Radiology Digest – January 24, 2023

January 19, 2023

Radiology Digest: News from the week of January 24, 2023.

8 Trends in Radiology Technology to Watch in 2023
By Dave Fornell | January 18, 2023 | Included in Radiology Digest – January 24, 2023

Here is a list of some key trends in radiology technology from the editors of Health Imaging and Radiology Business that clinicians should be aware of heading into 2023. These are observations they made covering radiology news on a daily basis, interviews with key opinion leaders and covering the Radiological Society of North American (RSNA) annual meetings.
 Radiology AI adoptionMovement to web-based enterprise imaging systemsMovement to off-site cloud storagePhoton-counting CT may replace current CT detector technologyMRI is becoming easier to use and less expensive to maintain3D mammography will replace standard digital mammoVirtual reality aids better understanding of complex anatomyPOCUS is rapidly expandingTo read more, and view video go to Radiology Business.


Patients Delaying Care Over Cost Reached All-time High in 2022: Survey
By Lauren Berryman | January 17, 2023 | Included in Radiology Digest – January 24, 2023

A record number of patients delayed medical care because of high costs last year, according to survey results Gallup published Tuesday.

Gallup found that 38% of respondents or a family member delayed treatment over costs in 2022, a 12 percentage point increase compared to 2020 and 2021. The upswing coincided with economywide inflation reaching a 40-year high.

Last year’s spike in delayed care was the largest over one year since Gallup first began tracking these data more than two decades ago. The previous high was 33% in 2014 and 2019, while an average of 29% of patients reported delayed care over costs from 2001 to 2021.

More than one-quarter of those who participated in the 2022 survey said the care they forewent was for “very” or “somewhat” serious conditions, while 11% went without care for non-serious conditions. Lower-income people, younger adults and women were among the groups more likely to delay care.

To read more, go to Modern Healthcare.


Current Prior Authorization Practices are Adding to Burnout, Surgeon General Says
By Susan Morse | January 18, 2023 | Included in Radiology Digest – January 24, 2023

The Centers for Medicare and Medicaid Services outlined changes that will be made to speed up and align the prior authorization process across all payers, during a press call on Tuesday.

CMS released the proposed rule on expanding access to health information and improving the prior authorization process on December 6.

One reason for implementing the changes is physician and clinician burnout, said Surgeon General Vice Admiral Vivek Murthy.

Current prior authorization, with its requirements to fax information and signatures, causes delays and sometimes results in patients abandoning care, he said.

Institutions have to hire people full time just to work on prior authorization, Murthy said. It is increasing clinician burden and driving burnout.

“This is a crisis for all of us,” he said.

The proposed rule would require certain payers to implement an electronic prior authorization process for attachments and signatures. It would require implementation of a Health Level 7 (HL7) Fast Healthcare Interoperability Resources FHIR standard Application Programming Interface (API) to support electronic prior authorization.

Certain payers would be required to implement standards enabling data exchange from one payer to another payer when a patient changes or has concurrent insurance coverage, which is to help ensure that complete patient records are available throughout the transition, CMS said.

Secondly, the proposed rule would require insurers to provide reasons for the denial.

The third change would align prior authorization policy across Medicare, Medicare Advantage, Medicaid, CHIP and Affordable Care Act marketplace plans, according to CMS Administrator Chiquita Brooks-LaSure.

To read more, go to Healthcare Finance.


2023 Set to be Big Year for Denials Management
By Amanda Norris | January 17, 2023 | Included in Radiology Digest – January 24, 2023

Healthcare organizations are on the verge of stepping up their denials management strategies in 2023 as rate cuts are expected to impact revenue.

On the delivery side, most practices plan to continue their telehealth operations in the new year, according to the 2023 Part B News Predictions Survey conducted in the first two weeks of December.

Asked how they would respond to the reduction to the payment conversion factor, more than half, or 51%, of respondents reported that they will be “more aggressive” in challenging denied claims.

About 46% of survey respondents also said they would increase their collections efforts with payers. One respondent added that “we will be more aggressive about authorizations for Medicare Advantage plans,” according to the survey results.

More drastic measures don’t appear to be on the agenda of most practices. Just 16% of respondents said they will add self-pay services; 15% reported that they would limit staff hours; and 11% said they would be forced to delay the purchase of office equipment or software. Less than 4% of practices said that staff lay-offs are on the table, according to Part B News.

These findings come on the heels of a similar survey by Experian Health that found that the nearly three out of four respondents reported that reducing denials is their highest priority, and 70% said that it is more important than prior to the pandemic.

Additionally, the top three reasons for an increase in claims denials in the Experian Health survey were insufficient data analytics (62%), lack of automation in claims/denials process (61%), and lack of thorough training (46%).

To read more, go to Health Leaders Media.


Study Finds MIPS Scores Don’t Reflect True Quality Performance
By Jacqueline LaPointe | January 17, 2023 | Included in Radiology Digest – January 24, 2023

A recent study out of the Weill Cornell Medical College questions whether the Merit-Based Incentive Payment System (MIPS) accurately captures the quality of care delivered by primary care physicians.

