Radiology Digest – June 24, 2022

June 23, 2022

Radiology Digest: News from the week of June 24, 2022.
Radiology Takeaways From the 2022 AMA Meeting
By Dave Fornell | June 22, 2022 | Included in Radiology Digest – June 24, 2022

The biggest medical imaging-related news was a resolution that directs the AMA to lobby Congress to change the language and implementation of the current Medicare mandate that all advanced medical imaging exams (CT, MRI, nuclear) needs documentation that the order included consulting of clinician decision support (CDS) software. This is to ensure all imaging exams ordered fall under appropriate use criteria (AUC) set by various medical societies. 

The goal of the legislation, which originated under the Protecting Access to Medicare Act of 2014 (PAMA), is to reduce costs associated with unnecessary, expensive imaging exams. However, numerous imaging societies have complained to CMS that the rule will cause undue administrative burden on radiologists. The policy also penalizes radiologists with non-payment if an order does not have CDS documentation. This is despite the fact that use the CDS software needs to come from the referring physicians and CDS documentation cannot be amended by the radiologist in the order. 

Van Moore also discussed AMA’s support of a policy that calls on Congress to take action against drug shortages to prevent problems in delivering healthcare. Medical imaging has faced a serious shortage of iodine contrast agents over the past couple months due to a COVID-19 shutdown of a manufacturing plant in China. This raised serious concerns about the stability of international supply chains.

The AMA resolution originally targeted a handful of everyday drugs that have been on shortage and is impacting hospital care, but the contrast agent language was added at the meeting because of the serious impact on care it has had.

To read more, go to Radiology Business.  
 New Class Action Lawsuit Claims Meta’s Discreet Patient Data Tracker Was Active Across 664 Provider Websites
By Dave Muoio | June 21, 2022 | Included in Radiology Digest – June 24, 2022

Facebook parent company Meta was hit with a class action lawsuit late last week alleging the tech company has been collecting sensitive patient-status data through hospital websites in violation of the Health Insurance Portability and Accountability Act (HIPAA).

The case was filed on Friday in the Northern District of California by an anonymous patient of Baltimore’s Medstar Health System on the behalf of “millions of other Americans whose medical privacy has been violated by Facebook’s Pixel tracking tool.”

The filing came just days after the publication of an investigation by The Markup detailing how the tech company’s analytics tool was found on roughly a third of the country’s top hospitals’ websites.

Both the report and the lawsuit detailed the tracker’s collection of identifiable information such as IP addresses alongside other potentially sensitive information including doctor names and recent web activity related to their health conditions. The two documents also said that patients using provider websites with the tracker would not have consented to the collection of these data.

While The Markup and experts cited in its group characterized the practices as a likely HIPAA violation, the class action was more explicit in its claims.

“Facebook is aware that it is receiving patient data from hundreds of different medical providers in the United States without patient knowledge, consent or valid HIPAA authorizations,” the plaintiff wrote in the lawsuit.

The plaintiff also said that they have identified “at least 664 hospital systems or medical provider web properties where Facebook has received patient data via the Facebook Pixel” as of the Friday filing.

To read more, go to Fierce Healthcare.  
Insurers Wrestle with Proposed Marketplace Rule
By Kara Hartnett | June 21, 2022 | Included in Radiology Digest – June 24, 2022

Insurers may soon be accountable for the health equity promises they make. In recent years, insurance organizations and professional groups have committed to programs that address social determinants of health and promote diversity, equity and inclusion.

Now, such initiatives could become the baseline.

Government entities are considering making the National Committee for Quality Assurance’s Health Equity Accreditation mandatory for Medicaid and marketplace plans, which would require insurers administering them to comply with new standards meant to eliminate disparities in the communities they serve.

Some states have already moved to enact the requirement, but insurers have pushed back against a federal mandate for marketplace issuers. They cite costly operational changes, overly broad guidance and unproven effectiveness as reasons to hold off from making accreditation a federal requirement.

Consumer advocacy groups and public entities, meanwhile, say the mandatory accreditation process is necessary to revamp practices that perpetuate inequality within the healthcare industry.

To read more, go to Modern Healthcare.  
AMA Will Ask Congress to Change Mandate on Appropriate Use Criteria Clinical Decision Support
By Dave Fornell | June 20, 2022 | Included in Radiology Digest – June 24, 2022

Alexander Ding, MD, MBA, a radiologist, incoming  American Medical Association (AMA) Board of Trustees member, AMA delegate with the California Medical Association, explains the new AMA policy calling on Congress to change the language and implementation of the current Medicare mandate that all advanced medical imaging needs certification that the order includes consulting a clinician decision support (CDS) software. The goal of the legislation, which originated under the PAMA Act in 2014, was to determine if the imaging exams falls under appropriate use criteria set by various medical societies.

