AMA Commends MedPAC for Move to Recognize Costs of Practicing Medicine
March 15, 2023
For the first time, the Medicare Payment Advisory Commission (MedPAC) today called for a physician payment update tied to the Medicare Economic Index (MEI). The American Medical Association (AMA) has long championed this move and appreciates MedPAC’s acknowledgement that the current Medicare physician payment system is inadequate—a critical first step toward the larger, necessary work of reforming Medicare to make it more rational and serve patients better.
In the face of inflation, the COVID pandemic, and growing costs of running a medical practice, physicians have struggled to keep open their doors, jeopardizing access to care, particularly in rural and underserved areas. Not only have Medicare payments failed to respond adequately, but physicians saw a 2% payment reduction for 2023, creating an additional challenge at a perilous moment.
“Having surveyed the health care landscape, MedPAC recognized that physician pay has not kept up with the cost of practicing medicine. Yet, we feel strongly that an update tied to just 50% of MEI will cause physician payment to chronically fall even further behind increases in the cost of providing care. Congress should adopt a 2024 Medicare payment update that recognizes the full inflationary growth in health care costs,” said AMA President Jack Resneck Jr., M.D.
“As one of the only Medicare providers without an inflationary payment update, physicians have waited a long time for this change. When adjusted for inflation, Medicare physician payment has effectively declined (PDF) 26% from 2001 to 2023. These increasingly thin or negative operating margins disproportionately affect small, independent, and rural physician practices, as well as those treating low-income or other historically minoritized or marginalized patient communities. Our workforce is at risk just when the health of the nation depends on preserving access to care.
Medicare reform is a central plank in the AMA Recovery Plan for America’s Physicians.
Also today, the AMA and 134 other health organizations—representing 900,000 physicians and tens of millions of Medicare patients—wrote congressional leaders, telling them that a full inflation-based update is “the principal legislative solution to the ongoing problems plaguing the Medicare Physician Fee Schedule.”
The letter notes that Congress has passed stopgap measures in the past few years to mitigate threats to Medicare physician payments. Yet, practice costs have outpaced those efforts. The gap between frozen physician payment rates and rising medical practice costs due to inflation will continue to widen. A permanent solution is needed to avoid this annual panic and legislative chaos.
To read more, go to AMA’s website.
AMA Pressures Federal Government to Fix Prior Authorization Problem Plaguing Radiology
By Marty Stempniak | March 15, 2023
The American Medical Association is increasing its pressure on the federal government to fix a prior authorization process that has plagued radiology and other medical specialties.
AMA on Monday released new survey data, which found that 89% of providers polled believe that this tactic used by health insurers has had a negative impact on care. Just last month, AMA and nearly 120 physician groups (including two in radiology) urged the Centers for Medicare & Medicaid Services to address this utilization-management tactic they believe is hindering the healthcare system.
“Health plans continue to inappropriately impose bureaucratic prior authorization policies that conflict with evidence-based clinical practices, waste vital resources, jeopardize quality care, and harm patients,” dermatologist and AMA President Jack Resneck Jr., MD, said in a March 13 statement announcing the survey results. “The byzantine system of authorization controls is rife with opportunities for reform and the AMA continues to work with federal and state officials on legislative solutions to reduce waste, improve efficiency and protect patients from obstacles to medically necessary care.”
Monday also was the deadline to submit comments to CMS on a proposed rule to speed up the prior authorization across Medicaid, Medicare Advantage and Affordable Care Act marketplace plans. Beginning in 2026, the rule would force payers to respond to prior authorization requests within a week (rather than 14 days) and 72 hours if the healthcare service is urgent, Kaiser Health News reported March 13. AMA highlighted its own 62-page comment letter on the rule, submitted Monday.
A total of 1,000 practicing physicians responded to the recent survey, including 600 specialists. About 94% said that prior authorization results in care delays, including 14% who said “always,” 42% who said “often” and 37% who said “sometimes.” Another 80% of medical doctors surveyed said that prior authorization can at least sometimes lead to patients abandoning their recommended course of treatment.
The Kaiser report highlighted instances where prior authorization policies directly impacted individuals seeking imaging. Paula Chestnut, for example, received an X-ray prior to hip surgery, which unearthed irregularities in her chest. A specialist in Los Angeles recommended an MRI to assess further, but her health insurer labeled the scan as medically unnecessary and refused to cover it. She later died in the hospital after a large tumor was discovered in her chest.
Amid pressure from patients and providers, some payers are responding. UnitedHealthcare, for one, has halved its number of prior authorizations in recent years, including cutting back the need to obtain permission for certain MRIs, CT scans and other diagnostic procedures, the KHN report noted. Radiologists face the heaviest burden from prior authorization, behind only radiation oncology and cardiology, a recent JAMA Health Forum analysis found.
