Radiology Digest – February 4, 2022

February 4, 2022

Radiology Digest: News from the week of February 4, 2022.

Bipartisan Bill Would Provide Relief for Small Practices Navigating Merit-based Incentive Payment System
By Marty Stempniak | February 3, 2022 | Included in Radiology Digest – February 4, 2022

A bipartisan bill introduced this week would provide relief for small physician groups navigating the Quality Payment Program.

Members of the U.S. House and Senate introduced the Small Practice, Underserved, and Rural Support Program Extension Act of 2022 on Wednesday. It would reauthorize a Centers for Medicare & Medicaid Services technical assistance initiative, set to expire on Feb. 15.

The program helps practices with 15 or fewer providers to comply with potentially cumbersome requirements stipulated as part of the Merit-based Incentive Payment System.

“Small healthcare providers in rural and underserved areas don’t have the big administrative staffs to deal with complex Medicare reporting requirements,” Sen. Bill Cassidy, MD, R-La., said in a Feb. 2 announcement. “This legislation gives support to small practice docs so they can focus on providing the best quality care for their communities.”

Others sponsoring the bill included Sen. Michael Bennet, D-Colo., along with Reps. Peter Welch, D-Vt., and Michael Burgess, R-Texas. The measure is also backed by several physician groups, such as the American Medical Association, MGMA and the American College of
Physicians. Since the Small Practice, Underserved, and Rural Support Program started in 2017, it has supported an average of more than 107,000 providers annually.

“Payment reform programs are complex, and clinicians require supplemental resources and guidance to meet the substantial quality and cost containment aspirations of payment models,” provider groups wrote in a Feb. 1 letter to members of Congress. “The COVID-19 pandemic has further exacerbated this issue by restricting the availability of these clinicians to understand updates and changes to payment reform programs,” they added later.

To read more, go to Radiology Business.

American College of Radiology Sees Opportunity for Legislative Wins in 2022, Despite ‘Partisan Gridlock’
By Marty Stempniak | February 2, 2022 | Included in Radiology Digest – February 4, 2022

The American College of Radiology sees opportunity for legislative wins in Washington this year, despite ongoing “partisan gridlock” and the upcoming midterm elections.

ACR highlighted clinical labor wage updates—being phased-in over the next four years—as one area to address through advocacy in early 2022. For the first time in nearly 20 years, the feds are boosting payments to benefit primary care and others who use clinical labor. But the
move is expected to gash pay for others who do not, including interventional radiologists and radiation oncologists.

Meanwhile, Medicare is also temporarily holding off on sequester cuts for the first six months of 2022 before they go into full effect in the fall. ACR believes such reductions present another shot at convincing Congress to intervene, and the college is confident it can work with lawmakers, regardless of which party is in power.

“The American College of Radiology is fortunate to enjoy good relationships on both sides of the aisle, and there are opportunities for ACR members to play a leading role in building the college’s policy agenda and engaging with congressional members in their districts,” the Reston, Virginia-based organization said in a Jan. 28 news update. “This will be vitally important through the 2022 election cycle.”

Democrats currently hold slim advantages in the House (221-212) and Senate (50-50, including two independents who caucus with the party), but it’s possible both chambers will flip. All representatives are up for reelection this year, with 41 declining to run for reelection.
Another 34 spots are opening in the upper chamber, and six senators are not seeking an additional term.

ACR hopes to build on momentum from the last few years, with lobbying efforts resulting in physicians retaining more than $1 billion through 2023. The college said it will continue to work alongside other doc groups hoping to “reinforce the message that Congress must enact permanent Medicare reimbursement reforms.”

The Medical Group Management Association echoed some similar concerns in its own letter to congressional leaders on Jan. 28. MGMA also wants lawmakers to address, among other things, sequester cuts that will start in April at 1% and increase to the full 2% by October.

“Since group practices are still struggling to meet the demands associated with the pandemic, MGMA urges Congress to extend the moratorium on the 2% Medicare sequester until the end of the COVID-19 public health emergency, or Dec. 31, 2022, whichever is later,” wrote Anders Gilberg, senior VP of government affairs for the association, which represents more than 15,000 physician groups across radiology and other specialties.

To read more, go to Radiology Business.

Medical Malpractice and AI: 4 Response Strategies When Rejecting an Algorithm’s Advice Backfires
By Marty Stempniak | February 2, 2022 | Included in Radiology Digest – February 4, 2022

As artificial intelligence’s role in radiology grows, physicians must contemplate their response
strategies if advanced AI use results in poor outcomes or litigation, experts charged Tuesday.

