CMS Bans Surprise Billing
By Michael Brady | July 1, 2021
The Biden administration on Thursday unveiled the first in a series of rules aimed at banning surprise billing.
The interim final rule bans surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency service. It also prohibits out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons, as well as other out-of-network charges without advance notice.
“No patient should forgo care for fear of surprise billing,” HHS Secretary Xavier Becerra said in a statement. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises.”
HHS: 130 Health Systems Might Be Exposing 2 Million Patients’ Medical Images, Data Online
By Hannah Mitchell | July 1, 2021
Millions of patients may be exposed because of vulnerabilities in medical imaging archiving software.
Picture archiving communications systems are used by hospitals to share medical images and data. Research discovered in 2019 that a vulnerability in these systems can be exploited to expose patient data. Hundreds of healthcare organizations continue to have unpatched PACS servers visible, and HHS recommends hospitals review their inventory to determine if PACS are still being used, according to a June 29 news release.
As of June, PACS are still widely used, with recent reports estimating 130 health systems are exposing more than 2 million patients and 275 million medical images, the report said. Patient data that can be exposed includes names, Social Security numbers, images and medical procedure information.
To mitigate breaches, HHS recommends applying basic security principles, such as validating internet connections, requiring passwords to access data and placing data behind a firewall.
To read the full HHS report, click here.
Hospitals to Biden: Don’t Touch Relief Funds or Restore Sequester Cuts to Pay for Infrastructure
By Robert King | June 30, 2021
Hospital groups are demanding that President Joe Biden and Congress stay away from diverting unspent COVID-19 relief funds to help pay for a bipartisan infrastructure package.
The collection of groups wrote to the White House and congressional leaders Tuesday outlining major concerns with the bipartisan framework for infrastructure that is expected to be considered by Congress in July. They were also concerned with restoring cuts to Medicare payments that were paused due to the pandemic.
“The need for these funds remains strong, as many healthcare facilities are still recovering from the impact of the pandemic, and unfortunately caseloads have increased in some areas of the country due to new virus variants and a lack of vaccinations,” the letter said.
America’s Essential Hospitals, the American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges were among the nine groups and organizations that signed onto the letter.
The pay-for was included in a $1.2 trillion infrastructure package Biden announced June 24. The package, supported by 10 Republican senators, included funding on a variety of infrastructure items such as modernizing roads and information technology systems.
But the framework calls for repurposing any unused COVID-19 relief funds as a way to pay for the infrastructure upgrades.
“As you know, hospitals and health systems and other healthcare providers are awaiting the distribution of additional dollars in provider relief funds as well as the recently allocated $8.5 billion for rural healthcare providers,” the letter said.
The Department of Health and Human Services has previously said there is roughly $24 billion out of the $178 billion appropriated as part of the CARES Act that still needs to be distributed.
Providers that received money by June 30, 2020, have to spend all of their funding by Wednesday or else return the funding. Providers that got money later have more flexibility to use up their money.
To read more, go to Fierce Healthcare.
Radiology Ranks Tops Among Specialties with Physicians Worth More Than $5M
By Matt O’Connor | June 30, 2021
In a pandemic-stricken year that saw many practices suffer imaging volume losses, radiologists still maintained their position as one of the wealthiest physician specialties, according to an annual report from Medscape.
Seven percent of the radiology workforce is worth more than $5 million, ranking second only behind internal medicine (9%) and tied with cardiology and orthopedics & orthopedic surgery. Overall doc compensation held steady, fluctuating from $346,000 in 2020 to $344,000 in this year’s report.
“Somewhat surprisingly, physician income on average ended up fairly on par with the previous year,” the report read. “Although many medical offices were closed for a period of time in 2020, some physicians made use of the Paycheck Protection Program; others cut staff, renegotiated leases, switched to telemedicine visits, and made other cost-cutting changes that kept earning relatively on par.”
The findings are part of Medscape’s annual Physician Wealth & Debt Report which surveyed nearly 18,000 providers across more than 29 specialties. Out of that total, 4% or about 716 were radiologists who responded to the 10-minute survey between October 6, 2020, and February 11, 2021.
Radiology ranked middle of the pack for providers worth less than $500,000, tied with a number of other specialties including cardiology, pathology and critical care. Family medicine sits atop that list (18% of physicians) followed closely by internal medicine. Both groups, however, also had the highest number of survey respondents.