To read more, go to Radiology Business.
Google Ups Activity in 4 Reaches of Healthcare AI
By Dave Pearson | March 14, 2023
Along with expanding research into large-language models to rival OpenAI’s ChatGPT, the search-engine king is working on AI for improving maternal care, ultrasound access and tuberculosis screening.
Google announced the concentrations March 14 in an update posted by Greg Corrado, PhD, the company’s head of health AI, during its annual health event, the Check Up with Google Health.
“We’ve taken a ‘move slow and test things’ approach to prove efficacy, equity, helpfulness and safety above all,” Corrado writes.
In healthcare, he adds, “there is enormous potential for AI to augment diagnostic and treatment planning processes, especially through partnerships to help bring high-quality care to communities that need it most.”
Here’s what Corrado says Google is doing in each of the four healthcare AI realms it’s spotlighting at the Check Up 2023.
Medical large-language models. Google is investing R&D dollars to design applications that maintain the “utmost focus on safety, equity and bias to protect patient well-being,” Corrado shares.
Google’s latest chatbot aimed at informing providers as well as patients is Med-PaLM 2. As the name implies, it’s an updated iteration of Med-PaLM, which last year topped 60% on a quiz styled like a medical-licensing exam.
Corrado says Med-PaLM 2 has upped the ante, consistently supplying correct answers at an 85% clip.
“While this is exciting progress, there’s still a lot of work to be done to make sure this technology can work in real-world settings,” Corrado writes. “We look forward to working with researchers and the global medical community to close [the] gaps [we’ve identified] and understand how this technology can help improve health delivery.”
AI-assisted ultrasound. Google is partnering with Kenya-based Jacaranda Health to train sub-Saharan healthcare workers in the use of maternal-fetal sonography for at-risk women and preborn babies. Concurrently the companies are developing AI tools to support point-of-care ultrasound (POCUS) for this population.
Meanwhile Google is collaborating with a hospital in Taiwan to bring AI-aided breast cancer screenings to Taiwanese women, including those with dense breast tissue, Corrado reports.
“In recent years, sensor technology has evolved to make ultrasound devices more affordable and portable, but many low-resource areas have a shortage of ultrasound specialists,” he points out. “To help bridge this divide, we’re building AI models that can help simplify acquiring and interpreting ultrasound images to identify important information like gestational age in expecting mothers and early detection of breast cancer.”
To read more, go to Health Exec.
Patient Access to Medical Imaging Varies by Zip Code
By Will Morton | March 14, 2023
Patients in the U.S. living in socioeconomically disadvantaged areas — as defined by zip codes — face barriers preventing them from timely access to imaging services, according to a study published March 14 in Radiology.
A group led by Dr. Anand Narayan, PhD, of the University of Wisconsin-Madison, explored the effects of extreme neighborhood deprivation on access to advanced imaging facilities and found that people living in socioeconomically disadvantaged areas have less access.
“If we as a community want to improve overall access to recommended imaging services, it is critical that we incorporate rural perspectives, particularly as many academic radiology departments are centered in urban or suburban areas,” Narayan said, in statement released by the RSNA.
Lack of access to high-quality imaging facilities can lead to delayed or missed diagnoses and further exacerbate health disparities experienced by people who live in communities with fewer resources, according to the authors.
To assess imaging discrepancies, Narayan’s team used the Area Deprivation Index (ADI), a tool originally developed in the 1980s by the Health Resources and Services Administration and now maintained and updated by the University of Wisconsin. It measures the level of socioeconomic disadvantages of a region using 17 census-based metrics, such as income, education, and housing quality.
To read more, go to Aunt Minnie.
Past-Due Medical Debt Impacts Over 1 in 7 Adults
By Jacqueline LaPointe | March 14, 2023
More than one in seven nonelderly adults live in families with past-due medical debt, according to the Urban Institute in a new report.
The report also finds that medical debt particularly impacts low-income families. Nearly two-thirds of adults affected by past-due medical debt have incomes below 250 percent of the federal poverty line, the Urban Institute gleaned from June 2022 data from its Health Reform Monitoring Survey (HRMS).
More of the past-due medical debt is owed to hospitals, with nearly three-quarters of affected adults owing at least some debt to hospitals. More specifically, 28 percent of affected adults owed to hospitals only and 45 percent owed to hospitals and some other providers.
Adults with past-due medical debt to hospitals tended to owe more compared to those with non-hospital medical debt, the report also shows. Additionally, about 61 percent of adults with past-due medical bills to hospitals reported that a collection agency contacted them about the debt.
Under federal law, non-profit hospitals must establish financial assistance policies and provide charity care to eligible patients before attempting to collect patient financial responsibility. However, non-profit hospitals set their own charity care eligibility requirements and many patients who likely qualify per hospital policies do not receive charity care, the Urban Institute points out.
