Becerra Eyes Work on Physician Pay, Medicare Advantage Reform
By Maya Goldman | March 17, 2022
Health and Human Services Secretary Xavier Becerra said Thursday that the department may readjust Medicare Part B premiums next month while it looks to work with Congress on other healthcare reforms in his second year on the job.
As Becerra approaches his one year anniversary in the position, he’s also fighting an uphill battle for more funding from Congress to keep COVID-19 relief and health coverage initiatives alive. HHS is interested in talking to Congress about Medicare Advantage overpayment issues and physician payment reform, Becerra told reporters Thursday.
“We can’t let this go over the cliff. Not when we’re on the verge of turning the page,” he said.
Part B Premiums
The Centers for Medicare and Medicaid Services’ plans for reassessing Medicare Part B premiums for 2022 will come soon, and Becerra said HHS will ensure seniors don’t pay more than necessary.
Becerra directed CMS to reassess Medicare Part B premiums in January after drug maker Biogen slashed the price of its controversial Alzheimer’s drug, Aduhelm. CMS announced in November that covering Aduhelm would increase premiums by 15%. CMS has since proposed only covering the drug in clinical trials. A final coverage decision will come in April.
“Once we have that determination, we’ll be able to fully assess what impact Aduhelm may have had on premiums for seniors in Medicare,” he said.
Becerra also indicated the department could look to Congress for help reforming the Medicare Advantage program in the future. However, he didn’t commit to how HHS would address some experts’ concerns that Medicare Advantage plans are overpaid relative to traditional Medicare. Insurers dispute claims of overpayment.
“We’re taking a close look at Medicare Advantage and working with our partners at [the Office of Management and Budget] and will try to make sure that we’re putting before Congress any reforms that will give Americans a better value for their Medicare buck,” he said.
The Medicare Payment Advisory Commission and other health policy experts have advised that HHS can take steps itself to level plan payment, like increasing the coding intensity adjustment, but the agency has not done so.
HHS is interested in discussing physician payment reform with lawmakers, Becerra said. Congress last year partially offset cuts CMS made to provider Medicare reimbursement that mainly impacted specialists. Physicians want a more permanent fix to their payment system that keeps up with inflation and practice costs.
The agency will examine provider payment where it can, but would support physician fee schedule reforms.
“I remember those cliffs when I was in Congress, we always have to deal with those, and you’d never want professionals… thinking that there may be a different profession for them down the line because they’re just not making ends meet where they are,” he said. HHS is working to increase the pipeline of providers as well, particularly in underserved areas, Becerra said.
To read more, go to Modern Healthcare.
‘Deeply Troubled’: Doc Groups Blast MedPAC Call for Zero Physician Services Pay Update in 2023
By Marty Stempniak | March 16, 2022
Physician advocacy groups are blasting the Medicare Payment Advisory Commission’s call to forgo a physician services payment update in 2023.
MedPAC issued its latest report to Congress on Tuesday, noting that beneficiaries have “good” access to care with a growing supply of clinicians. Private insurance payment rates continue to be higher than Medicare, the advisory group noted, while overall doc compensation is on the rise.
“The commission’s analyses suggest that, in aggregate, Medicare’s payments for clinician services are adequate,” MedPAC reported March 15. “Although clinicians have experienced declines in their Medicare service volume and revenue due to the pandemic, the Congress has provided tens of billions of dollars in relief funds to clinicians during the [public health emergency], and we expect volume and revenue to rebound to pre-pandemic levels (or higher) by 2023.”
Physician groups were quick to slam the recommendation Tuesday. The Medical Group Management Association said it was “deeply troubled” by the report while noting that physicians are fighting through the highest annual inflation rate in 40 years. After a brief pause, Medicare sequester cuts are set to resume April 1 at a time practices are “still reeling from pandemic related disruptions, rampant staffing shortages and skyrocketing expenses.”
