Opinion: Congressional Action to Prevent Radiology Pay Cuts is Welcome, But There’s Work Left To Do
By Bob Still | January 27, 2022
As radiology approached the end of 2021, the industry faced multiple crises: Proposed cuts in Medicare of nearly 11%; the worrisome implementation of the No Surprises Act; and yet another year in which COVID challenged medical practices throughout the country and put personnel at risk.
In response, RBMA’s Radiology Patient Action Network sprung into action, generating more than 1,400 contacts with Congress in just three days. And so came the reprieve: Congress took action to delay spending cuts that would have crippled radiology practices and patient access to care throughout the country.
Before this congressional fix, there was a real risk that practices would have to limit access to services in order to adjust to the lower federal reimbursement rates. That won’t happen, at least not for a time, and both doctors and patients are better for it.
But the patient action network’s call to action will need to continue into 2022 and beyond— and with good reason. Consider, for instance, the government’s implementation of the No Surprises Act. A bit of background: Doctors were broadly supportive of the No Surprises Act when it was first proposed. No healthcare professional wants to saddle their patients with out-of-network bills, and the idea behind the legislation was to prevent that practice and bring hospitals and insurance companies to the table to work out some agreements on what happens when a surprise expense comes up.
The problem: In the way that the government enforces the legislation, the “independent dispute resolution” process is supposed to resolve a disagreement between a healthcare provider and an insurance company. But the resolution process allows the insurance companies to set what is known as the “qualifying payment amount.” That’s the basis on which the arbitrator running the process would make a determination—but insurance companies set the terms from the get-go.
As a result, insurance companies have been reaching out to radiologists throughout the country and simply informing them that they are on the hook for procedures and expenses— with no discussion. It’s an untenable burden for providers to bear at a time when so much is uncertain about Americans’ health.
Already, we’re hearing concerning accounts from doctors who receive, well, “surprise” notices from insurers. In each case, it’s the natural consequence of how the government chose to administer the No Surprises Act. Rather than put payers and providers on equal footing when a disagreement over billing arises, the government stacked the deck in favor of insurance companies.
That all leaves more work to be done for the federal government. These issues arise at perhaps the most taxing time the medical profession has endured. Each week seems to bring fresh reporting about the stress, strain and difficulty of practicing medicine—which makes one wonder about how and why the government is choosing to tighten its belt right this second.
We need a change, urgently. Doctors have needed support for some time as we climb out of the global pandemic and deal with the possibility of third and fourth waves of infections. Radiologists, in particular, will be called upon to address both the near-term health effects but also the long-term consequences of COVID. At a time like this, we need bandwidth, support and clarity from Congress—not moves that pit payers and providers against one another or reduce reimbursement altogether.
To read more, go to Radiology Business.
Biden Admin Redirected Nearly $7B of Provider Relief to COVID Vaccine, Therapeutics Purchases
By Dave Muoio | January 26, 2022
The Biden administration reportedly shifted almost $7 billion in pandemic relief funding for providers to purchases of COVID-19 vaccines and therapeutics, according to a Stat report citing an internal document.
A Department of Health and Human Services (HHS) spokesperson told the publication that repurposing money from the Provider Relief Fund was appropriate because the vaccines and therapeutics that were purchased were given to providers for free.
“All Provider Relief Fund dollars have been used for Provider Relief Fund purposes,” the spokesperson told Stat.
Combining this with the Trump administration decision to divert $10 billion from the $178 billion fund for its Operation Warp Speed would mean that nearly a tenth of the money carved out by Congress in the CARES Act was not allocated for direct payments to hospitals and practices.
Fierce Healthcare has reached out to HHS to confirm the reporting.
The news comes as provider organizations are pleading to Congress to write additional relief money into next month’s potential omnibus spending bill, noting that none of the original $178 billion designated through the CARES Act addresses pandemic expenses incurred after March 2021.
“While this fund has been a lifeline for some healthcare providers, no distributions have been made or announced for expenses related to the delta or omicron surges … despite decreases in deaths, hospitalizations and cases,” American Hospital Association President and CEO Rick Pollack said during a Tuesday morning press call.
Further, the Biden administration is still working to hand out the last of the initial pot, having announced just this week the distribution of $2 billion to 7,600 providers and another $6 billion or so to go in the fourth phase of the relief program.
Stat also reported that the Biden administration is looking to redirect an additional $1 billion from Congress-provided COVID-19 testing funding to more vaccine and therapeutics purchases.
To read more, go to Fierce Healthcare.
3 Obstacles Radiologists Must Overcome Before Routinely Offering Virtual Patient Consultations
By Hannah Murphy | January 26, 2022
Telehealth visits offer radiologists the opportunity to continue providing care in a socially distanced society. But as COVID persists, adjustments must be made to integrate virtual patient care into daily practice.
“The need for in-person medical services has been critically reevaluated as a consequence of the COVID-19 pandemic, leading to an increased and more standardized utilization of virtual visits to conduct healthcare encounters between patients and providers,” Dania Daye, MD, PhD, with the Department of Interventional Radiology at Massachusetts General Hospital, and co-authors explained.
Now, more than two years after the first case of COVID was reported, it has become clear that some virtual radiology services are becoming routine. And while telehealth visits do present numerous benefits—better clarification of findings, increased communications between radiologists, patients and referring providers, etc.—there remain challenges to incorporating virtual care into everyday practice.
In a viewpoint published Tuesday in the American Journal of Roentgenology, experts detailed the barriers that lie in the way of streamlining virtual radiology consultations. Three key roadblocks are highlighted below.
You can view the article in its entirety in the American Journal of Roentgenology.