Furthermore, for-profit and public hospitals are not subject to federal laws about medical financial assistance. These hospitals can implement their own strategies for collecting patient financial responsibility, including using a collection agency, filing lawsuits against patients, and even garnishing their wages.
State lawmakers have recently gone after aggressive medical debt collection tactics. New York, for example, modified civil practice law last year to prohibit healthcare providers from placing liens on an individual’s primary residence or garnishing wages to collect medical debt.
The Biden Administration has also acknowledged the problem of medical debt and promised to protect consumers through several reforms, including requesting data from more than 2,000 providers to evaluate medical bill collection practices and financial assistance offerings.
The report from the Urban Institute finds that few adults experience the more aggressive medical debt collection tactics hospitals can use to get their money. Only about 5 percent of adults with hospital debt said a hospital filed a lawsuit against them, while 4 percent said hospitals had garnished their wages and 2 percent said hospitals had seized funds from a bank account.
More adults with past-due hospital debt (36 percent) said they worked out a payment plan. Meanwhile, about one-fifth of adults with past-due hospital bills received discounted care.
To read more, go to Revcycle Intelligence.
Senators Accuse Payers of Evading Price Transparency Rules
By Jakob | March 13, 2023
Two senators are asking CMS to address loopholes in its price transparency rule for payers that they say have allowed the industry to “evade accountability.”
“We are concerned that remaining technical loopholes have resulted in insurance companies publishing data that does not align with the intent of the CMS rule,” Democratic Sen. Maggie Hassan and Republican Sen. Mike Braun wrote March 6.
Since July 1, payers have been required by CMS to disclose in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for all covered items and services.
The lawmakers cited recent reports that say some payers have published data in confusing formats that omit important information. They also said the published data is “too large for anything but a supercomputer to process.” Because of those challenges, it’s difficult to compare health plans and researchers and employers have struggled to use the data to drive lower costs.
According to San Diego-based transparency data startup Turquoise Health, it would take 76,104 decades to count up all the data available in machine-readable files.
“Trying to locate a single provider in the [transparency in coverage] files is akin to trying to find a single word in a very large dictionary that isn’t in alphabetical order,” a January report from Georgetown University said.
“Experts have highlighted potential solutions, urging CMS to limit file sizes, create a standardized reporting template, reduce the frequency of reporting, and require a clear organizational system and standardized labeling,” the senators wrote.
The letter also urges CMS to conduct random audits of health plan data to ensure compliance and quality.
To read more, Becker’s Payer Issues.
American College of Radiology, Emergency Docs Release ‘Landmark’ Guidance on Incidental Findings
By Marty Stempniak | March 13, 2023
Professional societies representing radiologists and emergency physicians released “landmark” new guidance Monday for ensuring that actionable imaging findings are addressed in the ED.
Published Monday in the Journal of the American College of Radiology , the new white paper outlines four areas of consensus between the two specialties. Those include report elements and structure, communication of findings with both patients and other clinicians, and follow-up tracking systems.
More than 150 million patients visited U.S. EDs last year, with half of those encounters involving imaging, ACR and the American College of Emergency Physicians note.
Oftentimes, radiologists detect unexpected abnormalities in studies done for other purposes. But health systems frequently lack the processes to make sure that patients and providers follow through on such findings.Experts estimate that compliance for follow-up ranges from 29% to 77%, with potentially deadly consequences.
“Unlike other specialties, emergency physicians focus on addressing a patient’s possible life-threatening conditions and are less directly involved in follow-up care,” Susan E. Sedory, executive director and chief executive of ACEP, said in a statement.
“Partnerships at the national and local level can enhance information sharing to help ensure all patients receive the ongoing, quality care they need.”
The two societies formed a 15-member panel—with representatives from both specialties, patients and healthcare system leadership—to compile the white paper. They sought to build consensus around ways to address this issue, including conducting a two-part survey aiming to achieve 80% agreement. All involved stakeholders held discussions following the first round, and readministered questions that unearthed disagreements.
Experts noted that there was “particularly strong” consensus among all that this is a “system-level” issue. This means that any remedies would require much more than just the individual physician or patient actions to ensure that follow-up care is executed after a radiologist discovers something unexpected.
“Strong communication and collaboration between clinicians when addressing actionable incidental findings is key to providing optimal patient care and preventing adverse outcomes,” William T. Thorwarth Jr., MD, chief executive of ACR, said in the statement.
“The recommendations created by ACR and ACEP highlight a multispecialty effort between radiology and emergency medicine that aim to improve the reporting and communication of AIFs, which will ultimately benefit the patient.”
To read more, go to Radiology Business.