“As MGMA has continued to warn, without a modest annual payment update to keep up with the cost of inflation, physician practices will inevitably be forced to make difficult decisions about their Medicare participation—decisions that would certainly result in diminished access to the critical healthcare services on which beneficiaries rely,” said Anders Gilberg senior VP of government affairs for the association, which represents more than 15,000 physician groups across radiology and other specialties.
The American Medical Association similarly criticized the report, noting that there was a $13.9 billion decrease in Medicare physician fee schedule spending in 2020 as patients delayed treatments. Adjusted for inflation, doc pay in the program fell 20% over the past two decades and that does not account for the recent inflationary spike, AMA said.
“It is urgent that Congress work with the physician community to develop solutions to the systematic problems with the Medicare physician payment system and preserve patient access to care,” AMA CEO James Madara, MD, wrote in a March 15 letter to leaders of Congress.
To read more, go to Radiology Business.
White House Warns Uninsured Fund May End Without More COVID-19 Relief
By Maya Goldman | March 15, 2022
Congress’s failure to authorize further coronavirus response spending will have serious consequences, including the depletion of a fund to reimburse providers caring for uninsured COVID-19 patients, a senior administration official said Tuesday.
The Health and Human Services Department will begin scaling back that program next week, and it’s due to end completely in early April without additional money, the official said during a call with reporters. That would leave providers unpaid when they test, treat or vaccinate
Lawmakers approved a $1.5 trillion package to fund government operations last week but didn’t include any pandemic response money even though the White House requested $22.5 billion and previously warned that the uninsured fund was about to run dry.
Congressional leaders removed $15.6 billion for pandemic programs from the legislation at the last moment following a dispute about how to finance the spending. “We must continue to fight for urgently needed COVID assistance,” House Speaker Nancy Pelosi (D-Calif.) wrote in a letter to members ahead of the vote last Wednesday.
The lack of new funding also means the federal government won’t be able to acquire enough vaccine doses for people who haven’t received booster shots, the official said.
In addition, President Joe Biden’s administration is scrapping a plan to purchase more monoclonal antibody treatments and will distribute more than 30% fewer treatments in order to stretch the existing supply, according to the official. Authorities also would be forced to scale back research and surveillance on new COVID-19 variants and reduce U.S. commitments to global vaccination efforts, the official said.
To read more, go to Modern Healthcare.
JACR Study Explores Potential Bias in Patient Experience Scores and How Providers Can Respond
By Marty Stempniak | March 14, 2022
There are a few modifiable factors providers can address to improve patient experience scores, according to a new analysis published in the Journal of the American College of Radiology.
Such metrics are increasingly important in both measuring healthcare quality and reimbursement. However, they may be subject to bias, with factors such as physician gender influencing a consumer’s feedback.
Radiation oncology experts in New York recently set out to explore this issue, utilizing retrospective data across two large, multisite academic cancer centers. They found that demographic characteristics of docs did not impact scores, though one modifiable factor bubbled to the surface.
“Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients,” Deborah Marshall, MD, with the Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, and co-authors wrote March 2. “Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.”
Researchers utilized data from nearly 2,900 individuals who completed patient experience surveys between 2017-2019. They tracked patient-reported factors including physician characteristics, practice setting and wait times. Experience scores were “generally high,” the authors noted, with more than 90% of respondents answering 5 of 5 on the four survey items. Gender was not associated with receiving a higher score for likelihood to recommend, nor physician friendliness, explanation or concern. But rating the wait time as “good” was the strongest independent predictor of higher experience scores, the authors noted.
Marshall et al. labeled this finding as “reason for optimism” around policy decisions that emphasize patient experience metrics.
“With the introduction of novel payment models that place increased focus on the patient experience, it is important to understand the determinants of these constructs to avoid inadvertently making changes that lead to biased reimbursement,” the authors advised. “Ultimately, bringing financial incentives into line with measures of quality and patient experience has the potential to increase the value of healthcare services, carrying benefits both for patients and for the health system as a whole.”
The findings come after another recent study determined that interventional radiologists scored highly on patient experience surveys, achieving scores similar to other physician types.
To read more, go to Radiology Business.
