Radiology Digest: News from the week of January 21, 2022.
Department of Justice Fires Back Over Texas Physicians’ Surprise Billing Lawsuit
By Marty Stempniak | January 20, 2022 | Included in Radiology Digest – January 21, 2022
The Department of Justice is firing back in response to a lawsuit over legislation banning surprise medical bills, which went into effect on Jan. 1.
Physicians first filed suit at the end of October, hoping to halt a controversial provision of the No Surprises Act aimed at settling disputes between payers and providers. The DOJ has now issued its initial response, arguing that the Texas Medical Association has no standing in the case, as it has not demonstrated the law will negatively impact physicians.
“The plaintiffs simply do not provide sufficient detail to evaluate their claim that they are harmed by the rule, or that they would benefit if the rule were phrased differently,” the DOJ said in a Jan. 10 brief, Inside Health Policy reported Tuesday.
Texas doctors are concerned about the new dispute-resolution process’ focus on the “qualifying payment amount” — essentially the median contracted in-network rate for a service. Under Congress’ original intent, independent arbitrators were supposed to consider several factors before reaching a final reimbursement amount. But physicians believe the Biden administration’s interpretation of the final rule misunderstands lawmakers’ guidance, places too much weight on the QPA, and tips the scales in favor of insurers.
DOJ, however, believes docs must prove potential harm from the rule, instead of offering speculation. The department also contends the administration is correct in its reading of the statute.
“Indeed, it is difficult to imagine how the arbitrator could go about the decision-making process without starting with the qualifying payment amount,” the Department of Justice noted.
Oral arguments in the case are set to start on Feb. 4. Meanwhile, others including the American College of Radiology and American Medical Association have also filed suit against the feds over similar concerns stemming from the new dispute-resolution process.
To read more, go to Radiology Business.
Only 21% of US Hospitals Comply with Price Transparency Mandate for Shoppable Imaging Exams
By Hanna Murphy | January 19, 2022 | Included in Radiology Digest – January 21, 2022
In 2019, the Centers for Medicare and Medicaid Services implemented a rule requiring hospitals to publish prices for shoppable services. But new data examining those figures reveals that prices vary widely, and transparency remains lackluster.
The data, published Tuesday in the American Journal of Roentgenology, analyzed prices for four common musculoskeletal imaging exams: contrast-enhanced pelvic CT, unenhanced lower extremity MRI, unenhanced lumbar spine MRI and lumbar spine radiograph.
“Variability in charges for imaging examinations is well-recognized. Greater transparency in healthcare charges could potentially aid patients in predicting and controlling out-of-pocket costs,” corresponding author Matthew B. Petterson, MD, with the Department of Radiology at Stanford University, and co-authors wrote.
The doctors used “Newsweek’s Best Hospital’s” rankings to establish the top 250 hospitals in the U.S. They then gathered the publicly available charges for their four chosen musculoskeletal exams and assessed the price variability, ease of access to the chargemaster and the availability of consumer-friendly displays and cost estimators.
They found that all 250 hospitals listed total charges for the four exams within their chargemasters. However, 49 of those hospitals did not offer cost estimators for patients with insurance, and four more did not provide access to charges for consumers who were either uninsured or not current patients at the facility.
Only 21% of the hospitals had all required information available and offered consumerfriendly cost estimators. The doctors noted that the hospitals in total compliance tended to have significantly higher bed counts.
The doctors also pointed to the wide fluctuations in exam pricing. The maximum charge for a contrast-enhanced pelvic CT is listed as $14,238 compared to the minimum charge of $193—a 73.8-fold difference between the two prices for the exact same exam. The significant price variations remained consistent across all four exams.
“Early investigation found widespread noncompliance,” the doctors explained. “The impact of such information on patients’ decisions of where to seek such imaging warrants further investigation.”
Enforcement of the CMS-mandate is scheduled to begin in July 2022.
You can view the detailed data here.
To read more, go to Health Imaging.
CMS Vaccine Policy Now Enforceable in All 50 States
By Maya Goldman | January 19, 2022 | Included in Radiology Digest – January 21, 2022
The federal COVID-19 vaccine mandate for healthcare workers can officially go into effect nationwide after a judge tossed out a challenge to the mandate from Texas on Wednesday.
