Radiology Digest – March 19, 2021

March 23, 2021

Radiology Digest: News from the week of March 19, 2021.

‘Medicare for All’ Introduced with Support of Key House Members

By Jessie Hellman | March 17, 2021 | Included in Radiology Digest – March 19, 2021

Members of the House of Representatives’ Congressional Progressive Caucus rolled out their plan for a single-payer healthcare system Wednesday with the support of more than half of the Democratic caucus, including two key committee chairmen.

Rep. Pramila Jayapal (D-Wash.), chair of the CPC, reintroduced “Medicare for All” Wednesday, a proposal unlikely to pass this year but that sets the debate among Democrats and Republicans over how best to reform the healthcare system.

It would dramatically reshape the entire U.S. healthcare system, creating a national plan where all Americans get insurance and making private insurance obsolete.

While Jayapal conceded Medicare for All will be a long-term effort, she said she is pushing “very hard” for “foundational” pieces of the legislation to be included in the next reconciliation bill Democrats are expected to pass later this year, including provisions lowering the Medicare eligibility age, establishing a public option, allowing the government to negotiate the prices of drugs covered by Medicare.

Jayapal said the need for her proposal is underscored by the COVID-19 pandemic, which triggered record-high layoffs and insurance losses for millions of Americans who get coverage through work.
The pandemic has inspired more Democrats to sign on to the bill, Japayal said, including Energy & Commerce Committee Chairman Frank Pallone (D-N.J.) and Education & Labor Chairman Bobby Scott (D-Va.) who have both vowed to hold hearings on the proposal this year.

To read more, go to Modern Healthcare.

Amazon Jumps into Healthcare with Telemedicine Initiative

March 17, 2021 | Included in Radiology Digest – March 19, 2021

Amazon is making its first foray into providing healthcare services, announcing Wednesday that it will be offering its Amazon Care telemedicine program to employers nationwide.
Currently available to the company’s employees in Washington state, Amazon Care is an app that connects users virtually with doctors, nurse practitioners and nurses who can provide services and treatment over the phone 24 hours a day. In the Seattle area, it’s supplemented with in-person services such as pharmacy delivery and house-call services from nurses who can take blood work and provide similar services.

On Wednesday, the tech giant announced it will immediately expand the service to interested employers in Washington who want to purchase the service for their employees. By the summer, Amazon Care will expand nationally to all Amazon workers, and to private employers across the country who want to join.

In the Baltimore, Washington, D.C., and northern Virginia market, where Amazon is building a second headquarters that will house more than 25,000 workers, Amazon Care will include the in-person services that are currently limited to Seattle.

“Making this available to other employers is a big step,” said Amazon Care Director Kristen Helton in a phone interview. “It’s an opportunity for other forward-thinking employers to offer a service that helps bring high-quality care, convenience and peace of mind.”

Amazon launched the service 18 months ago for its Washington state employees. Helton said users have given it superior reviews, and business customers were inquiring about being able to buy into the service for their own workers.

Helton said the product is designed to be a supplement or an additional benefit to existing coverage provided by an employer.

Consumer demand for telemedicine and virtual healthcare has exploded during the pandemic. Stephen Morgan, a medical professor at Virginia Tech and chief medical information officer at the Carilion Clinic in southwest Virginia, said virtual visits increased there from about 100 a month before the pandemic to about 800 a day within a two-week span.

To read more, go to Modern Healthcare.

American Board of Radiology to Require Side-view Cameras for Future Remote Exams

By Marty Stempniak | March 16, 2021 | Included in Radiology Digest – March 19, 2021

With more than 1,500 physicians taking the American Board of Radiology’s virtual exams this year, the group is making a key change starting next month.

The Tucson, Arizona-based doc-certification nonprofit announced Monday that test takers will need to have side-view cameras on their computers beginning on April 15. ABR said the change became necessary after problems with recording exams while using old testing technology from higher education.

“It became clear that these tools, while very reasonable for colleges and universities, create stress in a high-stakes environment (because of, for example, standard methods for tracking eye movement),” the ABR said in an update posted March 15.

Candidates have one month to make the switchover away from standard, front-facing web cams. To help defray the cost, ABR is crediting candidates $40 toward future fees, which it will apply in early 2022.

To read more, go to Radiology Business.

MedPAC: Imaging Use, Charges Continued to Stay Steady

By Kate Madden Yee | March 16, 2021 | Included in Radiology Digest – March 19, 2021

That being said, it’s difficult to overstate what dramatic effect the pandemic has had on Medicare beneficiaries and on MedPAC’s ability to make recommendations to Congress for 2022, noted commission Executive Director Jim Mathews, PhD, in a teleconference.

“Here we are at the beginning of 2021, having gone through most atypical years in my memory in terms of changes in the provision of healthcare in the Medicare system,” Mathews said. “We hope that by 2022, the pandemic will be fading in the rearview mirror, [but in the meantime,] we’ve tried to separate the temporary effects of pandemic from its longer-lasting ones, even though our crystal ball isn’t any clearer than anyone else’s.”

In any case, the commission is not recommending any payment updates for 2022, it said.

“The Commission’s deliberations on payment adequacy for clinicians are informed by data assessing beneficiaries’ access to services, the quality of their care, and Medicare payments and providers’ costs,” it wrote. “We find that, on the basis of these indicators, there should be no update to payment rates in 2022.”

