AHA: Electronic Prior Authorization Implementation Requires Testing
By Victoria Bailey | March 22, 2022
The American Hospital Association (AHA) has expressed support for electronic prior authorization processes but urged the Office of the National Coordinator for Health Information Technology (ONC) to fully develop and adequately test any solution before requiring health systems to comply with a new regulation.
In response to a request for information on electronic prior authorization standards, implementation specifications, and certification criteria, AHA submitted comments to ONC regarding the best way to approach automating the prior authorization process.
While health plans aim to validate the efficacy and safety of patient care through prior authorizations, the requirement can create delays in care for patients and increase administrative burden and burnout for providers.
Establishing a standardized electronic prior authorization process may help expedite care delivery and preserve resources. However, AHA has asked ONC to work with CMS to ensure that automating prior authorization will not exacerbate the current workload problems health systems are facing.
“In order to effectively update and create standard transactions without unduly burdening healthcare payment processes, regulators should approach potential changes judiciously,” AHA wrote. “Any substantial change in the technology and/or standards used in healthcare information exchange should be sufficiently tested to ensure functionality, analyzed to establish projected return on investment, and incorporated according to an appropriate glide path to minimize systematic disruption.”
The trade organization said it supports an end-to-end automated prior authorization process that integrates with clinician EHR workflow. Health plans vary on which methods of prior authorization requests and documents they accept—some plans accept electronic information while most plans and providers communicate via fax or telephone.
Electronic submission typically requires providers to use proprietary plan portals, which can be a lengthy process and reduces administrative efficiencies, AHA said. Transferring EHR information into payer portals can also lead to entry errors and subsequent denials.
Implementing an end-to-end automated process that incorporates EHR data would help clinicians overcome this barrier, the letter stated. Additionally, using EHR technology could help increase real-time access to patient information for clinicians during treatment planning.
AHA urged ONC to fully develop and test the proposed implementation guides for electronic prior authorization processes before rolling it out to the entire industry.
To read more, go to Revcycle Intelligence.
HHS Distributes $413M More in Provider Relief Funds
By Kara Hartnett | March 22, 2022
The Health Resources and Services Administration is distributing another $413 million from the Provider Relief Fund to more than 3,600 providers, the Health and Human Services Department announced Tuesday.
These Phase 4 allotments target smaller providers and include bonuses to those that treat Medicare, Medicaid and Children’s Health Insurance Program enrollees, HHS said in a news release.
Including this round, $12 billion of the $17 billion available under Phase 4 has been allocated, according to HHS. HRSA has processed 89% of Phase 4 applications it’s received since September. Recipients have until June 20, 2023 to spend the monies.
Healthcare providers have clamored for more assistance as the COVID-19 pandemic continues. The American Hospital Association asked Congress to set aside another $25 billion but lawmakers have not done so. The AHA also has complained that HRSA is not moving swiftly enough to deliver the funds Congress previously approved.
To read more, go to Modern Healthcare.
Biden Aides to Congress: Fund COVID Aid, Don’t Cut Budget
By March 22, 2022
Congress should provide the $22.5 billion President Joe Biden wants for continuing the battle against COVID-19 without cutting other programs to pay for it, senior administration officials said Monday.
And if Republicans continue to insist that additional federal efforts to combat the pandemic must be paid for by culling spending elsewhere, the GOP should specify what it wants to cut, the officials said.
The remarks came nearly two weeks after a new round of COVID-19 funding was pulled out of a $1.5 trillion government-wide measure after rank-and-file Democrats rejected cuts that party leaders had negotiated with Republicans to pay for it. Though Biden signed the overall bill into law, the deletion of the COVID-19 funds was a major setback for Biden and Democrats.
“Our concern right now is that we are going to run out of money to provide the types of vaccines, boosters, treatments to the immunocompromised, and others free of charge that will help to continue to battle” the pandemic, White House press secretary Jen Psaki said Monday.
Top House Democrats have said they believe they will have to find savings to pay for the additional spending to move legislation through Congress. The biggest hurdle would be in the Senate, where Democrats will need at least 10 GOP votes to reach the 60 votes needed to move most significant bills to passage.
The White House has said the government is running out of funds for vaccines, testing and treatments, even as Omicron variant BA.2, which is fueling a virus resurgence in Europe and Asia, is appearing increasingly in the U.S.