It seems “inevitable” such models will eventually outperform human providers and become the standard of care. And transparent or interpretable AI offerings with sound rationales should introduce little risk of malpractice liability, when followed properly, scientists argued
in the Journal of the American College of Radiology.

“What might cause physicians considerable anxiety in the age of [advanced artificial intelligence], however, is their intentionally and knowingly rejecting an AAI’s findings or recommendations,” John Banja, PhD, a professor and medical ethicist with Emory University in Atlanta, and co-authors wrote Feb. 1. “In the event of technology-physician disagreement, clinicians should be able to defend themselves with certain strategies such as the following.”

Banja and co-authors offered four strategies to help physicians navigate such situations. Here they are in brief:

  1. Deploy an adjudicator algorithm that can help settle a radiologist-AI conflict. Providers might take a page from meteorology, where the best forecasts utilize multiple algorithms to form a consensus opinion.
  2. Involve the patient by utilizing an informed consent or shared decision-making approach.
  3. Work with AI vendors to develop contractual agreements stipulating how liability will be assigned in the event of a verdict or settlement.
  4. In the case of autonomous models that make their own decisions, ask the vendor to assume total liability for their product’s incorrect decisions.

You can read much more of their advice in the JACR here.

To read more, go to Radiology Business.

5 Things Moody’s Is Watching In Healthcare This Year
By Nona Tepper | February 1, 2022 | Included in Radiology Digest – February 4, 2022

High labor costs, insurance coverage changes and the continued presence of the COVID-19 pandemic will hit healthcare industry finances hard in 2022, although some segments will be impacted more than others, according to a recent report.

While patient changes in insurance eligibility pose a hardship for health plans and hospital systems, the aging population will continue to boost residency senior housing facilities, according to a quarterly report from Moody’s Investors Service. The pandemic will also propel mergers among medtech operators in 2022, although the value of deals will fall from previous years, the credit rating agency said.

Below are five things analysts Moody’s expects to see in the coming year:

  1. Medicaid redeterminations, ACA competition a negative for insurers.
  2. Coverage changes to upset health system finances.
  3. Senior housing to return to pre-pandemic levels by 2023.
  4. No medical device mega-deals, but lots of M&A.
  5. No Surprises Act will constrain physician staffing firms’ cash flow.

To read more, go to Modern Healthcare.

Nation’s Largest Commercial Insurer Launching New Program Aimed at Curbing Imaging Costs
By Marty Stempniak | January 31, 2022 | Included in Radiology Digest – February 4, 2022

The nation’s largest commercial insurer recently launched a new program aimed at curbing costs for major imaging services.

UnitedHealthcare is currently circulating surveys to hospitals and freestanding centers, asking them to share details on their quality performance. Using this data, the Minnetonka, Minnesota, company is placing physicians into separate tiers, with the highest labeled as
“Designated Diagnostic Providers.”

Patients seeking major radiology services—such as magnetic resonance imaging, CT, MR angiography, PET, or other nuclear exams—will now need to visit top-tiered providers to incur the lowest out-of-pocket cost.

“The new benefit design will protect our members from higher imaging costs by providing access to imaging facilities that meet broadly recognized quality and efficiency standards,” UnitedHealthcare said in a January 2022 update. “Benefits will be available for major imaging
services received from a non-Designated Diagnostic Provider, but it will be covered with higher member cost share.”

Providers in applicable markets started receiving the questionnaire the week of Jan. 17, the American College reported. Quality metrics considered include whether the facility is accredited, provides timely services, and submits electronic images. ACR also said UnitedHealthcare will measure efficiency by cost, with all radiology providers sharing the same monetary targets, regardless of setting.

“UnitedHealthcare has stated in discussions with the American College of Radiology that quality and efficiency are considered equally when determining a provider’s tier level,” the organization said Jan. 28. “The ACR will continue to engage with UnitedHealthcare as questions and/or concerns about the program arise. The ACR encourages providers that receive the survey to complete it as soon as possible.”

Fully insured, small group commercial plan members had the new benefit added to their insurance Jan. 1, while large group beneficiaries will join them July 1. Members and referring physicians will be able to start identifying and utilizing Designated Diagnostic Providers on the same summer date in five months, the insurer said in an FAQ document.

UnitedHealthcare said local availability of the new benefit is subject to state regulatory approval. The frequently asked questions document lists several exclusions, including the state of Hawaii, Medicare and Medicaid plans, and imaging services performed on an admitted inpatient, in an emergency room, or at a specialty or primary care provider office. Modalities such as X-ray, ultrasound and mammography are also outside the program’s scope. The insurer launched a similar service for preferred diagnostic laboratory providers in 2021.

To read more, go to Radiology Business.

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