Radiology Digest – July 16, 2021

July 16, 2021

Radiology Digest: News from the week of July 16, 2021.

‘This Must Be Countered’: Radiologists Launch Political Fund to Stop Nonphysician Scope-of-practice Gains
By Marty Stempniak | July 15, 2021 | Included in Radiology Digest – July 16, 2021
Radiologists are launching a new political fund aimed at stopping nonphysicians from expanding their scope of practice.

The American College of Radiology Association is providing the initial $225,000 with the goal of safeguarding patients’ access to physician-led care. Leaders are concerned provider societies representing nurse practitioners, physician assistants and others are attempting to gain the right to practice independently.

“The ACR is committed to protecting the quality of radiological care through aggressive advocacy in support of physician-led healthcare — specifically the radiologist-led imaging team,” Board of Chancellors Chair Howard Fleishon, MD, said in a statement. “This fund is an important commitment to help us in this fight.”

Earlier this month, the ACR rolled out new online resources to help rads track local bills related to scope of practice and stay involved in opposing new legislation. The college said these efforts frequently occur at the state level and highlighted several recent instances. The Rhode Island Senate on June 30 advanced legislation to expand physical therapists’ powers, while a day earlier, Florida Gov. Ron DeSantis signed legislation expanding PA’s abilities. At the national level, several doc groups have voiced opposition to physician assistants’ plan to rebrand as “associates.”

ACR said nonphysician professional societies have “ramped up” their fight to gain independence during the COVID-19 pandemic. Those involved with the new Scope-of-Practice Fund believe these efforts “must be countered,” the college said July 14.

“PAs and NPs do not have comparable training, competence or experience. They should not independently supervise or interpret imaging exams,” Fleishon added.
To read more, go to Radiology Business.

Providers Vow to Fight Medicare Pay Freeze
By Michael Brady | July 14, 2021 | Included in Radiology Digest – July 16, 2021
The lobbying began just minutes after CMS released a physician payment rule for next year that doesn’t include pay raises for doctors, physician assistants, nurse practitioners and others.

Provider groups re geared up for a rerun of the battle over this year’s physician fee schedule, which originally financed a pay increase for primary care providers by cutting payments to
specialists. Congress intervened after a sustained lobbying effort that culminated in an across-the-board 3.75% pay rise for the 2021 calendar year, at a cost of $3 billion to taxpayers. CMS issued the proposed rule for 2022 on Tuesday.

The payment boost this year enabled Medicare to pay more for office visits and avoid larger cuts for specialists. But they were only possible because Congress decided to increase Medicare spending rather than adhering to the program’s budget neutrality requirement.

Now that the short-term boost is due to expire, CMS has proposed a 3.75% reduction in the physician fee schedule’s conversion factor, which is used to calculate physician payments, for next year. As a result, total provider payments won’t increase in 2022 unless Congress allocates additional money.

Specialists are particularly upset about the pay freeze since they would bear the brunt of the costs.

“Today’s proposed rule maintains the cuts to surgical care that Congress stopped last year. These cuts harm the care patients need and deserve, which is the opposite of what CMS is trying to achieve,” American College of Surgeons Executive Director Dr. David Hoyt said in a joint statement from the Surgical Care Coalition.

To read more, go to Modern Healthcare.

CMS Stark Law Advisory Grants Radiology Practices More Flexibility in Structuring Their Organizations
By Marty Stempniak | July 14, 2021 | Included in Radiology Digest – July 16, 2021
A new Centers for Medicare & Medicaid Services advisory opinion may allow radiology practices greater flexibility in structuring their organizations and relationships, experts advised recently.

The Stark Law forbids docs from referring Medicare or Medicaid patients for imaging and other designated health services, if said referrer has a financial relationship with the entity. However, there’s an exception carved out for entities employing multiple physicians that qualify as a “group practice.”

In a recent advisory, CMS said this exception also applies to physician groups furnishing imaging and other services through wholly owned subsidiary practices that are separately enrolled in Medicare. The opinion provides greater leeway, potentially allowing physician practices to use subsidiaries for different markets or different payer arrangements, said Danielle Sloane, an attorney with Bass Berry & Sims.
The news is most meaningful for radiology practices that offer interventional services.

“For diagnostic-only practices where they generally receive referrals from outside treating physicians, this would not be as important. However, for any IR practices that are providing imaging, drugs or other services within their practice, it is noteworthy—particularly for those involved in consolidation transactions,” she told Radiology Business.