Most docs cited a mortgage as their largest expense (64%), followed by car loans (37%) and college or medical school loans (25%). On that same note, 20% of rads indicated they were putting money toward college loans, ranking 19th.
Nearly 70% of U.S. Physicians Now Employed by Hospitals or Corporations, Report Finds
By Tara Bannow | June 29, 2021
Almost seven in 10 U.S. physicians are now employed by hospitals or corporations like private equity firms and health insurers as the COVID-19 pandemic drove doctors away from independent practice, a new report finds.
Between Jan. 1 2019 and Jan. 1, 2021, 48,000 physicians quit private practice to take jobs at hospitals or other companies, Avalere Health researchers concluded in the study. These employers now own almost half of the country’s medical practices.
The Physicians Advocacy Institute, a not-for-profit group that advocates for fair and transparent payment policies, commissioned the study. The organization is not necessarily opposed to the trend, said CEO Kelly Kenney. But its members, who include leaders of state medical associations, are concerned about the loss of physician autonomy and about the rising costs associated with companies that employ physicians, she said.
“Physicians really need to maintain that independence and preserve that aspect of the patient-physician relationship,” Kenney said.
Cost is a demonstrable concern. A recent pair of Health Affairs studies found that doctors employed by hospitals were more likely to order inappropriate magnetic resonance imaging tests and that overall testing volume spiked after hospitals acquired physician practices.
More physicians flocked to corporate entities like private equity groups and health insurers than to hospitals over the two-year period Avalere Health studied. During that time, 29,800 more physicians became employees of those kinds of companies, 11,300 of which made the transition after the beginning of the COVID-19 pandemic. That represents a 31% increase in the percentage of corporate-employed physicians over the years examined, Avalere Health found.
Hospitals scooped up 18,600 more physicians during the study period, leading to a 5% increase in the share of doctors employed by hospitals. Hospitals also acquired 3,200 more physician practices during that time, an 8% increase.
Hospitals employed more doctors than other kinds of companies prior to the past two years, so there may have been less room to grow, Kenney said.
“We were at a fairly high level at the beginning of the study period, meaning that hospitals had already acquired lots of physician practices,” she said.
Hospitals employed 283,000 doctors in January 2019, or 46.9% of all U.S. physicians at the time, and 301,600 by January 2021, or 49.3% of all U.S. physicians, the Avalere Health data shows. The uptick became sharper after July 2020.
Corporate entities, meanwhile, employed 92,400 physicians in January 2019, or 15% of all U.S. physicians, and the total increased to 122,200, or 20%, by January 2021.
To read more, go to Modern Healthcare.
CMS Erects ‘Unexpected’ New Barriers to Payment for PET Imaging In Certain Scenarios
By Marty Stempniak | June 29, 2021
Imaging advocates are expressing dismay after the Centers for Medicare & Medicaid Services recently erected new barriers preventing payment for PET scans examining inflammation and infection.
Back in March, the Society of Nuclear Medicine & Molecular Imaging expressed excitement, with the federal agency relenting after refusing to cover such scans for more than a decade. However, SNMMI had to walk back its comments on Tuesday after a recent federal update.
CMS published an updated list of nationally covered imaging indications on June 8. “Unexpectedly,” SNMMI said, codes for some imaging of osteomyelitis (an infection of the bone) and “fever of unknown origin” are listed as not covered.
“The information in this transmittal is contrary to our understanding of the January 1, 2021, retirement of the infection and inflammation [National Coverage Determination],” the society said in a June 29 news alert. “SNMMI is working with CMS to clarify, potentially reverse, and obtain more information for our members regarding this unanticipated and conflicting information in the transmittal.”
CMS first ceased coverage of fluorodeoxyglucose (FDG) PET imaging for infection and inflammation in 2008, citing scant evidence at the time. SNMMI, the American College of Radiology, and the American Society of Nuclear Cardiology have crusaded to reverse the decision, with the feds revoking the noncoverage determination in December. Experts said previously that the 2008 change has “severely” limited PET use in these clinical scenarios since then.
This month’s transmittal is binding on Medicare Administrative Contractors, and these indications are not currently being covered by MACs, experts noted.
To read more, go to Radiology Business.