Radiology Digest – June 20, 2023

June 15, 2023

Radiology Digest: News from the week of June 20, 2023.
‘Past the Breaking Point’: AMA Calls for Urgent Action to Fix ‘Dilapidated’ Payment System

By Mary Stempniak | June 15, 2023 | Included in Radiology Digest – June 20, 2023

The American Medical Association is calling for urgent action to address what it says is a broken Medicare payment system.

AMA highlighted challenges physician practices have faced in recent years, including the COVID pandemic, inflation and the growing cost of running a business. Amid this, Medicare has “failed to respond,” with medical doctors absorbing a 2% pay cut for 2023, the association said Monday.

When adjusting for inflation, Medicare physician payment actually dropped 26% between 2001 to 2023, AMA said, quoting a commonly cited statistic.

“This cannot wait; we are past the breaking point.

Congress must urgently address physician concerns about Medicare to account for inflation and the post-pandemic economic reality facing practices nationwide,” AMA President Jack Resneck Jr., MD, said in a statement. “Our patients are counting on us to deliver the message that access to healthcare is jeopardized by Medicare’s payment system. Being mad isn’t enough.”

The association said it plans to develop a targeted, grassroots campaign to help drive this message home to lawmakers. AMA is pushing for the passage of the Strengthening Medicare for Patients and Providers Act, introduced by bipartisan members of the U.S. House in April. The bill proposes to provide a permanent annual inflationary physician payment update tied to the Medicare Economic Index. AMA, the American College of Radiology, the Society of Interventional Radiology and more than 100 other professional associations voiced their support for the measure the same month it was introduced.

Absent any action from Congress, the association is concerned about the physician workforce’s future.

“We are deeply worried that many practices will be forced to stop taking new Medicare patients—at a time when access to care is already inadequate,” Resneck said. “Duct-taping the widening cracks of a dilapidated payment system has put us in this precarious situation,” he added later. “Physicians are united in our determination to build a solid foundation rather than further jury-rigging the system.”

To read more, go to Radiology Business.


Medicaid Disenrollments Top 1 Million

By Rylee Wilson | June 13, 2024 | Included in Radiology Digest – June 20, 2023

More than 1 million people have been disenrolled from Medicaid as part of the redeterminations process, according to KFF. 

As of June 12, at least 1,027,000 people have lost Medicaid coverage, according to data reported by state agencies analyzed by KFF. Not all states have publicly reported data on Medicaid disenrollments. 

Around half of those disenrolled live in Florida, Arizona and Arkansas. Florida has disenrolled nearly 250,000 individuals as of June 12. 

Some states began terminating coverage for ineligible Medicaid recipients in April after continuous coverage requirements in place during the COVID-19 public health emergency ended. 

Many individuals who have lost Medicaid coverage were disenrolled because they did not return required paperwork or other procedural reasons, rather than being determined ineligible for the program. 

In seven states — Kansas, Indiana, Connecticut, West Virginia, Florida, Arkansas and New Hampshire — more than 80 percent of those disenrolled from Medicaid were due to procedural reasons, according to KFF’s analysis. 
In a June 12 letter to state governors, HHS Secretary Xavier Becerra urged states to do more to prevent procedural disenrollments. 

“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Mr. Becerra wrote. 

The agency implemented new flexibility for states aimed at curbing the number of people unnecessarily disenrolled from the program. 

To read more, go to Becker’s Payer Issues.


Considerations for Supplemental Imaging Should Extend Beyond Breast Density Analysis Suggests

By Hannah Murphy | June 12, 2023 | Included in Radiology Digest – June 20, 2023

Although the need for supplemental imaging in women with dense breasts has been a hot topic among the imaging community recently, new data suggest that considerations for supplemental exams should extend well beyond breast density. 

Experts recently compared tens of thousands of supplemental breast ultrasounds alongside more than 800,000 screening mammograms that did not include additional imaging evaluations to better understand who is at greatest risk of mammography screening failure.

After using Breast Cancer Surveillance Consortium (BCSC) prediction models to determine individuals’ risk of interval invasive cancer and advanced cancer between the groups, the team found that only a modest proportion of women with dense breasts were at higher risk of mammography screening failure, despite being the primary targets for supplemental US recommendations.

This prompted the team to suggest that additional risk factors outside of breast density should hold more weight when considering who needs supplemental screening in the future.

“In addition to breast density, other breast cancer risk factors (e.g., family history of breast cancer, prior benign breast disease diagnosis, obesity) have been shown to be associated with likelihood of a mammography screening failure,” corresponding author of the newly published analysis Brian Sprague, PhD, of the University of Vermont Cancer Center, and colleagues noted. “In the current clinical setting of variable referrals for ultrasound screening, it is unclear how closely use of ultrasound screening is associated with a woman’s risk of mammography screening failures.” 

Exams included in the analysis took place from 2014 to 2020 at 32 U.S. imaging facilities within three regional registries of the BCSC. Of the 38,166 supplemental US exams included, 95.3% were performed in women with dense breasts; this was the case in 41.8% of the 825,360 screening mammograms without supplemental screening.  

To read more, go to Health Imaging.


HHS Nears Deal to Preserves ACA Preventive Care Mandate

By Jakob Emerson | June 12, 2023 | Included in Radiology Digest – June 20, 2023

The Biden administration has reached a tentative deal that would preserve a provision of the ACA requiring insurers to cover preventive services while a Texas judge’s ruling against the mandate is appealed in court.