A judge in the United States District Court for the Northern District of Texas granted a temporary block of the Centers for Medicare and Medicaid Services requirement that employees at Medicare and Medicaid-certified facilities be fully vaccinated against COVID-19 in Texas.
But Texas moved to dismiss the case on Tuesday following the Supreme Court’s decision to let the CMS enforce the mandate while appeals are considered at lower courts.
Accordingly, the federal government’s requests to block both the lawsuit’s proceedings and an injunction pending appeal were dismissed as irrelevant.
The Supreme Court’s decision came after hearing arguments on two separate lawsuits against the mandate brought by 24 states. Texas had filed its own challenge against the policy that was not heard by the Supreme Court, so the court’s decision did not impact Texas providers.
CMS on Friday pushed back compliance dates for providers in the 24 states newly subject to the guidance following the Supreme Court decision. CMS officials said at the time that the guidance specifically did not apply to Texas, as litigation was ongoing. CMS did not immediately respond to questions about whether deadlines will be changed for Texas providers as well.
To read more, go to Modern Healthcare.
Emergency Providers, Radiologists Must Communicate Critical Reports More Effectively
By Hannah Murphy | January 17, 2022 | Included in Radiology Digest – January 21, 2022
Critical radiology reports are meant to convey urgent findings to referring providers, but a new study published in PLOS One uncovers a breakdown of communication when flagging musculoskeletal reports in emergency departments.
Critical radiologic reports (CRRs) arise when a radiologist’s findings warrant extra attention from the referring provider. Improperly communicating these diagnostic errors or abnormalities may lead to potential legal and clinical ramifications for all involved.
“Critical or unexpected imaging findings with clinical significance may require timely nonroutine communication,” corresponding author Yu Mi Jeong, with the Department of Radiology at Gil Medical Center in South Korea, and co-authors explained. “Radiologic reports with clinical significance or requiring immediate action should be promptly informed to the referring physician to ensure the continuity of patient treatment.”
Clinicians have little insight into how often critical reports emerge in musculoskeletal imaging, resulting in a limited understanding of potential issues. To get a better grasp of CRRs in the musculoskeletal space, researchers had two musculoskeletal radiologists retrospectively analyze 3,217 CRRs completed between January 2017 and December 2020.
Their findings were categorized by clinical setting (emergency department, inpatient, outpatient, etc.), body part, type of image modality, reason for CRR, incidental lesion and clinical outcome.
Out of all the reports, musculoskeletal CRRs accounted for only 5.4% (175), with most (94.9%) pertaining to the musculoskeletal system. Missed fractures occurred in 54.3%. More than half of the critical radiologic reports were for patients who presented to the emergency department (50.3%), followed by inpatients (30.9%).
When it came to communication, 80% of referring physicians actively acknowledged CRRs. However, the researchers noted a lack of follow-up action, particularly among ED patients.
A 35.2% loss of follow-up care was observed in ED patients compared to 6.1% for outpatients and 3.7% for inpatients, prompting the experts to call for change.
“Physicians in the ED must pay more attention to CRRs, and radiologists should effectively communicate with the referring physicians and provide accurate and timely radiologic reports,” the authors added. “A reliable standardized CRR manual is needed, and deployment is necessary across clinical practice.”
To read more, go to Health Imaging.
Diagnostic Radiology Absorbed a 44% Medicare Reimbursement Reduction Over the Last Decade
By Marty Stempniak | January 14, 2022 | Included in Radiology Digest – January 21, 2022
Adjusting for inflation, diagnostic radiology absorbed a more than 44% Medicare reimbursement reduction across the 50 most common imaging exams, according to new research published Friday.
Only three services on the list saw pay increases between 2011-2021, including radiographs with varying views of the abdomen (up 2.5%), hip (3.3%) and femur (6%). Meanwhile, many others have sustained sizable drops, with ultrasound guidance for biopsy (down 75%), DEXA bone axial (66.2%) and MRI of the brain without contrast (64.1%) sustaining the biggest blows.
The numbers appear “troublesome” and offer strong evidence of the need for payment reform, researchers argued in Current Problems in Diagnostic Radiology.
