Bipartisan Bill Would Bolster Medicare Patients’ Access to Diagnostic Imaging Agents
By Marty Stempniak | July 21, 2021
Members of Congress recently introduced bipartisan legislation aimed at bolstering Medicare beneficiaries’ access to diagnostic imaging agents.
Current federal payment rules prevent safety-net hospitals and other providers from affording certain radiopharmaceuticals, leaving many without access to cutting-edge diagnostics. Rep. Bobby Rush, D-Ill., and others have proposed the Facilitating Innovative Nuclear Diagnostics Act of 2021 to close such care gaps.
“We cannot tolerate a two-tiered healthcare system—one for the rich, and one for everyone else,” said Rush, who is sponsoring the bill alongside Reps. Scott Peters, D-Calif., Neal Dunn, R-Fla., and Greg Murphy, R-N.C. “Unfortunately, many low-income and minority patients are being denied access to the most efficient tests, therapies and care due to the current payment structure for diagnostic radiopharmaceuticals that makes it nearly impossible for many hospitals serving our most vulnerable populations to offer these lifesaving diagnostics.”
The FIND Act would guarantee adequate Medicare reimbursement to hospitals that use nuclear agents to diagnose, evaluate and treat certain cancers, Alzheimer’s disease and other concerns. Rush said the bill is budget-neutral and would not require tax increases to cover such care.
Both Rush and Peters blasted the Centers for Medicare & Medicaid Services “flawed” payment policy for such drugs in April, prompting a meeting with the agency. Since 2008, CMS has treated radiopharmaceuticals as “ancillary” to the imaging procedure in the hospital setting, resulting in them being “policy packaged” into the procedure amount in payment classifications. However, this system fails patients, the lawmakers said, as the cost of imaging agents often outstrips the procedure tally. Their proposal would direct the feds to pay separately for all diagnostic radiopharmaceuticals with a cost threshold of $500 per day.
Industry lobbying group the Medical Imaging & Technology Alliance applauded the proposal Tuesday, anticipating it will significantly expand Medicare users’ options.
“The FIND Act represents a much needed, bipartisan legislative solution that would modernize CMS payment policies for diagnostic radiopharmaceuticals and expand beneficiary access to diagnostic modalities that can improve outcomes and reduce downstream medical costs,” Sue Bunning, MITA’s industry director of molecular imaging and PET, said July 20.
To read more, go to Radiology Business.
Congress Eyes Bigger Incentives for Medicare ACO Participants
By Jessie Hellmann | July 21, 2021
New bipartisan legislation aims to boost participation in Medicare’s Accountable Care Organization (ACO) program by enabling healthcare providers to recoup a greater share of cost savings—and bear a smaller share of risk—resulting from their efforts.
The bill aims to reverse modifications President Donald Trump’s administration made the Medicare ACO program, which allowed providers to keep a smaller portion of cost savings and exposed them to a greater proportion of risk if savings weren’t achieved. Reps. Suzan DelBene (D-Wash.), Peter Welch (D-Vt.), Darin LaHood (R-Ill.) and Brad Wenstrup (R-Ohio) unveiled the legislation Wednesday.
“The pressure is on for Congress to address programs that prioritize value in our healthcare system,” DelBene said at a press briefing. “We should start with ACOs.”
ACOs are groups of doctors, hospitals and other providers who coordinate care for Medicare patients,. The Medicare ACO program aims to limit unnecessary care and prevent medical errors. Top-performing ACOs can receive bonuses for good outcomes. The Affordable Care Act authorized Medicare ACOs as part of its provisions designed to shift the healthcare system toward rewarding value instead of volume. Nearly all ACOs surpassed regular fee-for-service providers on 81% of quality measures, according to a 2017 HHS inspector general’s report.
The Trump administration decreased the savings ACOs could keep and required them to take on more risk sooner ,in 2019 likely leading to fewer providers taking part in the program.
There are 477 Medicare ACOs this year serving 10.7 million beneficiaries, a drop from 561 ACOs serving 11.2 million beneficiaries three years ago.
Under the House members’ proposal, new ACOs could receive between 50% and 60% of savings generated. The bill would allow new ACOs to operate for three years before they have to take on risk.
To read more, go to Modern Healthcare.
RSNA Launches New Program to Certify Radiologists In Artificial Intelligence
By Matt O’Connor | July 21, 2021
RSNA is launching a new program that would allow radiologists to pursue certification in artificial intelligence, the society announced Wednesday.
The Imaging AI Certificate program is an online-based curriculum geared toward helping rads incorporate AI into daily practice, with a focus on diagnostic imaging and workflow improvements.
Radiologists can work at their own pace to watch on-demand videos, complete hands-on cases, and learn how algorithms are built and programmed, among other topics.
“The RSNA Imaging AI Certificate will be quite impactful for all radiologists, especially those who want to be more involved with the implementation of AI algorithms in their clinical practices,” Linda Moy, MD, course director and professor of radiology at the NYU Grossman School of Medicine, said in a statement. “The certificate will provide radiologists with an understanding of how to evaluate the usefulness and accuracy of AI algorithms and allow them to develop realistic expectations of how AI software may change their clinical workflow.”
After completing the course, graduates will receive a certificate and RSNA will offer continued options to gain additional training. Enrollment opens this coming fall.
“We are at a pivotal time in the progression of radiology,” said Matthew B. Morgan, MD, course director and associate professor and director of informatics and quality improvement in breast imaging at the University of Utah in Salt Lake City. “For the first time, we have AI that can … ‘see’ beyond what we can see to process and recognize patterns in quantitative data that is beyond human ability,” he went on to say. “This is where some of the most exciting advancements may come.”