Middle of the pack
The report found that Medicare payments per beneficiary are growing, but imaging continues to run in the middle of the pack in terms of growth in spending by type of service. The commission found the following allowed charge growth between 2018 and 2019 across a range of services:
• Anesthesia, 2.6%
• Evaluation and management services, 2.9%
• Imaging, 3.5%
• Major procedures, 5.1%
• “Other procedures” (which includes services such as radiation oncology, dialysis, chiropractic, chemotherapy, and physical and occupational therapy), 5.6%
Imaging also didn’t stand out in terms of its share of overall percentages of allowed charges in Medicare. Imaging made up 11% of charges, after evaluation and management (50%) and other procedures (23%), MedPAC reported.

To read more, go to Aunt Minnie.

ACR Slams JAMA Mammography Study, Editorial Over ‘Outrageous and Insulting’ Claims

By Marty Stempniak | March 15, 2021 | Included in Radiology Digest – March 19, 2021

The American College of Radiology slammed new JAMA research and a corresponding editorial on Monday over “outrageous and insulting” claims related to breast imaging.
In a research letter published March 15, Weill Cornell Medicine scientists estimated that 87% of specialized breast cancer centers in the U.S. provide screening recommendations that differ from national societies. That included an average start date of 40 years, with 81% of centers advising annual screening.

Only about 12% of breast cancer centers highlighted the importance of shared decision-making between a woman and her primary care doc. In a corresponding editorial University
of California, San Francisco, experts criticized these findings and breast imaging providers for operating based on “nonevidence-based” guidelines.

“The recommendation for annual mammography in women younger than 50 years is, at best, confusing for patients and is likely to conflict with advice from their primary care physicians, which can create tension,” Anand Habib, MD, a resident physician in internal medicine at UCSF, and colleagues wrote March 15. “This recommendation can also produce unnecessary testing, invasive procedures, overdiagnosis and anxiety among women who receive screening. Breast cancer centers with clear financial benefits from increased mammography rates may wish to reconsider offering recommendations that create greater referral volume but conflict with unbiased evidence-based USPSTF guidelines and have the potential to increase harms among women,” he and co-authors added.

ACR shared its own response to the editorial and research on Monday, condemning the new JAMA content. The college believes the original research letter was based on “serious omissions of fact.”
“The claim that facilities offering mammograms to women ages 40 and older are operating counter to recommendations of ‘national societies’ is misleading at best,” ACR said. “Also, to assert that financial incentives may be driving local site screening recommendations—with no evidence to back the claim—is outrageous and insulting to the medical professionals working to save lives from the nation’s second leading cancer killer in women.”

The college further noted that it, alongside the Society of Breast Imaging and American Society of Breast Surgeons, all recommend that women start receiving annual mammograms at age 40. And the American College of Obstetricians and Gynecologists recommends women also begin at 40 and get tested every 1-2 years.

To read more, go to Radiology Business.

CPT Code Blunders Cost One Radiology Practice More than $20K Per Month, New Analysis Shows

By Matt O’Connor | March 15, 2021 | Included in Radiology Digest – March 19, 2021

Delays in adopting new current procedural terminology codes cost one academic radiology practice hundreds of thousands of dollars in revenue, according to a new analysis.
Each year, the American Medical Association elects an editorial panel to audit CPT codes and institute necessary edits. While effective coding is crucial to physician billing practices, it’s well-known that many radiologists and other specialty providers fall short in this area.

And for one large radiology organization, education and communication lapses in reporting new moderate sedation codes resulted in losses of upwards of $21,000 per month over a 17-month period.
Taking this hit to the bottom line should serve as a warning for other organizations, Duke University researchers wrote March 13 in Current Problems in Diagnostic Radiology.

“While today many practices have undoubtedly adjusted to moderate sedation coding changes, this work highlights the critical importance of adopting preventative and preparative strategies to effectively transition coding and billing operations after CPT coding paradigms are altered,” corresponding author Jonathan G. Martin, MD, with Duke Health’s Department of Radiology, and colleagues added.
For their findings, the team collected billing and reimbursement data between January 2017 to the end of April 2019. They specifically compared moderate sedation code reporting to the number of radiology-performed procedures during the 28-month study period. In 2017, the AMA implemented a coding change unbundling moderate sedation from procedural codes, creating a new separate set of billable codes with “significant” financial effects, the authors explained.

Upon analysis, Martin et al. found the practice did not adequately achieve appropriate coding until June 2018, amounting to a nearly 17-month delay in implementation.
In 2017—when the change went into effect—MS was reported with 2.5% of cases, they explained. That figure jumped to 47.8% in 2018 and 69.1% in 2019. All in all, however, the failures resulted in a $363,069 (± $67,065) loss of procedural revenue, according to the group’s root cost analysis.

And what drove the delays? Lags in education and coordination at multiple points along the reporting chain, among other problems, Martin and co-authors found. Longer lead times and earlier meetings would have been beneficial, as would have adjusting report templates prior to coding changes.

Taking these precautions will be particularly important as practices contend with the U.S. Centers for Medicare & Medicaid Services’ planned 2021 changes to evaluation and management (E/M) coding that’s projected to lower overall radiology payments, Martin and colleagues explained.

To read more, go to Health Imaging.

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