Cigna Eliminates Prior Authorization for Coronary CT Scans
By Nona Tepper | February 3, 2021
Cigna will no longer require prior authorization for some CT scans of the heart, a move that providers said will relieve administrative burdens among physicians and result in better outcomes for patients.
On Feb. 1, Cigna will end prior authorizations for CT angiogram of the heart, coronary arteries and bypass grafts with contrast material. This includes 3D image post-processing. Cigna also removed prior consent for fractional flow reserve-computed tomography. Patients must have stable chest pain and an intermediate risk of coronary artery disease for coverage under the policy.
Dr. Julie Kessel, medical officer of coverage policy at Cigna, said the policy change reflects the insurer’s regular process of examining its prior authorization requests and will result in better health outcomes for Cigna members.
“By removing the pre-authorizations for CTA and FFR-CT Analysis when medically necessary, providers can now move more quickly to help customers who are experiencing chest pain and are at risk of coronary artery disease,” Kessel wrote in an email.
Dr. Dustin Thomas, chair of the advocacy committee at the Society of Cardiovascular Computed Tomography, said he believes Cigna is the first payer to remove prior authorization for these scans but hoped that its move will set a precedent for other insurers. By using a coronary CT scan to evaluate individuals with chest pain, providers can view cholesterol plaque built up in heart arteries and institute preventative care measures like prescribing cholesterol-lowering medications, aspirin and blood pressure medicine. In addition to allowing providers to identify pre-clinical disease, Thomas said patients are more likely to adhere to therapies if they know they are at risk for heart disease.
“It’s a great thing for the medical practices to have an opportunity to pursue what those of us in the sector think is the single best test for the evaluation of coronary disease without having to work through all those various barriers that do make our work sometimes challenging,” Thomas said.
He said multiple double-blind studies have shown that CT scans of the heart can lead to a 40% reduction in myocardial infarction and cardiovascular death.
To read more, go to Modern Healthcare.
American College of Radiology Urges CMS to Scale Back ‘Excessive’ Cuts in Mandatory Payment Model
By Marty Stempniak | February 3, 2021
The American College of Radiology is criticizing the federal government for failing to scale back “excessive” cuts in a forthcoming mandatory payment model, while also praising officials for pushing back the effort.
Congress first delayed the Radiation Oncology Advanced Payment Model back in December as part of a massive year-end spending bill. Previously slated to launch in July, the value-based care initiative will now kick off on Jan. 1, 2022.
College Chief Executive William Thorwarth Jr., MD, lauded the postponement in a recent letter, while also urging the Centers for Medicare & Medicaid Services to further modify the effort. Along with steep reimbursement reductions, he’s also “very concerned” about the mandated participants.
“The ACR is alarmed that such a significant number of small and rural practices are included in the model, while many large metropolitan areas have been spared, and are expected to use their limited resources to adopt and implement certified EHR technology, among all of the other reporting requirements for participation,” Thorwarth wrote to Acting CMS Administrator Liz Richter on Jan. 29.
The college wants the feds to reduce discount factors in the model to no more than 3%, to account for the significant financial challenges physicians are facing from the pandemic. It also wants the agency to conduct further rulemaking before implementing the project next year, and has previously pushed for other changes, including establishing a COVID case mix adjustment and allowing for more simplified monitoring requirements.
“The ACR is disappointed that none of the additional modifications the college recommended in light of the COVID-19 [public health emergency] were taken into consideration,” Thorwarth wrote, adding that he agrees with previous criticisms raised by the American Society for Radiation Oncology.
To read more, go to Radiology Business.
Surprise Billing Ban Will Constrain Cash Flow For Radiology Services Providers, Moody’s Predicts
By Marty Stempniak | January 31, 2021
The ban on surprise medical bills enacted by Congress in December could constrain cash flow for radiology services providers, according to research published by Moody’s on Thursday.
Any physician firm that bills patients directly for their work will have “some level of exposure,” the investor service noted. That includes physicians in imaging, alongside anesthesiologists and emergency medicine specialists, with the latter most vulnerable to these changes.