HHS Releases $2B in Relief Grants as AHA Pleads for More Help
By Maya Goldman | January 25, 2022
The Health and Human Services Department will make roughly $2 billion more in Provider Relief Funding payments this week, the government announced Tuesday.
But that’s not enough for the American Hospital Association, which is urging President Joe Biden’s administration to distribute another $6 billion and Congress to authorize $25 billion more.
According to the Health Resources and Services Administration, there is no money left over, however. The $6 billion remaining in the account is already set aside for purposes such as reconsiderations of previous grants and reimbursements to providers that treated uninsured patients, an agency spokesperson wrote in an email. The PRF dollars come from the $178 billion CARES Act that President Donald Trump enacted in 2020.
The latest grants round, known as Phase 4, focuses on reimbursing a higher percentage of losses for smaller providers and offering additional payments to Medicaid, Children’s Health Insurance Program and Medicare providers. HHS has allocated $17 billion to Phase 4.
HHS will send out $2 billion to 7,600 providers this week after distributing $9 billion in Phase 4 grants to more than 74,000 providers last month. HRSA has processed more than 80% of Phase 4 applications so far, the agency disclosed in a news release.
The administration will hopefully able to pick up the pace of releasing funds, said Brenna Jenny, a partner at Sidley Austin who served as HHS’s principal legal adviser on the Provider Relief Fund during the Trump administration. “Providers have understandably been frustrated that it took the Biden administration this long to resume distributing money they were just sitting on,” she said.
To read more, go to Modern Healthcare.
ACR Challenges Lack of Transparency in Medicare Administrative Contractor Coverage Determinations
By Marty Stempniak | January 21, 2022
The American College of Radiology is joining 17 other provider groups in challenging the lack of transparency in how Medicare Administrative Contractors reach local coverage determinations.
ACR and others voiced their concerns in a recent letter to Centers for Medicare & Medicaid Services leadership. Back in 2018, the agency revised its policies governing how new coverage policies are developed and determined. But the groups have continued to experience challenges navigating the process, including a lack of opportunities to comment or hold MACs to specific timelines.
“Sound coverage development and implementation processes support Medicare beneficiaries’ access to medically necessary and appropriate healthcare services,” ACR and others wrote to Lee Fleisher, MD, chief medical officer and director of the Center for Clinical Standards and Quality. “However, our experience leads us to have concerns regarding lack of transparency and deteriorating and haphazard stakeholder engagement, as further detailed below.”
In particular, as providers wait for MACs to make local coverage determinations, there are several stages in which there is no specified timeline. A contractor has 60 days to determine if a local coverage determination request is complete. Yet after that there is no established timeframe for MACs to issue a draft coverage determination. The college and its colleagues also decried a lack of public notices in these processes and corresponding opportunities to comment.
And while CMS has established advisory committees to serve as a “vital link” between contractors and providers, the relationship has eroded since the process was revised a few years ago. Meetings occur less frequently, at inopportune times, or in more difficult-to-reach locations.
“Meaningful engagement by [Contractor Advisory Committee] representatives enables contractors to benefit from the education, experience, and expertise of individuals who engage in patient care on a daily basis and can put evidence into context based on their practice area,” ACR and others wrote. “Failure to uphold the advisory role of CAC members can result in reduced access to care, harm to Medicare beneficiaries, and unnecessary burden on health care practitioners.”
The groups issued a list of six recommendations to fix the process. Those include requiring contractors to provide a public notice period ahead of changes in coverage policies, and publicly reporting performance metrics to hold MACs accountable for adhering to key timelines. You can read the full letter here. Others signing the note included the American College of Surgeons, the Coalition of State Rheumatology Organizations, and the College of American Pathologists.
To read more, go to Radiology Business.
Are LDCT Lung Screening Programs Overdiagnosing Cancer?
By Hannah Murphy| January 20, 2022
Low-dose computed tomography (LDCT) scans of the chest are a vital screening tool used to detect early-stage lung cancer. But new research suggests that the simple screening mechanism might actually be overdiagnosing the disease in certain patients.
The study, which used figures from the Taiwan Cancer Registry, noted that there has been a massive increase in early-stage lung cancer diagnoses over the past 15 years. Despite less than 5% of young women in Taiwan identifying as smokers, the uptick in cancer diagnoses was particularly prevalent among this young group. Researchers questioned why these women are being screened for lung cancer at such high rates in the first place.
“Promotions for lung cancer screening in Taiwan feature images of young women and dramatic language encouraging people to ‘avoid the tragedy of sudden death from terminal lung cancer,'” lead author H. Gilbert Welch, MD, with the Brigham’s Center for Surgery and Public Health, and co-authors wrote. “These campaigns conflate the risk of diagnosis and the risk of death.”
The doctors wanted to analyze how the screening campaigns might have impacted the overall cancer diagnosis and survival rates for these women. To achieve this, they used the Taiwan Cancer Registry to identify young women who had been diagnosed with early-stage lung cancer between January 1, 2004, and December 31, 2018.
Out of approximately 12 million women, the data indicated 57,898 were diagnosed with lung cancer. The incidence of early-stage lung cancer increased from 2.3 to 14.4 per 100,000 people after LDCT screenings were introduced to the population, while the late-stage diagnoses remained virtually unchanged. Notably, the five year survival rate saw a significant spike during that time, more than doubling from 18% to 40%.
“Because the more than 6-fold increase in early-stage cancer was not accompanied with a decline in late-stage cancer, we surmise that virtually all the increased detection after the introduction of LDCT screening in 2004 represents overdiagnosis,” the doctors explained.
You can view the detailed research in JAMA Internal Medicine.
To read more, go to Health Imaging.