To read more, Modern Healthcare.
Breast Density Notifications Leave Many Women in the Dark, Survey Results Suggest
By Hannah Murphy | March 21, 2022
Letters notifying women of their breast density after mammographic screening miss the mark when it comes to health education, new survey results suggest.
Women with dense breasts have an increased risk of developing breast cancer during their lifetime and these findings can also mask suspicious lesions on mammograms, making it difficult for radiologists to detect some cancers. For this reason, many states have laws in place that require institutions to notify women of their breast density via written communication. While these materials are meant to inform women on the unique risks of having dense breasts, research indicates that the notifications might be leaving some in the dark.
“These notifications were developed with limited input and without extensive testing among women in the general population, and many are written at a high literacy level, often discordant with population literacy levels,” corresponding author Nancy R. Kressin, with the Department of Medicine at Boston University School of Medicine, and co-authors wrote. “Prior studies of women’s knowledge from and reactions to DBNs demonstrated racial/ethnic disparities. Low awareness of breast density, especially among racial/ethnic minority and socioeconomically disadvantaged women, supports the need for input from varied population groups.”
To better understand preferences pertaining to breast density communication, researchers at Boston University School of Medicine conducted a national telephone survey with 2,306 racially/ethnically and literacy diverse women, 61 of whom also participated in in-depth qualitative interviews.
They found that most women (80%) preferred learning about their breast density and accompanying risks from providers, rather than letters. These findings were more prevalent among Non-Hispanic Black women (85%) compared to Non-Hispanic White (80%) and Asian women (72%). The opposite was true for women with low literacy, who preferred written notification over personal communication. Women with high literacy most often favored learning of their results via an online portal.
To read more go to Health Imaging.
American College of Radiology Issues Call to Action to Stop ‘Dangerous’ Scope-of-practice Bills
By Marty Stempniak | March 21, 2022
The American College of Radiology issued a call to action Thursday, urging members of the specialty to help stop two “dangerous” scope-of-practice bills.
Lawmakers in Wisconsin’s House and Senate recently passed the “APRN Modernization Act,” sending the bill to Gov. Tony Evers for his final signature. Senate Bill 394 would “greatly expand” advanced practice registered nurses’ authority, allowing some to operate autonomously, ACR reported.
The Wisconsin Nurses Association has fought for the bill, arguing it will provide healthcare consumers with “quality, economical, safe and patient-focused care.” But ACR and other doc groups are asking physicians to speak up against it.
Meanwhile, Kentucky is advancing its own proposal to expand scope for advanced practice registered nurses. House Bill 354 would, among other things, eliminate the one-year practice requirement before an APRN could prescribe controlled substances under a collaborative agreement with a physician. ACR said the Kentucky Radiological Society also opposes the bill—which already advanced in the House—and urged docs to contact lawmakers to prevent passage in the Senate.
To read more, go to Radiology Business.
States Move Breast Cancer Screening Bills Forward
By Hannah Murphy | March 21, 2022
In Connecticut, the Senate is presenting a bill that would change the age at which insurance carriers are required to cover baseline mammographic screenings.
Senate Bill 358, which is set to be heard by the Joint Committee on Insurance and Real Estate, would lower the coverage eligibility age for baseline mammogram screening to 35-39 years old, and annual mammograms thereafter for women aged 40 and older.
The bill would also require carriers to cover yearly mammograms for women age 40 and younger who are considered to be at an increased risk of developing breast cancer during their lifetime. These guidelines include women who have a family history of breast cancer, have tested positive for BRCA1 or BRCA2 (or other variants that can increase cancer risk) or were treated for cancer with radiation therapy directed at the chest during childhood.
If women fall under any of these categories, or if they have dense breast tissue, carriers would be required to cover screening and diagnostic ultrasounds as well. The bill would also update language in the current statute that would guarantee coverage of breast tomosynthesis for women at high risk, which is especially important for women with dense breast tissue, as DBT screenings have been shown to increase cancer detection rates among those individuals.
The proposed act would take effect Jan. 1, 2023.
A similar bill in Oklahoma just passed the House of Representatives. House Bill 3504 would require carriers to cover diagnostic mammography, which would include breast MRI and ultrasound, and would also update language to include tomosynthesis in the definition of screening mammography.
To read more, go to Health Imaging.