Published in JAMA in December, the cross-sectional observational study of over 80,200 primary care physicians found that MIPS scores were inconsistently related to performance on both process and outcome measures. Physicians treating more medically complex and socially vulnerable patients were also more likely to receive low MIPS scores even when they provided relatively high-quality care, according to the study.

MIPS is a mandatory reimbursement program for Medicare providers, including physicians, physician assistants, and nurse practitioners, as long as they bill enough for Part B-covered professional services and see enough Part B patients based on Medicare-set levels. Nearly 1 million providers participate in MIPS every year.

Medicare reimburses providers in MIPS based on their performance across four categories: Quality, Promoting Interoperability, Improvement Activities, and Cost. However, critics of the largest value-based payment program to date have questioned whether the measures used to judge and pay providers are relevant. Some stakeholders have also complained about the administrative burden of MIPS participation.

The JAMA study underscores a disconnect between the measures MIPS uses to judge quality of care and the care actually delivered to patients. For example, for some measures, physicians with the lowest MIPS scores—those subject to financial penalties—had better performance relative to physicians with the highest MIPS scores, who were eligible for “exceptional performance” bonuses.
“The findings support concerns that program performance may not accurately capture the quality of care that physicians provide but rather that quality of care is related to the characteristics of patients they care for and the ability of their organizations to report data,” states the JAMA study.

“Primary care physicians with low MIPS scores tended to see more clinically and socially complex patients than physicians with high MIPS scores; they were also more likely to work in small and independent practices. Importantly, the study did not find evidence that physicians with low MIPS scores provided consistently worse care.”

Researchers point to a clinician’s ability to select the measures they report to MIPS as a possible reason for the high level of discordance between physician MIPS scores and performance on patient outcomes. Other possible explanations include invalid measures, skewed weight distribution of the performance categories, and the program’s tendency to reward clinicians who are better at collecting and reporting data.

CMS has addressed some MIPS concerns, particularly around measure selection. The agency is implementing common sets of measures based on a clinician’s specialty. These MIPS Value Pathways will have subsets of measures and activities that will meet most program requirements.
However, further work will need to be done to ensure that MIPS penalties do not exacerbate health inequities.

To read more, go to Revcycle Intelligence.


HHS: Uninsured Rates Decline for Younger Americans from 2019 Through 2021
By Robert King | January 13, 2023 | Included in Radiology Digest – January 24, 2023

More Americans in key demographics that have been historically uninsured saw coverage gains from 2019 through 2021, a new federal report finds. 

The Department of Health and Human Services (HHS) released a report Friday detailing gains in coverage from 2019 through 2021. Officials attributed a decline in the uninsured rate from 11.1% in 2019 to 10.5% in 2021 due to expansions in Medicaid and other gains via the Affordable Care Act’s (ACA’s) marketplace. 

“We know that access to quality, affordable healthcare is key to healthier lives, economic security, and peace of mind” said HHS Secretary Xavier Becerra in a statement. “As we move forward, [HHS] will continue to do everything we can to protect, expand and strengthen the programs that provide the quality, affordable healthcare Americans rely on and deserve.”

The report found that the decline in the uninsured rate in 2021 was the largest among people with household incomes between 100% and 250% of the federal poverty level. In 2021, the White House engaged in a special enrollment period as well as enhanced and expanded premium tax credits.

The enhanced credits were recently extended through 2025 as part of the Inflation Reduction Act passed last year. 

Those credits helped lower the cost of insurance for low-income ACA consumers and are a key driver of record enrollment of 15.9 million people for the latest 2023 open enrollment

To read more, go to Fierce Healthcare.


Groups Clash with CMS Over Independent Dispute Resolution
By Dave Pearson | January 13, 2023 | Included in Radiology Digest – January 24, 2023

Last month the federal government raised the administrative fee providers have to pay when seeking independent dispute resolution of reimbursements under the No Surprises Act.

Specifically, HHS via CMS, along with the U.S. Labor and Treasury departments, announced an executive action changing the admin fee from $50 to $350.

That’s a 600% jump, and it took effect on New Year’s Day.  
Two weeks later, on Jan. 13, the heads of four medical management associations locked arms and pointed their voices in the general direction of Washington.

“The Associations call on CMS to fairly rebalance the independent dispute resolution (IDR) process, keep administrative fees at fair and stable 2022 levels, and address their unsustainable backlog of claims under the No Surprises Act,” the executives said in written remarks. “To ensure this appropriate and much needed reform at CMS, the Associations call on the new Congress to initiate oversight proceedings on these processes at CMS.”

The groups—the Radiology Business Management Association (RBMA), Emergency Department Practice Management Association (EDPMA), Healthcare Business Management Association (HBMA) and Medical Group Management Association (MGMA)—also stated they “strongly oppose” the price hike.

The four called on CMS to “immediately reverse this decision” and on Congress to “initiate oversight proceedings” on it.
CMS’s December memo on the fee hike is here. The call for IDR amendments from the four association heads is here.To read more, go to Radiology Business.
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