Hospitals Implore Congress to Punt Medicare Payment Cut Slated for July
By Dave Muoio | June 15, 2022
The American Hospital Association (AHA) penned a last-ditch letter to congressional leaders pleading for Medicare sequester cuts slated to take effect July 1 to be halted in light of the financial strain many of the nation’s hospitals are expected to face throughout 2022.
Congress had initially paused the 2% payment cut as part of the CARES Act when the COVID19 pandemic began to threaten providers’ bottom lines. Sequestration cuts were continually punted downfield until last December, when a bill was signed to resume a 1% cut in April and the full 2% in July.
With half a month to go, AHA Executive Vice President Stacey Hughes warned majority and minority leaders Tuesday that financial relief from the pending cut is necessary for hospitals “to maintain access to care for the patients and communities they serve.”
Providers are still under the pressure of COVID-19 with higher expenses tied to labor costs and supply chain issues, Hughes wrote. Hospitals are also unable to absorb or deflect “historic inflation levels” as most of their payments come from Medicare and Medicaid’s nonnegotiable, fixed reimbursement rates, she said.
“All these factors have led to a historically poor first quarter financially for hospitals and health systems this year,” Hughes wrote. “And as recently as April, operating margins were down nearly 40% from the prior month.
“Without immediate action, the AHA estimates hospitals will lose at least $3 billion by the end of the year,” she wrote.
Hospital industry groups had hoped that another delay to the sequestration cuts could be included alongside other health priorities in omnibus spending bills passed earlier this year. In particular, the groups had noted that the decision to end the cuts came before hospitals faced their worst COVID-19 surge of the pandemic.
To read more, go to Fierce Healthcare.
Anthem Revives Wellpoint Name in Rebranding Effort
By Nona Tepper | June 15, 2022
Anthem is continuing its corporate makeover.
The nation’s second largest insurer, which will change its name to Elevance Health on June 28, is extending its rebranding campaign, Anthem announced Wednesday. The company’s healthcare services arm will be dubbed Carelon and some of its health plans will take on the Wellpoint brand, which was the parent company’s name before it became Anthem in 2014. The divisional renaming will take place over the next few years.
In markets where Anthem does not own Blue Cross and Blue Shield plans, its Medicare, Medicaid and commercial insurance products will take on the Wellpoint moniker. The name change will not impact the Anthem Blue Cross and Blue Shield plans the company operates in 14 states.
To read more, go to Modern Healthcare.
AMA to Fight Legislation Expanding Scope of Practice
By Jessica Kim Cohen | June 14, 2022
The American Medical Association pledged to fight legislation that expands mid-level providers’ autonomy.
Under a new policy proposal adopted Tuesday by the AMA House of Delegates, the trade group will support research on the cost and quality of nurse practitioners, physician assistants and other advanced practice practitioners caring for patients without a doctor’s supervision. The association will help craft state legislation to oppose laws that expand the scope of practice for non-physicians and to reverse such laws that already exist.
The AMA convened delegates from groups including state and territorial medical associations and national specialty societies in Chicago this week to vote on a slate of policy proposals.
Expanding scope of practice has been a longstanding point of contention between physicians and advanced practice practitioners. Nurses have pointed to a number of studies that found no significant difference in care quality between APPs and physicians.
State legislators drafted more than 70 bills this year that would adjust scope-of-practice laws. Most of those bills sought to codify the relaxing of such laws during the COVID-19 pandemic, when physicians were occupied by the most acute cases. Currently, nearly half of states give nurse practitioners broad practice authority.
Mid-level providers prescribed antibiotics more frequently, ordered more imaging and provided more expensive care, according to research cited by the AMA.
While doctors at the meeting Tuesday agreed on the research proposal, they diverged on how the AMA should support state medical societies and whether the AMA should push to reverse existing legislation.
The AMA’s reference committee had suggested deleting the section calling for state legislation on reversing scope of practice laws. The trade group already has model legislation on related topics, like team-based care, which emphasizes coordinating care across providers and settings, the committee said.
To read more, go to Modern Healthcare.
HHS Issues Guidelines on Audio-only Telehealth Use
By Eric Wicklund | June 14, 2022
Federal officials are cracking down on healthcare organizations using audio-only telehealth platforms – such as the telephone – to deliver healthcare services.
