Radiology Digest – February 26, 2021

March 1, 2021

Radiology Digest: News from the week of February 26, 2021.

Radiology Groups Part of 1M Provider Coalition Urging Congress to Quash Future Medicare Pay Cuts

By Marty Stempniak | February 24, 2021 | Included in Radiology Digest – February 26, 2021

Several prominent radiology groups are part of a coalition representing 1 million providers asking Congress to permanently address drastic Medicare pay cuts on the docket for next year and beyond.

Professional associations including the American College of Radiology thanked lawmakers for taking action in December to mitigate “devastating” physician reimbursement reductions slated for Jan. 1 of this year. But such actions were only a temporary Band-Aid, they wrote on Monday. ACR, the Society of Nuclear Medicine & Molecular Imaging and others want politicians to stop using budget neutrality to enact “arbitrary reductions to reimbursement unrelated to the cost of providing care.”

They believe the Medicare Physician Fee Schedule’s primary goals should be to encourage broad provider participation and reflect a modern healthcare delivery system that allows clinicians to collaborate.

“Unfortunately, these goals are not reflected given that there are additional scheduled deep cuts to providers who are reimbursed under the MPFS for 2022, 2023 and 2024,” the groups wrote in Feb. 22 letters to the House and Senate. Such cuts, they added, “will negatively impact patient care and diminish practitioners’ small businesses, further slowing our nation’s health and economic recovery from the pandemic. We urge Congress to consider additional policy options in the year ahead to address these shortcomings.”

Legislators injected $3 billion into the 2021 fee schedule to help offset these cuts. Along with the cash infusion, the Consolidated Appropriations Act blocked a new code to further blunt payment reductions by one-third over the next three years. Diagnostic radiologists were slated to see a 10% drop to offset corresponding pay increases for primary care and others who bill for evaluation and management services. The rad reduction, however, fell to about 4% in 2021, with phased-in adjustments to follow.

Others signing Monday’s letter included the Radiology Business Management Association, the American Society of Neuroradiology, the Society of Interventional Radiology, the American College of Radiation Oncology, and the Association for Quality Imaging.

To read more, go to Radiology Business.

American Board of Radiology Says ‘Persistent Barriers’ Preventing It From Reducing User Fees

By Marty Stempniak | February 24, 2021 | Included in Radiology Digest – February 26, 2021

The American Board of Radiology revealed recently that has no plans to reduce exam fees following its transition to a virtual test-taking business model.

ABR is making the switch away from in-person certification in 2021 after radiologists demanded alternatives amid the COVID-19 pandemic. One of the “perceived potential benefits” of the change was a reduction in costs and user fees. However, leaders with the Tucson, Arizona, doc-certification group said uncertainty is preventing them from changing pricing.

“There are persistent barriers to fee abatement at the time of this writing,” Executive Director Brent Wagner, MD, MBA, and American Board of Radiology President Vincent Mathews wrote in the latest issue of the Beam. Those include the new exam structure’s unproven track record, a lack of dependable forecasting, long-term financial commitments for in-person exam centers, and unpredictable costs tied to the virtual exam software.

Wagner and Mathews said their organization is committed to controlling costs and optimistic this will be achievable in the future.

“Despite these obstacles, the board members view themselves as responsible stewards of ABR resources, both financial and otherwise,” they concluded. “In this vein, they consistently challenge each other, and the ABR staff, to reduce costs and, subsequently, fees, to the extent possible.”

The American College of Radiology and others have criticized ABR in recent years over its finances, alleged secrecy and “power imbalance” over members of the specialty. A report from ACR’s Task Force on Certification estimated the average rad spends $14,680 during their career to maintain accreditation—one of the highest tallies among medical specialties. A Tennessee radiologist twice attempted to sue ABR over its program, but a judge tossed the claim in January.

High fees are one of the chief complaints from radiologists, the report noted. Residents and fellows pay about $640 a year for ABR’s services, on top of high student debt loads, while the board has tens of millions in assets and annual revenue of $14 million in 2018.

To read more, go to Radiology Digest.

Biden Asks High Court to Drop Two Trump-era Medicaid Cases

Associated Press | February 22, 2021 | Included in Radiology Digest – February 26, 2021

The Biden administration is asking the Supreme Court not to hear arguments in two cases on its March calendar about the Trump administration’s plan to remake Medicaid by requiring recipients to work.

The Biden administration has been moving to roll back those Trump-era plans and cited “greatly changed circumstances” in asking Monday that the cases be dropped from the court’s argument calendar. They are currently scheduled to be heard on March 29. The court has been hearing arguments by phone because of the coronavirus pandemic.

The high court had in December agreed to review lower-court decisions involving Arkansas and New Hampshire that found that the Trump administration’s support for work requirements went beyond what’s allowed by law. Arkansas on Monday opposed the Biden administration’s request that the cases be dropped, writing in a brief that the “central question in these cases — what Medicaid’s objectives are — will likely return” to the Supreme Court and that the need to decide the cases is “as pressing today” as when the court agreed to hear them in December.
To read more, go to Modern Healthcare.

ACR ‘Greatly Pleased’ With the American Medical Association’s New Payment Policy Leader

By Matt O’Connor | February 23, 2021 | Included in Radiology Digest – February 26, 2021

The American College of Radiology announced its support Tuesday for a new imaging leader who will be tasked with assessing and informing Medicare payment policy.
Ezequiel Silva III, MD, has been appointed chair of the 32-member American Medical Association Multispecialty Relative Value Scale Update Committee, the AMA Board of Trustees announced Feb. 23.