Bottom line, Sloane said, the advisory approves an entity that is enrolled in Medicare and billing as a physician practice to own other entities that are also enrolled and billing as physician practices. “However, CMS seems to thread this needle by calling the parent the ‘group practice’ and not the subsidiaries,” she added.

“It demonstrates CMS’ continued recognition that the healthcare industry is innovating, and its need to allow flexibility to foster that innovation,” Sloane said. “This is not likely to increase enforcement given it is a positive advisory. In other words, it outlines what is permissible and doesn’t highlight a problematic structure.”

You can read the full advisory opinion—written in response to an unnamed practice’s request—here, and find Nashville, Tennessee-based Bass Berry & Sims breakdown of the decision here.
To read more, go to Radiology Business.

CMS Releases 2022 Proposed Medicare Physician Fee Schedule
July 13, 2021 | Included in Radiology Digest – July 16, 2021
The Centers for Medicare & Medicaid Services (CMS) released the calendar year 2022 Medicare Physician Fee Schedule (MPFS) proposed rule, which includes payment provisions and policy changes to the Quality Payment Program (QPP) for 2022 and beyond.

Medicare Physician Fee Schedule (MPFS)
With the proposed budget neutrality adjustment to account for changes in RVUs, and expiration of the 3.75% payment increase provided for CY 2021 by the Consolidated Appropriations Act, 2021 (CAA) the proposed 2022 MPFS conversion factor is $33.5848; a 3.75% decrease from 2021’s $ 34.8931.

The separately calculated Anesthesia conversion factor is proposed at $21.0442, a 2.39% decrease from the 2021 conversion factor of $21.5600.

CMS estimates an overall impact to allowed charges from MPFS proposed changes as follows:
• Anesthesiology: 1%
• Diagnostic Radiology: –2%
• Interventional Radiology: -9%
• Diagnostic Testing Facility: 0%
• Emergency Medicine: 0%
• Critical Care: 0%
• Nuclear Medicine: -2%
• Pathology: -1%
• Radiation Oncology/Therapy Centers: -5%
• Physician Assistants: 1%
• Nurse Practitioners: 1%
• Independent Laboratory -2%

Additional Resources:
Proposed Rule
Fact Sheet
2022 QPP Proposed Rule Resources

Most Referring Providers Fine with Radiologists Delivering Imaging Results; Some Patients Remain Hesitant
By Matt O’Connor | July 9, 2021 | Included in Radiology Digest – July 16, 2021
There’s been a recent push to increase radiologists’ visibility by communicating results directly to patients. But new research shows providers and patients don’t see eye-to-eye on this topic, suggesting an individualized approach for delivering findings may be best.

Imaging results are presented in many ways, including via web portals, from referring physicians, nurse coordinators or radiologists. One thing is certain, however: there’s no universal agreed-upon approach, Weill Cornell Medicine experts explained Friday in JACR.

Hoping to find a solution, the New York-based practitioners surveyed 192 referrers and 258 patients as they came in for CT lung cancer screening exams. Most were OK with radiologists delivering both normal and abnormal results, but it isn’t that straightforward.

For example, 51% of patients preferred to receive general imaging results from their referring provider, with 25% citing a radiologist as their top choice. At the same time, all providers surveyed said they were comfortable with rads disclosing normal results without consulting with them beforehand. That figure dipped for abnormal findings.

The conclusions suggest stakeholders may need to reevaluate their approach to communicating exam results, the authors explained.

“Variation among provider and patient preferences advocates for an individualized approach to optimize both referrer satisfaction and patient care,” Joanna G. Escalon, MD, director of Thoracic MRI at New York-Presbyterian/Weill Cornell, and colleagues added July 9.

Escalon and co-authors noted only 47 of 192 providers responded to the survey with 140 patient replies.

Below are additional findings:
• Seventy-four percent of referrers agree with radiologists delivering normal results and reviewing images with patients after talking with physicians over the phone. The remaining 26% disagreed.
• At the same time, 81% of referring providers think the interpreting rad should deliver abnormal results and review images after a phone call with the referring physician. Nineteen percent, meanwhile, didn’t think this was OK.
• Out of the 38 who agreed with the above statement, 34 are fine if radiologists deliver results without talking to them beforehand. Three didn’t want rads discussing abnormal findings with patients at all.
• For lung cancer screening CT, 49% of patients prefer to leave immediately and receive normal results from their referring provider, whereas 40% said the same if results were abnormal.
• Patients are comfortable hearing normal or abnormal results from a radiologist and want to see their CT images (74% for both).

Read the full study here.

To read more, go to Health Imaging.

Learn more about what Zotec Partners can do for your radiology practice here.