The Health and Human Services Department’s Office for Civil Rights (OCR) has released guidance on how providers can use “remote communication technologies to provide audio only telehealth services” without running afoul of the Health Insurance Portability and Accountability Act (HIPAA), which focuses on how sensitive health information is disclosed over various communications channels.
“Audio telehealth is an important tool to reach patients in rural communities, individuals with disabilities, and others seeking the convenience of remote options,” OCR Director Lisa J. Pino said in a press release. “This guidance explains how the HIPAA Rules permit health care providers and plans to offer audio telehealth while protecting the privacy and security of individuals’ health information.”
Audio-only telehealth platforms have been heavily regulated in the past, and in many cases healthcare providers aren’t permitted to conduct healthcare via that technology. But during the pandemic, which forced providers to move away from in-person services and conduct more business via telehealth, the federal government issued a series of waivers, including one on HIPAA enforcement, aimed at expanding telehealth use and coverage.
Telehealth advocates have noted that the pandemic has proven the value of audio-only telehealth, particularly in rural and remote areas and for people who don’t have access to audio-visual telemedicine platforms or rely on the telephone as their only means of communication. While the federal waivers are scheduled to end with the public health emergency (PHE), some states have already taken action to permit the use of audio-only telehealth for certain services, and several bills before Congress aim to make those freedoms permanent and nationwide.
To read more, go to Health Leaders.
Health IT Execs Skeptical of Oracles’ Lofty Vision to Build National Medical Records System
By Heather Landi | June 14, 2022
A unified digital health record system for American patients has long been considered the “holy grail” for the healthcare industry. And, like the medieval legend, it’s been a quest embarked on by countless health IT leaders and industry groups over decades.
Oracle Chairman Larry Ellison’s vision to use the power of Cerner to build a national health records database is a lofty ambition, and it’s an aspiration that will take an unprecedented level of collaboration to execute, health IT execs told Fierce Healthcare.
Ellison’s announcement last week, on the heels of its $28 billion deal to pick up the electronic health record company, was met by a healthy dose of skepticism by interoperability experts who have been striving for years to build technical “roadways” to make it easier to access and share health data.
“The concept is not new, and the barriers still remain,” Patrick Murta, a health IT leader and chief platform architect at digital health company BehaVR, told Fierce Healthcare. “Saying that you’re going to build a national database and bringing that to fruition is a different story. This particular model is going to face the same barriers that have been there for many years and there’s no easy path to overcome those barriers quickly.”
Murta is a former co-chief architect for the Office of the National Coordinator for Health IT’s FHIR at Scale Taskforce (FAST), an effort to accelerate the adoption of the Fast Healthcare Interoperability Resource (FHIR) standard for application programming interfaces to improve data sharing. FHIR serves as the core data standard to allow patients to access medical records on their smartphones.
There are immense and long-standing barriers to sharing health information with the same ease that consumers can share their financial information using banking apps. These hurdles include a lack of coordination among different facilities and health systems and inconsistent
technical standards resulting in EHR systems that can’t “talk to each other.” Along with technical challenges, there are also operational and business roadblocks, such as divergent policies related to privacy that govern how electronic health information is exchanged or used.
There are significant data security issues, and the industry has to contend with different approaches to gaining consent from patients to share information.
To read more, go to Fierce Healthcare.
Preventative Care May Be Free, but Follow-up Diagnostic Tests can Bring Big Bills
By Michelle Andrews | June 14, 2022
When Cynthia Johnson learned she would owe $200 out-of-pocket for a diagnostic mammogram in Houston, she almost put off getting the test that told her she had breast cancer.
“I thought, ‘I really don’t have this to spend, and it’s probably nothing,’” said Johnson, who works in educational assessment at a university. But she decided to go forward with the test because she could put the copay on a credit card.
Johnson was 39 in 2018 when that mammogram confirmed that the lump she’d noticed in her left breast was cancer. Today, after a lumpectomy, chemotherapy, and radiation, she is disease-free.