Throughout his two-year term beginning March 1, the San Antonio radiologist will assess how medical advances in science and technology have impacted patient care and lead expert physicians on the path toward advancing Medicare reimbursement rules.

“Dr. Silva’s outstanding collaborative work and contributions in the fields of medicine and healthcare economics have earned the respect and trust of physicians and allied professionals across the house of medicine,” William T. Thorwarth, MD, chief executive of the ACR, said in a statement. “I can’t think of a better choice to lead the AMA Multispecialty Relative Value Scale Update Committee into the future.”

Those contributions include serving as the immediate past chair of the ACR’s Commission on Economics and founding board member of the ACR’s Harvey L. Neiman Health Policy Institute. Silva has been a member of the RUC since 2016, including his most recent position as chair of the RUC Research Subcommittee.

The longtime healthcare payment expert has also been a leading advocate for safe and effective care during the pandemic, presenting during the U.S. Centers for Medicare & Medicaid Services and White House COVID-19 Task Force series “Lessons from the Front Lines: COVID-19.”

“The rise of the digital-native physician will have a profound impact on healthcare and patient outcomes, and the RUC will be increasingly called upon to assess the impact of digital health technologies on patient care,” AMA Board Chair Russ Kridel, MD, said Tuesday. “Dr. Silva’s respected insights into emerging digital technologies and his leadership qualities will help guide the RUC’s vital work as a source of physician input on policies that govern Medicare.”

To read more, go to Health Imaging.

What Entrepreneurs Can Learn From The Healthcare Industry’s Covid-19 Response

By Rhett Power | February 21, 2021 | Included in Radiology Digest – February 26, 2021

The healthcare industry was put to the test last year due to the pandemic, and a lot of innovation shone through—from new drugs and medical devices to supply-chain breakthroughs and better collaboration processes. Business leaders from all areas of the industry found new ways to accelerate growth to support the common good and generate critical revenue.

In a McKinsey survey of more than 200 organizations across industries conducted in June 2020, more than 90% of executives believed Covid-19 would fundamentally alter how they do business over the next five years. Almost as many said the crisis would have a lasting impact on their customers’ needs. However, more than three-quarters agreed that the pandemic will create significant new opportunities for growth, although this varies significantly by industry.

In a retrospective endeavor, I connected with half a dozen business leaders and entrepreneurs in the healthcare space to see what they learned and experienced over the past year:

  1. T. Scott Law Sr., Founder and CEO at Zotec Partners
    As Covid-19 crashed down, Zotec Partners reacted quickly and leveraged its revenue cycle management technology to build a multifaceted solution to manage testing and vaccinations across the state of Indiana. To date, this solution has facilitated more than 500,000 tests and over 1.1 million vaccines—creating a seamless patient experience, automating processes for providers, and delivering custom dashboards to track Covid’s spread and vaccine deployment.
    “This experience has been an exercise in perseverance, and until the need no longer exists, we’ll continue to deploy innovative solutions to meet the current healthcare challenges,” Law said. “Relationships matter. Zotec values personal connections, and only because of this were we able to engineer so many impactful solutions. When it comes to business, people choose people, and that’s what makes a difference in times of crisis or calm.”
    To read more, go to Forbes.

Where Nominated CSM Administrator Brooks-LaSure Stands on 4 Key Issues

By Michael Brady | February 19, 2021 | Included in Radiology Digest – February 26, 2021

Chiquita Brooks-LaSure is President Joe Biden’s pick to lead CMS. Colleagues describe the long-time Beltway insider as a consummate professional and point to her experience and track record in Washington.

“America’s hospitals and health systems applaud the nomination of Chiquita Brooks-LaSure to serve as the next administrator of the Centers for Medicare & Medicaid Services, the American Hospital Association said in a statement. “Her previous experiences as a senior CMS and HHS official who helped implement the Affordable Care Act and her work on the House Ways and Means Committee gives her a deep understanding of the importance of healthcare coverage and protections for consumers.”

In addition to her work on the Affordable Care Act during her time on the House Ways and Means Committee, Brooks-LaSure has worked on Medicare, Medicaid and commercial insurance at the White House budget office and CMS. She’s also advised providers, insurers, life sciences companies and states on a wide range of healthcare issues. Most recently, she led the HHS agency review team during the Biden-Harris transition.

Her former boss, Clinton administration official and Avalere Health founder Dan Mendelson, called her a “team player,” saying that she would carry out Biden’s healthcare agenda rather than push specific issues of interest if she’s confirmed.

Ruth Tabak, director at consulting firm Berkeley Research Group, overlapped with Brooks-LaSure during her earlier stays on Capitol Hill and CMS. She expects her former coworker to run an orderly agency that’s committed to developing and implementing effective, durable policies with considerable input from providers, payers and other stakeholders. The future CMS leader knows the agency must get buy-in from providers and insurers since they’ll play critical roles in putting CMS policies into practice, Tabak said. She doesn’t expect too many of the agency’s policies to get tied up in court because Brooks-LaSure would likely take a measured approach to rulemaking.

Here’s what we know about the nominated CMS administrator on four key issues.

  1. Coverage expansion and affordability
  2. Health equity
  3. Surprise billing
  4. Value-based payment
    To read more, go to Modern Healthcare.

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