In a June 9 filing with the 5th U.S. Circuit Court of Appeals, attorneys for the involved parties said they hoped to submit a final agreement by June 13. 

Under the deal, the challenged ACA provision would remain in place while the case is appealed, but the Texas company that filed the lawsuit would be exempt. The company, Braidwood Management, would remain exempt if the appeals court restores the mandate.

In March, U.S. District Judge Reed O’Connor struck down the ACA provision requiring payers and employers to provide coverage for preventive services without copays. The judge’s ruling said preventive care recommendations made by the U.S. Preventive Services Task Force do not need to be complied with and blocked the federal government from enforcing its recommendations. 

The ACA requires payers to cover more than 100 preventive health services recommended by the task force, which are used by about 100 million Americans annually, according to KFF.

The ruling applies only to task force recommendations made by the panel on or after March 23, 2010 (when the ACA became law), such as statins, lung and skin cancer screenings, and pre-exposure prophylaxis, or PrEP, an HIV prevention drug. Sexually transmitted infection screenings and cancer screenings such as mammograms and cervical screenings would still be included for preventive coverage.

The Biden administration appealed the Texas ruling in early April. The 5th Circuit granted an administrative stay May 15 while the court reviews the case.

If Mr. O’Connor’s ruling is not overturned by the 5th Circuit, payers would be able to charge members in new plans for preventive services.

To read more, go to Becker’s Payer Issues.


Radiology Societies Issue ‘Call to Action’ Against Looming Threat to Physician Offices’ Financial Viability

By Marty Stempniak | June 8, 2023 | Included in Radiology Digest – June 20, 2023

Radiology societies issued a “call to action” this week, urging the specialty to help fight a looming threat to physician offices’ financial viability.

The American College of Radiology highlighted the campaign on Thursday, June 8, noting that it has worked alongside like-minded groups to educate the Biden administration about this impediment to patient access. They’re concerned about forthcoming cuts in the Medicare Physician Fee Schedule that will impact specialties with high equipment costs, such as interventional radiology and radiation oncology.

“Office-based specialty care is critical and important for patient access, especially in underserved areas,” the Radiology Advocacy Network said in the call to action, urging radiologists to reach out to their local representatives. “Unfortunately, the prolonged instability within the MPFS threatens the financial viability of community, office-based physician practices.”

ACR, the Society of Interventional Radiology, and the American Society for Radiation Oncology are  hoping to drum up support for H.R. 3674introduced by bipartisan members of the U.S. House on May 25. The Providing Relief and Stability for Medicare Patients Act would increase nonfacility practice expense RVUs for procedures performed in office settings that require high-tech devices or equipment. Currently, Medicare payment for clinical labor, medical supplies and equipment costs are “budget neutral,” meaning an increase in one leads to cuts for another.

The bill has four initial sponsors: Reps. Gus Bilirakis, R-Fla., Tony Cárdenas, D-Calif., Danny Davis, D-Ill., and Greg Murphy R-N.C., who also is an MD. ACR, ASTRO and SIR are asking physicians to phone or write representatives to increase the total.

“This bipartisan legislation will mitigate practice expense cuts but only if you make your voice heard by participating in the call to action,” the announcement concluded.

To read more, go to Radiology Business.


Interventional Radiology Among 4 Specialties with the Greatest Growth in Claims Volume Since 2018

By Marty Stempniak | June 8, 2023 | Included in Radiology Digest – June 20, 2023

Interventional radiology is among the top four physician group specialties with the greatest growth in medical claims volume, according to new data.

The specialty saw an 83% uptick in billing between 2018 and 2022, publicly traded data and analytics firm Definitive Healthcare reported June 1. That places IR behind only hospice and palliative care (786%), pediatric rheumatology (544%) and preventive medicine (125%).

Nuclear medicine also cracked the top eight, logging 55% growth in the number of claims submitted during the five-year period. The findings are derived from Definitive Healthcare’s all-payer claims database and its PhysicianGroupView, which tracks more than 122,000 provider entities.

“The healthcare industry is rapidly changing, and physician groups are not exempt from these changes,” Definitive Healthcare noted. “Consolidation and increased ownership of physician groups by private equity firms are two trends impacting these practices nationwide. Clinicians may sell their practices due to the competitive landscape, the need for capital, financial uncertainty, high purchase prices, or all of the above.”

Others rounding out the top eight include dietician/nutritionists (up 64%), geriatric medicine specialists (57%), and massage therapists (56%).

According to Definitive Healthcare data, there was a 67% increase in unique patients seen by physician groups specializing in interventional radiology between 2018-2022. More individuals are seeking out IR services, creating rising claims volume, said Rachel Kolbin-Gupp, MBA, senior marketing data analyst. 
“That growth may be due to an increase in minimally invasive procedures and innovations in imaging technologies such as AI/VR,” she told Radiology Business Thursday. “An increase in chronic diseases such as cancer also may be driving the growth as CT scanners and MRI procedures become more in demand.”

The analysis also offered insights into the top three specialties on the list. Definitive Healthcare noted that the surge in hospice and palliative care is likely driven by the aging population. It’s also a newer physician specialty, with growth anticipated as the supply of clinicians increases. Experts, meanwhile, have predicted rising demand for pediatric rheumatology by 2030. An increased focus on value-based care is likely spurring interest in preventive medicine.

“Additionally, the increase of health maintenance organization insurance plans offered by employers may be contributing to this growth as HMOs require the patient to establish care with a primary care provider before obtaining a specialist referral,” Definitive Healthcare noted.

To read more, go to Radiology Business.

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