Federal Court Strikes Down Part of HHS Surprise Billing Rule
By Rachel Cohrs | February 23, 2022
A federal court on Wednesday struck down the Biden administration’s interpretation of a controversial part of the federal law banning surprise medical bills.
Health care providers have filed several lawsuits challenging how the Department of Health and Human Services created a mediation process for hospitals and doctors and insurers to settle disputes over out-of-network medical bills.
A federal court judge in Texas sided with Texas Medical Association, a trade association representing more than 55,000 physicians, and decided that HHS was mistaken in its decision to instruct mediators to give rates insurers and providers contracted with in the past extra weight compared with other factors.
“This decision is an important step towards restoring the fair and balanced process that Congress enacted to resolve surprise billing disputes between health insurers and physicians,” said Diana Fite, immediate past president of the Texas Medical Association.
The legal dispute cuts to the heart of an issue that roiled Capitol Hill ahead of the law’s passage in December 2020 — what specific factors an arbitrator would be allowed to consider in mediating the disputes, and how much weight each of those factors should get.
Lawmakers involved in drafting the bill have split on whether they think the Biden administration interpreted the law correctly. Senate health committee Chair Patty Murray (DWash.) and House Energy & Commerce Chair Frank Pallone (D-N.J.) said they think the Biden administration’s interpretation is correct, but Ways & Means Chair Richard Neal (D-Mass.), Rep. Kevin Brady (R-Texas), and a bipartisan group of 152 other lawmakers who prefer the more doctor- and hospital-friendly approach argued that lawmakers intended for all factors to have the same weight.
Pallone tweeted Wednesday night that the Texas court decision “ignores the clear letter and intent” of the No Surprises Act, and wrote that the lawsuit will endanger patient protections and raise costs for consumers.
The patient protections in the law went into effect in January, but the mediations between insurers and providers have not yet begun. The patient protections were not struck down by the Texas judge.
The American Hospital Association and American Medical Association filed a separate lawsuit as well, and a decision has not been made in that case.
To read more, go to Stat News.
Radiologists Often Aren’t Credited for 2nd Opinion Reads, Despite the Increased Workload
By Hannah Murphy | February 23, 2022
When outside facilities submit requests for second opinions on breast imaging exams, workloads substantially increase at cancer centers, yet the effort involved is not reflected in the reimbursements radiologists receive.
National Comprehensive Cancer Network-designated centers receive thousands of such requests on breast imaging every year, and up to 43% of those referrals result in a new or differing diagnosis than what was stated on the original read.
Second opinions are clinically valuable, but they represent a substantial amount of extra work for radiologists.
“The breast radiologist providing a second opinion must interpret all the imaging studies as if he or she were performing the primary interpretation; merely confirming the findings of a prior interpretation is insufficient, especially as expert opinion may significantly change
management recommendations or result in a new cancer diagnosis,” corresponding author Catherine M. Tuite, MD, with the breast imaging section of the Department of Radiology at ChristianaCare Helen F. Graham Cancer Center and Research Institute, and colleagues explained.
Radiologists also take on more liability when issuing a second opinion, which increases their risk of being involved in medical malpractice claims. All this combined has caused experts in the field to question reimbursement practices pertaining to second opinions.
However, the exact value of such effort has yet to be universally established. This is what led experts to dig deeper in an attempt to quantify the effort involved compared to the credit received when radiologists complete second opinions.
Utilizing data spanning three years, researchers conducted an analysis of reports for “outside film review.” In total, 2,216 studies were reinterpreted. The calculated range of annualized work relative value units (wRVUs) per specific CPT code was 3,135 to 3,804. However, for the
years of 2015, 2016 and 2017, the credits received for outside reads based on the number of patient requests fell short at 385, 375, and 345 wRVUs, respectively.
“Practices such as crediting only the wRVUs for the lowest-value examination interpreted or assigning an arbitrary and highly discounted value not only significantly undervalue the work and time effort involved but also devalues the intellectual contributions and expertise of that physician,” the authors wrote.
Tuite and colleagues believe their results support study-specific professional fees being billed and credited to the interpreting radiologist. However, further discussions are needed to determine appropriate crediting and reimbursement, they added.
49% of Radiologists Surveyed Say They’re Burned Out, with ‘Lack of Respect’ a Top Driver
By Marty Stempniak | February 22, 2022
About 49% of radiologists surveyed say they are burned out, placing the profession tied for seventh among specialists experiencing such workplace fatigue, Medscape reported Friday.
Radiologists cited “lack of respect” from administrators, colleagues or other staffers as the top contributor to burnout at 60%. Other popular answers included “too many hours at work” (50%), lack of control or autonomy over one’s life (47%), and too many bureaucratic tasks (30%). The findings are based on an online survey of more than 13,000 physicians including 300 radiologists, conducted between June and September.
