CMS Proposes Small Bump in MA Payments, Sweeping Risk Adjustment Changes
By Rylee Wilson | February 2, 2023
CMS is expecting a small revenue bump of 1.03 percent on average for Medicare Advantage and Part D plans in 2024 as part of a slate of potential risk adjustment and star ratings changes that has some industry leaders concerned.
In an advance notice published Feb. 1, the agency proposed a rate increase of 2.09 percent for MA and Part D plans next year, largely driven by increases in fee-for-service costs, and a MA risk score trend of 3.3 percent.
The agency also signaled a 3.12 percent decline in payments based on proposed changes to the risk adjustment model, and a 1.24 percent decline in payments based on changes to the star ratings system — 2023-star ratings will impact quality bonus payments in 2024.
In addition, CMS proposed shifting MA’s diagnosis coding from ICD-9 to ICD-10 in 2024 — the latter has been used since 2015 and by more physicians.
CMS said these changes will “keep the model up to date and improve payment accuracy.”
The proposed rule builds on a risk adjustment rule finalized by CMS Jan. 30 that could leave Medicare Advantage plans on the hook for up to $4.7 billion in repayments to the federal government.
See the full advance notice here.
To read more, go to Becker’s Payer Issues.
CMS Seeks to Make Quality Measures More ‘Universal’ in Rollout of New Program
By Robert King | February 2, 2023
Top Medicare and Medicaid officials want to create a “universal foundation” of quality measures aligned across all programs in a bid to ease reporting burdens and confusion.
Officials with the Centers for Medicare and Medicaid Services called for aligning quality measures across more than 20 agency programs in a letter in the New England Journal of Medicine Thursday. CMS’ Universal Foundation aims to focus provider attention on the quality measures which affect the largest segments of a patient population and advance health equity.
“Our intention is that the Universal Foundation will eventually include selected measures for assessing quality along a person’s care journey—from infancy to adulthood—and for important care events, such as pregnancy and end-of-life care,” according to the NEJM letter.
The letter lays out the initial preliminary measures as part of the foundation, which will eventually be used across all CMS programs to the extent they are applicable.
To read more, go to Fierce Healthcare.
Global Survey Finds Radiology Social Media Users Like YouTube Best
By Dave Pearson | February 1, 2023
The most popular social media platform among radiologists looking to keep up with the profession from around the world is YouTube, named by more than 71% of respondents in a survey that drew more than 250 representative responses from 65 countries.
Instagram is a fairly close second at 62%, Facebook a fighting third at 44%, Twitter a respectable fourth at 21% and LinkedIn a visible fifth at 16%.
Rounding out the field, albeit in also-ran percentages, are Pinterest (7%), Reddit (6%) and TikTok (4%).
Another 8% are using platforms other than the leaders and runners-up, and 2.4% aren’t using any.
The survey was conducted by radiology researchers at Johns Hopkins and is described in Current Problems in Diagnostic Radiology .
Senior study author Elliot Fishman, MD, and colleagues distributed a 30-item questionnaire via numerous online and email channels specific to radiology in spring of 2022.
The project’s primary objective was to tease out up-to-date ways “the global radiology community is using social media specifically for radiology education.”
All respondents but one indicated their role, and the field shook out as 42% radiologists, 25% technologists, 18% residents and 17% “other.”
The largest single block by age was comprised of 25-to-34-year-olds (n=89). Next were those aged 35 to 44 (n=47) and 45 to 54 (n=36).
As a combined group, Fishman and co-authors report, some 80.71% said they use social media “every day” or “a few times a week.”
Commenting on YouTube’s global popularity, the authors state the finding makes it safe to assume that radiology social-media users “find video content to be particularly helpful or interesting.”
To read more, go to Radiology Business.