“Diagnostic radiology has experienced significant reimbursement cuts over the past decade, most severely among cross-sectional modalities,” Derrek Schartz, MD, with the Department of Imaging Sciences at the University of Rochester Medical Center, and co-authors concluded. “This data further characterizes reimbursement trends for the field and suggests the need for sustainable future reimbursement schedules.”
Study authors gathered their global reimbursement data from the Centers for Medicare & Medicaid Services. They noted that the one increase in reimbursement for diagnostic radiology was recorded between 2016-2017 (0.2%). On the other side, 2013-2014 saw the steepest decline at 16%, while the overall annual percent change averaged about -5.5%. MRI experienced the biggest drop during the study period at 60.6% followed by reductions in CT (44.4%), ultrasound (31.3%) and radiographs (6.2%).
Average work relative value units also dropped 1.3% during the study period, falling from 0.79 to 0.78. About 68% of imaging exams experienced no change in wRVUS, nine had a reduction, and seven sustained increases. Maxillofacial CT without contrast dropped the most at -25% (1.14 to 0.85) and limited breast ultrasound increased the most at 26% (0.54 to 0.68).
“The relative stability of both wRVUs and [the conversion factor] has likely contributed to reimbursement not keeping up with inflation but may not fully explain the 44% overall reduction in adjusted reimbursement,” Schartz and co-authors wrote. “Other possible factors contributing to this decline include the technical component and geographic component, both of which could be investigated in future studies on reimbursement in radiology.”
To read more, go to Radiology Business.
MedPAC Recommends 0% Physician Pay Update in 2023, Drawing Swift Rebuke from Docs
By Marty Stempniak | January 14, 2022 | Included in Radiology Digest – January 21, 2022
The Medicare Payment Advisory Commission is recommending a 0% physician pay update for
2023, drawing a swift rebuke from doc groups.
MedPAC approved the decision Thursday, following a staff report back in December deeming
current doc pay adequate. The number of clinicians is stable, patient experience scores
remain high, commercial rates exceed Medicare reimbursement, and compensation
increased between 2019-2020 despite the pandemic, the report noted.
Medicare payments to clinicians dropped by some $9 billion in 2020. However, the decrease
was offset by $17 billion in relief funds and $18 billion more in forgiven loans through the
Paycheck Protection Program. Commissioners expressed some hesitance about the
recommendation but ultimately decided in favor of no pay increase.
“Hard to conceive of a more misguided recommendation to Congress at a time when
practices face massive staffing shortages and skyrocketing expenses,” Anders Gilberg, senior
VP of government affairs for the Medical Group Management Association, tweeted Jan. 13,
while noting that the consumer price index is up 7%.
The American Medical Association said the decision will “imperil” patient access to care at a
time when practice costs continue to climb. AMA pointed to its own recent research, which
found that Medicare physician payment dropped 20% between 2001-2020. Inadequate
reimbursement is spurring consolidation among providers at a time when COVID continues to
challenge physician finances.
“Burnout, stress, workload, and fear of COVID-19 infection are leading one in five physicians
to consider leaving their current practice within two years. MedPAC’s analysis of payment
adequacy relies on trailing indicators and does not account for these canaries in the coal
mine,” AMA President Gerald Harmon, MD, said in a statement.
Docs said they appreciated Congress’ action to avert nearly 10% cuts to provider payment in 2022. But they believe more stable annual updates are needed to keep pace with inflation and the pace of innovation in medicine.
The American College of Emergency Physicians called the decision “slap in the face” to frontline providers.
“ACEP strongly believes that a zero percent update to physician reimbursement in CY 2023, which is an update Congress enacted six years ago in the Medicare Access and Chip Reauthorization Act, is artificially low and does not nearly cover the increased cost due to inflation of provider care to Medicare beneficiaries,” President Gillian Schmitz, MD, said Thursday. “Therefore, ACEP strongly encourages MedPAC to reverse course and instead recommend ongoing stable updates to the PFS,” she added later.
MedPAC’s advisory, nonbinding decision is expected to be included in its March 2022 report to Congress.
To read more, go to Radiology Business.
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