Female radiologists have been hit harder, Medscape found, with 65% saying they’re burned out compared to 44% of males surveyed.
“There’s no question that women have reported far more role strain during the pandemic than men,” psychiatrist Carol Bernstein, MD, a professor and vice chair for faculty development and wellbeing at the Albert Einstein College of Medicine, told Medscape. “Often women assumed more of the childcare and homeschooling responsibilities in their households. As a result, we know that more women dropped out of the workforce.”
About 55% of radiologists said they feel more burned out now than during the early days of the pandemic, while 39% stayed the same. Another 67% of radiologists believe burnout has had a negative effect on their relationships, while 33% did not. Common tactics to alleviate this concern include participating in meditation or using other stress-relieving techniques (26%), reducing hours (21%), changing work settings (21%), or speaking with administration about “productivity pressure” (13%). Most radiologists (62%) said they would take a salary reduction in exchange for better work-life balance.
Read more, Medscape Radiologist Lifestyle, Happiness & Burnout Report 2022.
To read more, go to Radiology Business.
CMS Ends ACO Track in Rural Pay Transformation Model
By Maya Goldman | February 22, 2022
The Centers for Medicare and Medicaid Services eliminated a program meant to increase the adoption of Accountable Care Organizations in rural areas, the agency announced Tuesday afternoon.
On the agency’s website, CMS cites “broader efforts underway” as its reasoning for removing the ACO Transformation Track, which was part of an alternative payment demonstration for rural health system transformation, known as the Community Health and Rural Transformation Model. The Trump administration’s Center for Medicare and Medicaid Innovation announced the model in 2020.
CMS said in an emailed update on the program that it remains invested in creating opportunities to spur ACO adoption in rural communities. According to the email, the agency is developing a vision and strategy for accountable care, as it will look at lessons from the previous ACO Investment Model to inform future policies. It also expects to announce additional proposals soon.
CMS did not respond by publication to questions about the end of the program.
The next ACO proposals from CMS will likely focus on broader health equity, rather than geography, said David Pittman, senior policy advisor at the National Association of ACOs.
“Despite today’s announcement, NAACOS remains optimistic that CMS will soon launch more options to encourage ACO participation… the administration recognizes the value of ACOs and has stated their commitment to increase MSSP participation, which is critical for reaching their goals of expanding value-based care to all Medicare beneficiaries,” the organization said in a statement.
CMS originally slated the ACO Transformation Track to begin January 2022, but regulators delayed applications in March 2021, after the Biden team took over the agency. The agency has moved forward with the model’s separate Community Transformation Track.
The ACO Transformation Track would have given rural ACOs upfront payments of at least $200,000 per beneficiary, along with monthly prospective payments for each beneficiary, for two years if they took part in the Medicare Shared Savings Program and CHART Model. CMS had planned to allow up to 20 rural ACOs to join the track.
To read more, go to Modern Healthcare.
Senate Finalizes Radiologist-supported Bill to Address Burnout Following Physician’s Suicide
By Marty Stempniak | February 22, 2022
The U.S. Senate passed a radiologist-supported bill to address provider burnout on Thursday, Feb. 17, in response to a New York emergency physician’s suicide in 2020.
House lawmakers already approved the Dr. Lorna Breen Health Care Provider Protection Act in December, with the bill now headed to President Joe Biden for his signature.
Measures in the legislation include grants for helping train physicians address mental health issues, along with pinpointing best practices to prevent provider suicide. Numerous healthcare groups have previously voiced support for the act, including the American College of Radiology and the American Medical Association.
“We mourn Dr. Breen and take solace that her death prompted a desperately needed effort to focus on the mental health of physicians,” AMA President Gerald Harmon, MD, said in a statement. “These issues have always been present in medicine, and the COVID-19 pandemic has pushed them to the forefront. The AMA is grateful the Breen family advocated for this legislation, and that Congress listened.”
The bill will 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 are funded by the American Rescue Plan Act, signed into law in March 2021.
Sen. Tim Kaine, D-Va., introduced the legislation in July 2020, joined by other supporters including Sens. Todd Young, R-Ind., Jack Reed, D-R.I., and Bill Cassidy, MD, R-La. A version of the legislation previously passed in both chambers but needed to return for another round of votes “due to a small technical difference” between the House and Senate versions.
“Doctors, nurses and healthcare workers shoulder the responsibility of saving lives and have worked overtime during the pandemic,” Cassidy said in a statement. “Passing this bill through Congress provides an important lifeline for medical professionals so they too can get the care they need.”
To read more, go to Radiology Business.