Read more about the program here.
To read more, go to Health Imaging.
CMS Dropping Coverage Restrictions Around PET Imaging Outside of Oncology Care
By Marty Stempniak | July 20, 2021
The Centers for Medicare & Medicaid Services is dropping certain coverage restrictions around PET imaging outside of oncology, a move providers are calling “significant” for the field.
The noncoverage determination dates to 2000, when CMS enacted broad, national restrictions for using positron emission tomography scans outside of cancer care. This forced providers to seek coverage determinations for each individual indication beyond oncology.
Under the recently released 2022 Medicare Physician Fee Schedule, however, CMS is proposing to lift this “outdated” restriction. This would leave coverage decisions tied to non-oncologic PET scans up to each Medicare Administrative Contractor.
“We believe that extending local contractor discretion for non-oncologic indications of PET provides an immediate avenue to potential coverage in appropriate candidates and provides a framework that better serves the needs of the Medicare program and its beneficiaries,” CMS said in the proposed fee schedule, released July 13.
The Society of Nuclear Medicine & Molecular Imaging on Monday called the news “significant” for the profession.
“We applaud CMS’s coverage decision, which results from years of work by SNMMI and our industry partners,” the Reston, Virginia-based group said in a July 19 update.
Meanwhile, the nuclear society joined others such as the Medical Group Management Association in expressing “dismay” at proposed cuts to physician pay in 2022. It’s pleased, however, that the feds plan to delay the penalty phase of the Appropriate Use Criteria program by one year, until Jan. 1, 2023.
“This is great news for referring physicians who needed the extra time to implement because of COVID-19,” SNMMI said.
To read more, go to Radiology Business.
Imaging Alliance Wants CMS Policies to Encourage Adoption, Promote Access to Radiology AI
By Matt O’Connor | July 19, 2021
The Medical Imaging & Technology Alliance is calling on members of Congress to ensure patients have access to the latest imaging tools and other digital health technologies.
MITA outlined its thoughts on the House Committee on Energy and Commerce’s 21st Century Cures 2.0 draft legislation in a letter shared July 16. The trade association said it was “encouraged” by the continued inclusion of digital health innovation but wants to see more mechanisms in place to enhance access and adoption, particularly for artificial intelligence.
“We believe more must be done to encourage CMS to implement policies that will ensure patient access to digital health technologies, including artificial intelligence,” Patrick Hope, executive director of MITA, wrote in the letter.
This will require, Hope added, aligning CMS policies and incentives to reward early adoption and continued innovation. The trade group outlined a few requests, including that imaging tools using AI should be given payment codes distinct from existing diagnostic services, MITA argued.
Additionally, such technologies should be covered as entirely separate imaging services and be accounted for under new or existing payment systems, such as the New Technology Ambulatory Payment Classifications, direct costs for calculating practice expense relative value units, or separate payments when used as distinct services.
MITA also indicated its support for improved communication between CMS and the FDA when approving breakthrough technologies. It did, however, push for the inclusion of the Ensuring Patient Access to Critical Breakthrough Products Act to bridge the gap between regulatory approval, coding, coverage, and reimbursement.
“We commend your commitment to build on the progress made in the 21st Century Cures Act by addressing changes needed to support patient access to innovative therapies and devices,” Hope wrote July 16. “We look forward to working with you to achieve these goals.”
Read the entire letter here.
To read more, go to Health Imaging.
Hospitals Dodging Imaging Price Transparency Rule Could Face Fines as High as $2M, CMS Says
Marty Stempniak | July 19, 2021
Hospitals dodging federal requirements to disclose prices for imaging and other “shoppable” healthcare services could face fines upward of $2 million under a new rule proposed Monday.
The Centers for Medicare & Medicaid Services began requiring institutions to provide upfront pricing for care, including 13 radiology services specified by the agency. However, recent analyses have discovered many hospitals failing to honor the new price transparency rule.
Members of Congress urged the administration to respond, prompting recent presidential action, along with Monday’s announcement.
“No medical entity should be able to throttle competition at the expense of patients,” Health and Human Services Secretary Xavier Becerra said July 19. “I have fought anti-competitive practices before, and strongly believe healthcare must be in reach for everyone. With today’s proposed rule, we are simply showing hospitals through stiffer penalties: concealing the costs of services and procedures will not be tolerated by this administration.”
CMS is proposing to increase the penalty for some institutions that fail to comply with the rule. Hospitals with a bed count of 30 or fewer would face civil monetary penalty of $300 per day (same as the original rule), while larger providers will pay $10 daily for each bed not to exceed $5,500. The cost for a full year of noncompliance would range from $109,500 per hospital, with a maximum of $2,007,500, the agency said in its announcement.
The administration is accepting suggestions for alternative methods of assessing penalties, including hospital revenue, the severity and scope of noncompliance, and the organizations reason for defiance. CMS will also prohibit hospitals from erecting barriers that make it harder to fine machine-readable files listing their prices, it said in a fact sheet.
Becerra and colleagues said they’ve unearthed widespread variation in prices, based on the info hospitals made public this year. One recent analysis found the price of a diagnostic ultrasound is seven times higher, depending on which state it’s delivered. Another study in JAMA discovered patients paying nearly five times as much for the same scan within the same institution, depending on their insurance.
“CMS is committed to ensuring consumers have the information they need to make fully informed decisions regarding their health care, since health care prices can cause significant financial burdens for consumers,” the agency said in its announcement.
To read more, go to Radiology Business.