature that provides important context and understanding,” he wrote. “Selection of such experts should not be made in a manner that reinforces bias against screening mammography; the deliberative process is enhanced when open discussion and debate are embraced.”

The task force last issued breast cancer screening recommendations in 2016, maintaining its controversial 2009 view that women in their 50s should receive mammograms every two years. A number of healthcare groups, including the ACR, have lobbied against such recommendations, instead advocating for USPSTF’s 2002 guidance to screen every 1-2 years beginning at age 40.

You can read the full comment letter from the American College of Radiology here, and the task force’s Draft Research Plan for Breast Cancer Screening here.

CMS Pulls Back on Medicaid Work Requirement Policies

By Michael Brady | February 12, 2021 | Included in Radiology Digest – February 18, 2021

The Biden administration on Friday started to unwind a controversial Trump-era policy that allows states to force low-income residents to work, volunteer or take part in other so-called “community engagement” activities to enroll in Medicaid coverage.

The news comes just two weeks after President Joe Biden ordered federal health officials to reexamine policies that make it more difficult for individuals to access or afford coverage, including Medicaid work requirements. CMS withdrew a 2018 letter from former CMS Administrator Seema Verma to state Medicaid officials that invited them to apply for the waivers. The agency also reversed its approval for Georgia’s partial Medicaid expansion, which is now “pending.” CMS will also send a letter to 10 states with waivers for Medicaid work rules, informing them that the agency will repeal their waivers soon, Politico first reported. It in its letter to Arkansas, the agency said it had “preliminarily determined that allowing work and other community engagement requirements to take effect in Arkansas would not promote the objectives of the Medicaid program.”

“In the midst of the greatest public health emergency in generations, now more than ever, people with Medicaid need access to care. Medicaid’s primary objective, as set out by Congress, is to provide medical assistance in order to serve the health and wellness needs of our nation’s vulnerable and low-income individuals and families, based on need, not based on one’s ability to find work. This is not the time to experiment or test policies that risk a substantial loss of health coverage or benefits, especially for individuals and communities significantly impacted by COVID-19 and other health inequities,” a CMS spokesperson said in an email.

Dan Mendelson, a former Clinton administration official and founder of consulting firm Avalere Health, said undoing the waivers is consistent with the Biden administration’s stated goal to increase the number of people with health insurance because the Trump-era “policy directly contradicts what they are trying to accomplish.” But it could take time to undo the waivers. Just before former President Donald Trump left office, Verma asked states to sign contracts that would make it more challenging for CMS to end states’ work requirements. Experts have questioned whether those contracts are legally enforceable.

The Biden team will need to review the contracts to see how much flexibility they allow. Mendelson said that Medicaid is an ongoing negotiation between the federal government and states because it is jointly funded and administered.

To read more, go to Modern Healthcare.

Imaging Advocates Issue ‘Call to Action’ Over UnitedHealthcare Payment Policy

By Marty Stempniak | February 12, 2021 | Included in Radiology Digest – February 18, 2021

Imaging advocates issued a “call to action” on Thursday over a UnitedHealthcare payment policy they worry is infringing on the patient-physician decision-making process.

The nation’s largest commercial insurer recently updated its coverage to provide reimbursement for coronary CT angiography, labeling such imaging as a “first line test” for assessing stable chest pain.

UHC has insisted it is not pushing CCTA over other tests including positron emission tomography or single-photon emission CT, according to the American Society of Nuclear Cardiology. Yet, the Fairfax, Virginia-based said it is hearing reports to the contrary from its membership, with the insurance giant allegedly favoring CCTA over SPECT.

“ASNC is adamant that the choice of tests is within the purview of the physician’s clinical judgment and that such decisions should be made in consultation with the patient,” the group wrote Thursday night, adding that it “advocates for putting the patient—never any specific test—first.”

The nuclear cardiology group is asking the field for immediate input to further understand the matter. It has created a reporting form and wants to hear about such prior authorization roadblocks from radiology benefits managers, encountered when recommending a certain modality for patients.

ASNC also warned physicians about its dispute with UnitedHealthcare back in November.

To read more, go to Radiology Business.

ACR Worries Value-based Initiatives Are Ignoring Radiologists’ Care Coordination Skills

By Marty Stempniak | February 11, 2021 | Included in Radiology Digest – February 18, 2021

The American College of Radiology is concerned that federal value-based care initiatives are overlooking the specialty’s skills at coordinating care, leaders shared recently.

A federal contractor is currently working to gather input on the possible development of new measures under the Merit-based Incentive Payment System. And Burlingame, California-based Acumen is seeking feedback from the field on behalf of the Centers for Medicare & Medicaid Services.

ACR said it supports the process, but is seeking changes, CEO William Thorwarth Jr., MD, wrote in comments submitted Feb. 5. Previous MIPS quality measures have not typically been attributed to radiology groups, as they were meant to assess imaging costs, rather than radiologic care.

“A significant challenge that radiologists confront is a lack of opportunity to be recognized for care coordination and the inability to be rewarded for team-based care led by radiologists,” he wrote to Acumen. “We hope that the potential areas of future cost measure development that we have outlined may increase radiologists’ opportunities to participate in value-based care.”
Thorwarth noted that care provided by rads doesn’t quite fit into the traditional episode framework. He urged Acumen and CMS to consider developing cost measures that connect with existing quality topics, including incidental imaging findings or breast cancer screening.

The group could potentially create an episode-based measure tracking screening mammography to cancer diagnosis. The cost window for this episode could potentially last a year and would be entirely under a radiologist’s control, he noted. Breast imaging physicians already have well-established quality metrics used for auditing their own practices and MIPS had previously included measures tied to cancer detection, recall rates and true/false positives, he added.

You can read the entire letter to Acumen here and a Feb. 9 news update from the college with further information here.

Learn more about what Zotec Partners can do for your radiology practice here.