In addition, the No Surprises Act will have modest financial repercussions for hospitals that depend on staffing firms for outsourced radiology and other care.
“Many rated staffing companies carry leverage, cash flow and liquidity metrics that place them well into speculative-grade territory,” Jonathan Kanarek, vice president and senior credit officer for agency, said in a statement. “As such, even a modest reduction in collections could negatively impact cash flow and liquidity, placing further pressures on their credit profiles.”
However, Moody’s believes negotiating leverage and the greater likelihood of being in a larger insurer’s network may help insulate some of the largest staffing companies from these effects. Those include investor-backed radiology provider Envision Healthcare, along with Team Health.
“Instead, it will be the smaller, independent and local or regional providers that are more likely to have considerably higher out-of-network exposure due to lack of scale,” Moody’s said.
Former President Donald Trump signed the legislation into law on Dec. 27, following months of wrangling on the matter and fierce lobbying from Envision and other provider groups. It will take effect on Jan. 1, 2022, requiring insurers and radiologists to first attempt to negotiate payment before an independent third party steps in.
On the plus side for physicians, Moody’s said the act is less onerous than previous surprise billing proposals that relied on median rates to help curb balanced billing. The final act also forbids arbiters from using Medicare and Medicaid rates in their deliberations, since they’re typically much lower than commercial payment.
To read more, go to Radiology Business.
Patient Privacy Laws Are Due For an Overhaul, Experts Say
By Michael Brady | January 30, 2021
The Health Insurance Portability and Accountability Act—HIPAA—turns 25 years old in August, and experts say it’s time for the patient privacy law to finally live up to its promise.
While HIPAA mostly succeeded in safeguarding patient health information created in the healthcare system, it hasn’t enabled widespread information sharing and doesn’t really protect health-relevant information outside the traditional healthcare system.
Most experts agreed the nation’s health privacy rules are long overdue for an overhaul, given all the changes that have taken place in healthcare and technology since 1996, though some insiders think the current regulatory system works well enough.
CMS in December unveiled proposed changes to HIPAA regulations to ramp up information sharing. The measures have ample support from providers, health plans, technology vendors and privacy experts. But there’s a growing need for more robust protection of patient health information and health-relevant data to ensure industry stakeholders can successfully use digital data to improve patient outcomes.
The proposed rule aims to achieve two key goals: give patients more control over their data while at the same time make it easier for clinicians to share patient data with other providers, insurers and social service agencies for coordinating patient care. Experts say the plan would help shift providers’ mindset from protecting patient health information to sharing it, which was HIPAA’s original goal.
Those changes were in line with the Trump administration’s focus on ensuring regulations don’t stand in the way of patients being able to access their health information, with updates like shortening the period in which covered entities’ are required to respond to patients’ record requests from 30 to 15 days. The rule builds on the “Right of Access Initiative” that HHS’ Office for Civil Rights announced last year, as well as former HHS Deputy Secretary Eric Hargan’s push to eliminate barriers to coordinated care. It also aligns with the Office of the National Coordinator for Health Information Technology’s recent rule regulating interoperability and information blocking.
It’s unclear whether the Biden administration will move forward with the proposals, although several of the planned changes have bipartisan support.
To read more, go to Modern Healthcare.
Radiologists Must Master Potential Imaging Pitfalls Stemming from COVID-19 Vaccinations
By Marty Stempniak | January 29, 2021
Radiologists must educate themselves about the potential imaging findings stemming from COVID-19 vaccinations, experts charged on Wednesday.
Imaging can serve as a “valuable asset” in this process, providing crucial data on these drugs. This could include everything from vaccine efficiency in the research setting to understanding the various confusing radiologic patterns that may pose diagnostic challenges for physicians, according to an editorial in Clinical Imaging.