Q&A: What Updated Reimbursement Policies Could Mean for CT Lung Screening Rates in the United States
By Dave Fornell | March 11, 2022
Recent reimbursement rule changes for low-dose computed tomography (CT) lung screen scans are expected to help open up screening for more patients, according to the American College of Radiology (ACR).
The ACR recently released a detailed summary of the Centers for Medicare and Medicaid Services (CMS) National Coverage Determination related to screening for lung cancer with low-dose CT.
To find out more details on the changes and expansion of the program, Health Imaging interviewed Alicia Blakey, the ACR’s principal economic policy analyst.
Why are the CMS lung screening reimbursement changes important?
Alicia Blakey: We are really trying to increase screening uptake for lung cancer screening. Prior to these changes in the guidelines and the coverage updates, there was less than a 15% uptake rate for lung cancer screening in general. So we are definitely interested in raising awareness about the availability of the low-dose CT scans.
Can you explain more about the LDCT lung screening program and how the changes may help expand the number of patients who can be screened?
Alicia Blakey: The goal of screening is to detect disease at its earliest and most treatable stage of lung cancer, particularly in individuals who have a high risk of developing lung cancer, but do not have signs or symptoms. Lung cancer is the leading cause of cancer related deaths in the United States, and worldwide about 85% of lung cancer deaths occur in current or former cigarette smokers. This type of cancer is most commonly non-small cell lung cancer.
The ACR was interested when the United States Preventive Service Task Force (USPSTF) issued its final recommendations in March of 2021. We were excited with the changes, because they lowered the screening age and smoking pack per-year history. These changes will expand lung cancer screening to underserved populations, such as African American women and people who do not have a long history of smoking.
The ACR also was elated when we knew that this final recommendation would expand access to lung cancer screening for the commercial payers and also Medicaid expansion states. So as an action item and an urgent request of our membership, we reached out to Medicare to make sure that they update their national coverage determination to line up with the USPSTF current recommendation for lung cancer screening.
How has the patient population changed for LDCT lung screening?
Alicia Blakey: The screening population is the most important eligibility criteria within the changes. It is now recommended that patients younger than age 55 get screened by Medicare. We’ve gotten several questions from membership on how many patients fall within that category. When we think of Medicare, we think of age 65 and older, and there is actually a growing millions of Americans who could benefit from this screening update, due to disability status, as well as end-stage renal disease. So there is a need for Medicare to update its coverage.
Has the shared decision-making criteria for CT lung screening changed to now include nurse practitioners and nurse navigators?
Alicia Blakey: The other notable change is that in order to do low-dose CT scans, there was a shared decision making requirement, that each visit includes counseling on smoking sensation. The old policy stated you had to be a provider or a non-physician practitioner to offer the shared decision making visit. This has now been expanded to include other auxiliary personnel incidental to a physician’s professional service.
Many of the centralized lung cancer screening programs have a have nurse navigator who schedules the patient and makes sure they schedule appointments for follow up care. This is an annual test that does require you to come back each year. So those facilities that have a nurse coordinator or navigator role are now able to order low-dose CT scans. This is another benefit of expanding the eligibility criteria to make sure that we get more patients into the office to be scanned.
Do the new Medicare rules allow for outpatient imaging centers to perform low-dose CT lung screening?
Alicia Blakey: One other notable change that the ACR was excited about is that since 2015, low-dose CT scans that were performed in an independent diagnostic testing facility (IDTF) received denied claims for all scans. In the coverage update, CMS has removed imaging facility criteria that would have prevented IDTFs from performing low dose CT scans.
IDTFs should have been able to bill Medicare for low-dose CT scan since 2015, but there were some errors and administrative barriers that have now been removed. We hope these facilities will help with screening uptake as we try to reverse course back to pre-pandemic levels. There are a lot of patients that need to be scanned.
The American Cancer Society said in its latest stats for 2021, there will be 131,000 deaths due to lung cancer. So we have a big job ahead of us to improve access to this scan, and that includes allowing all facilities to perform this life saving preventive test.
To read more, go to Health Imaging.