Having to choose between paying rent and getting the testing they need can be a serious dilemma for some patients. Under the Affordable Care Act, many preventive services — such as breast and colorectal cancer screening — are covered at no cost. That means patients don’t have to pay the normal copayments, coinsurance, or deductible costs their plan requires. But if a screening returns an abnormal result and a healthcare provider orders more testing to figure out what’s wrong, patients may be on the hook for hundreds or even thousands of dollars for diagnostic services.
Many patient advocates and medical experts say no-cost coverage should be extended beyond an initial preventive test to imaging, biopsies, or other services necessary for diagnosing a problem.
“The billing distinction between screening and diagnostic testing is a technical one,” said Dr. A. Mark Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design. “The federal government should clarify that commercial plans and Medicare should fully cover all the required steps to diagnose cancer or another problem, not just the first screening test.”
A study that examined more than 6 million commercial insurance claims for screening mammograms from 2010 to 2017 found that 16% required additional imaging or other procedures. Half the women who got further imaging and a biopsy paid $152 or more in out of-pocket costs for follow-up tests in 2017, according to the study by Fendrick and several colleagues and published by JAMA Network Open.
People who needed testing after other preventive cancer screenings also racked up charges: half paid $155 or more for a biopsy after a suspicious result on a cervical cancer test; $100 was the average bill for a colonoscopy after a stool-based colorectal cancer test; and $424,
on average, was charged for follow-up tests after a CT scan to check for lung cancer, according to additional research by Fendrick and others.
To read more, go to Modern Healthcare.
Radiologists Can Reclaim an Hour Every Day with AI Assistance
By Hanna Murphy | June 13, 2022
Radiologists can reclaim up to an hour of their time every day by incorporating the use of artificial intelligence into certain clinical tasks.
That’s according to a release published by the American Roentgen Ray Society that touts the results of their study involving the workflows of 390 patients who underwent outpatient chest CT scans at the Medical University of South Carolina from January 19–28 of 2021. Using commercial software (AI-Rad Companion) as an assistive device, three cardiothoracic radiologists shaved an average of 93 seconds per exam off of their interpretation times.
“This is the first study to our knowledge to assess the impact of an AI support platform on chest CT interpretation times in a real-world clinical setting,” corresponding author U. Joseph Schoepf, from the Medical University of South Carolina said. “The platform’s integration into clinical workflow resulted in a mean reduction in interpretation times of 22.1% among three cardiothoracic radiologists for whom the AI results were made available.”
ARRS indicates that the AI software assisted in various tasks, such as segmenting, labeling and measuring normal structures, which provided an automated analysis of pulmonary, cardiac and musculoskeletal findings. In addition to this, the software was able to detect, label and measure abnormalities.
Researchers compared interpretation times both with and without the use of AI assistance using a stopwatch. Reductions in read times were between 63 and 123 seconds per exam, or 22.1% per exam. These time differences were found to be consistent in studies regardless of the use of contrast as well, with interpretations taking 20% and 24.2% less time for contrast enhanced and non-contrast scans.
To read more, go to Health Imaging.
Providers are Calling for More Time to Implement Estimate Requirement in Surprise Bill Rule
By Robert King | June 8, 2022
Providers have a little more than six months to find a way to deliver good faith estimates to patients on medical bills, but some say a lack of automated solutions is going to create a colossal burden for them to meet.
Several groups have written to the Centers for Medicare & Medicaid Services (CMS) asking for more time to implement the good faith estimate portion of a rule that bans surprise medical bills. The rule, which is the subject of a broader legal fight with the healthcare industry, is set to take effect on Jan. 1, 2023.
“In light of the impending deadline and the to-date lack of guidance from CMS, we request an extension in enforcement discretion until a technical solution has been identified and implemented,” the American Hospital Association said in its letter to CMS.
The No Surprises Act signed into law last year calls for a ban on surprise medical bills and sets up an arbitration system to handle disputes between payers and providers over out-of network charges. The law also requires providers to give uninsured or self-pay patients a “good faith estimate” of charges for care when a procedure is scheduled or upon request, according to CMS. Providers must also give estimates for certain insured patients to their plan or health insurer.
The law includes an arbitration process to handle charges that are well above the estimate.
Providers must start making these estimates available Jan. 1, but groups say the Department of Health and Human Services (HHS) has a massive misunderstanding of the infrastructure they are needed to meet the estimate requirements.
To read more, go to Fierce Healthcare.