The goal is to reduce the use of expensive imaging exams that are not necessary. However, implementation of the rule has been delayed for years because of technical issues and complaints about the policy, which penalizes radiologists, even though the order and the need to use the CDS software comes from referring physicians. 

The American Society of Nuclear Cardiology (ASNC) spearheaded an effort to get 44 medical societies to sign on to a letter earlier in 2022 asking Congress to change the requirements in the rule or repeal it. Discussions at the AMA led to the AMA resolution being considered to remove the repeal language. Ding said the medical societies are in control of the appropriate use guidelines, and the AMA policy seeks to change the language of the mandate to make it easier to implement with less administrative burdens.

The Medicare rule is slated to go into effect in January 2023.

To read more, go to Radiology Business.  
Hospitals Call Medicare Pay Proposal ‘Woefully Inadequate’
By Maya Goldman | June 20, 2022 | Included in Radiology Digest – June 24, 2022

The proposed Medicare payment update for inpatient services is nowhere close to covering hospitals’ rising costs, industry groups warn the Centers for Medicare and Medicaid Services in comment letters.

Hospitals are calling on CMS to make further upward adjustments to the fiscal 2023 inpatient prospective payment system rule to compensate for underpredictions from this fiscal year’s rule and to eliminate a separate negative adjustment for the coming year.

“The current inflationary economy combined with the COVID-19 crisis has put unprecedented pressure on America’s hospitals and health systems,” the American Hospital Association wrote. “These shifts in the healthcare environment are putting enormous strain on hospitals and health systems, which will continue in FY 2023 and beyond.”

CMS proposed a 3.2% increase in Medicare inpatient payments for fiscal 2023, including a 3.1% market basket update, in a draft regulation issued in April. The market basket predicts future hospital costs using data from prior years. CMS incorporated data through the third quarter of 2021, but may use more recent information in the final rule, according to the draft regulation.

The market basket can adequately predict cost trends in a more stable economy but it doesn’t work well under the present circumstances, the AHA wrote.

“The end of calendar year 2021 into calendar year 2022 should not, in any sense, be considered a steady-state economic environment that is a continuance of past trends,” the AHA wrote. Using these data would result in “woefully inadequate reimbursements,” the letter says.

Furthermore, the 2.7% fiscal 2022 inpatient payment update underpredicted costs, industry representatives wrote. The 2022 market basket is now trending toward 4%, hospital groups note, citing CMS projections. “Because this market basket was a forecast of what was expected to occur, it missed the unexpected trends that actually did occur,” the AHA wrote. Inflation jumped from 2.6% in March 2021 to 7% in December. The 2022 market basket didn’t anticipate that factor nor increased labor costs during the second half of 2021, the AHA wrote. Inflation reached a 40-year high this spring, and could accelerate even further this summer, Fannie Mae projected this month.

Pressures from the COVID-19 pandemic also strained hospitals over the past two years. Federal relief stabilized hospital finances in 2020, but the funding is nearly depleted.

To read more, go to Modern Healthcare.  
Radiologist Pay, Productivity Jostled by Pandemic Recovery, CMS Coding Changes
By Dave Pearson | June 17, 2022 | Included in Radiology Digest – June 24, 2022

Diagnostic radiology saw its median compensation rise just 1.6% from 2020 to 2021, from $512,918 to $521,326. During that timeframe the specialty’s median total wRVUs rose 5.2% while its compensation per wRVU fell 4.4%.

On the other hand, interventional radiology enjoyed a 9.9% compensation raise—from $581,175 to $638,787—alongside a 1.5% drop in wRVUs and a spike in compensation per wRVU of 11.6%.

The findings are from the American Medical Group Association’s 35th annual survey of medical group compensation and productivity. Releasing a sampling of survey results in a June 16 news release, AMGA observed that, overall, provider compensation and productivity started returning to normal in 2021 after getting scrambled by the COVID pandemic in 2020.

CMS made significant changes to its wRVU schedule in 2021, “which makes an apples-to-apples comparison between 2020 and 2021 more challenging than in years past,” comments Fred Horton, MHA, president of AMGA Consulting. “For this year’s survey, wRVU values were collected using both the 2021 CMS wRVU weights and the prior year values. We analyzed the data in a manner that isolates the differences between volume increases and increases attributable to the new coding weights.”

AMGA adds that the latest data reflects an overall 11.1% increase in production associated with the volume recovery from the pandemic and an additional 7.2% increase due to the wRVU weight changes.

To read more, go to Radiology Business.
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