Biden Administration to End COVID-19 Public Health Emergency in May
By Jakob Emerson & Erica Carbajal | January 31, 2023
The Biden administration has informed Congress it will end the COVID-19 national and public health emergencies May 11 — signaling an end to the pandemic’s crisis era and an unwinding of federal flexibilities that reshaped the nation’s healthcare system.
“At present, the administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date,” the Office of Management and Budget said in a Jan. 30 statement. “This wind-down would align with the administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.”
Over the last three years, the PHE has played a significant role in its influence of national healthcare policy — it reformed telehealth and expanded who can use it, fast-tracked approvals of COVID-19 vaccines and treatments, and preserved healthcare coverage for millions of Medicaid beneficiaries nationwide. HHS has renewed the PHE every 90 days since January 2020, with the most recent renewal declared on Jan. 11.
Though states could not disenroll people from Medicaid during the PHE, Congress passed a $1.7 trillion omnibus spending bill in December that detached the federal policy from Medicaid redeterminations. Starting April 1, states will begin redetermining who is and is not eligible for Medicaid, a process that could leave up to 18 million people without health coverage over the span of about a year.
The spending bill also extends Medicare telehealth flexibilities through 2024, which previously would have ended 151 days after the PHE expired. Acute hospital care at home waivers and flexibilities were also extended for two years through 2024. Similar to telehealth, the deadline for hospital at home waivers was tied to the status of the PHE. More than 250 hospitals have been approved by CMS to participate in the acute hospital care at home program.
To read more, go to Becker’s Hospital Review.
Age and Workload Affect Reader Performance for Screening Mammograms
By Hannah Murphy |January 30, 2023
As the prevalence of breast imaging continues to grow, so too will the modality’s associated workload. This notion recently prompted experts to question whether all radiologists are equipped to handle the intricacies of interpreting breast imaging.
According to a meta-analysis conducted by experts at the University of Sydney, there is no single, smoking gun radiologist quality that separates them from the pack when it comes to their accuracy for interpreting screening mammograms. However, age, specialty training and reading volume were found to give readers an edge over their peers according to certain metrics .
The meta-analysis reviewed data from 28 other published studies. Its findings were shared on Jan. 26 in Clinical Breast Cancer.
Detailed insight from the study is as follows:
Older radiologists record lower false positive rates. Radiologists with consistently higher reading volumes achieve increased sensitivity, cancer detection rates, lower recall rates and lower false positive rates. Breast specialists typically have better cancer detection rates (CDR), sensitivity and specificity. Those who complete breast imaging fellowship record lower recall rates and improved positive predictive value compared to those who do not. Reader gender was not found to significantly affect performance. Limited data was available to assess how years of experience and facility-level characteristics impact performance. To read more, go to Health Imaging.
Majority of States Looking to Regulate Prior Authorization This Year
By Andrew Cass | January 27, 2023
As many as 42 states could introduce bills this year to limit or change prior authorization, Miranda Motter, AHIP’s vice president of state affairs, told Axios Jan. 27.
So far, 26 bills have been introduced in 16 states, according to the report.
Prior authorization reforms have been targeted by states in recent years. Texas passed a “gold card” law in 2021.
Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services. Rules for the law went into effect in October.
In 2022, Louisiana and Michigan also passed gold card legislation, and others, like Mississippi, are looking to do the same this year.
Payers have called gold cards a “mixed bag,” according to a November survey by AHIP, an industry lobbying group.
Forty-six percent of payers surveyed said gold cards have reduced administration burdens and improved provider satisfaction, but a third said such programs are administratively difficult to implement. In the same survey, 76 percent of payers said state regulations have negatively impacted prior authorization programs.
New Jersey lawmakers are weighing a change to existing law to reduce the time payers can take to approve or deny a claim from 15 days to one day. Prior authorization reforms could also be handed down at the federal level this year. CMS in December issued a proposed rule it says will streamline the prior authorization process. Federal officials held a listening session with providers on the proposed rule Jan. 17.
To read more, go to Becker’s Payer Issues.