“Radiologists need to be aware of vaccines’ potential implications on imaging studies,” Ali Gholamrezanezhad, MD, with the Department of Diagnostic Radiology at the University of Southern California’s Keck School of Medicine, and colleagues wrote Jan. 27. “Being familiar with these findings and pitfalls will help radiologists prepare for possible imaging challenges in immunized patients in the future.”
Gholamrezanezhad et al. gave four examples in which radiology could prove pivotal during the vaccine rollout:
“The clinical value of current imaging technology on the study of vaccine efficacy is a pertinent field of concern and, as demonstrated, a valuable asset for diagnostic medicine,” Gholamrezanezhad and colleagues concluded.
You can check out the rest of the editorial from Clinical Imaging here. For further reading, the journal also published this study on imaging features from recipients of the vaccine, and RSNA’s Radiology shared this case study on the imaging of a vaccinated patient using FDG-PET/CT.
To read more, go to Radiology Business.
Will Hospital Patient Visits Return to Normal in 2021?
By Jacqueline LaPointe | January 29, 2021
Hospitals still have some time before they recover from historic patient visit reductions during the COVID-19 pandemic in 2020, according to a new analysis.
Hospital patient visits are unlikely to return to pre-pandemic volumes in 2021 and are likely to stay at lower levels throughout the new year, the analysis released earlier this week by TransUnion Healthcare revealed.
Patient visits to the hospital have stagnated below pre-pandemic levels in the last 25 weeks of 2020, showed the analysis, which uses average weekly hospital patient visit volumes from the first eight full weeks of 2020 as the pre-pandemic baseline.
This new low is likely to be the new volume baseline for hospitals in 2021.
“The challenges of COVID-19 in 2020 were widespread and hard felt within the healthcare industry, and these impacts are expected to persist well into 2021, particularly from a financial and operational standpoint,” David Wojczynski, president of TransUnion Healthcare, said in a press release.
The analysis of data from over 500 hospitals in the US found that emergency department visits were down by 30 percent compared to pre-pandemic volumes during the week of December 13, 2020.
Inpatient volumes were also down, falling by 8 percent, while outpatient volumes actually increased to 1 percent by the end of the period.
The recent trend is in line with the leveling out of hospital patient visit volumes experienced in June 2020, which researchers put at -23 percent for emergency department visits, -9 percent for inpatient visits, and -1 percent for outpatient visits compared to the same period in 2019.
Researchers expect outpatient visits to continue to make a comeback as hospitals get into the new year with a new baseline of 5 percent over volumes observed from June 30 to Dec. 12, 2019.
However, the new baseline for emergency department visits will remain at about -22 percent compared to the same period the previous year. Meanwhile, researchers projected a -7 percent new baseline for inpatient visits.
To read more, go to Revcycle Intelligence.
Radiology’s Input on New USPSTF Breast Cancer Screening Plan is ‘Critical,’ ACR Says
By Matt O’Connor | January 28, 2021
The United States Preventative Services Task Force has opened a public comment period for its new breast cancer screening research plan, and radiology’s input on the topic is “critical,” the American College of Radiology said Thursday.
Last week, the USPSTF published its draft document and said it would be open to feedback through Feb. 17. The document outlines its planned research approach, including study features and criteria, that will be used to determine new breast screening recommendations.
The American College of Radiology, meanwhile, called on radiology as a specialty to offer up guidance. ACR noted that its Breast Imaging Government Relations Committee, Breast Imaging Commission, and Screening Leaders group will be reviewing the draft to inform its own comments.
“Radiology’s input on the draft research plan is critical because the plan sets the foundation for what will be considered during USPSTF’s review of the topic,” the college said in a statement.
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 one to two years beginning at age 40.
“Since 2009, USPSTF’s recommendations on breast cancer screening have diverged from those of leading breast cancer experts,” the ACR noted.
In the document published last Thursday, the task force indicated it would again rely on evidence from randomized controlled trials, as it did for its 2016 statement.
Unlike its guidance issued five years ago, however, forthcoming recommendations will address how structural racism, social inequalities and unequal healthcare access impact breast cancer screening and treatment.
To read more, go to Health Imaging.