Radiology Lost $627M in Anticipated Medicare Payment During 2020’s First Half
By Marty Stempniak | March 4, 2021
Diagnostic radiology sustained a roughly $627 million or 22% drop in anticipated Medicare reimbursement during the first half of 2020 due to COVID-19, according to a new analysis published Wednesday.
Across all physician types, the cumulative decrease in physician services spending totaled $9.4 billion (19%) as stay-at-home orders and virus fears kept people away from the healthcare sector. Coupled with increased expenditures on protective equipment and other coronavirus-related costs, physicians are in a perilous position, the AMA said.
“The economic impact of the COVID-19 pandemic has placed significant financial stress on medical practices as expenses have spiked and revenues have dropped,” AMA President Susan Bailey, MD, said March 3. “For practices that have struggled to remain viable as the pandemic stretches on, many will face a difficult and precarious road to recovery.”
For the report, AMA chief economist Kurt Gillis, PhD, analyzed Medicare claims data exclusive to physician services in 2020. He found that spending for imaging, procedures and tests continued plummeting into mid-April, dropping upward of 70% below anticipated 2020 spending. By the end of June, imaging and evaluation and management payments were still down 10%, researchers noted.
Based on historical trends, diagnostic radiology Medicare spending should have hit $2.795 billion in 2020’s first half but landed at $2.168 billion instead. Imaging certainly was not alone, as Medicare’s actual allotment toward physician services dropped across all service types, settings, specialties or states, Gillis reported. Physical therapists saw the biggest decrease in expected over actual Medicare pay at $706 million (34%), while New York was the hardest hit state, with physicians there losing $964 million (27%) between January and June.
Senate Votes to Open Debate on Biden’s $1.9 Trillion Coronavirus Relief Bill
By Erica Werner, Jeff Stein and Tony Romm | March 4, 2021
Democrats Move Forward Without GOP Support After Flurry of 11th-hour Negotiations.
The Senate voted Thursday to open debate on President Biden’s $1.9 trillion coronavirus relief bill, as Democrats moved forward with no GOP support after failing
to win over a single Republican senator on the new president’s first major legislative initiative.
The vote was 51 to 50, with Vice President Harris breaking the 50-to-50 tie. GOP unity against the procedural motion suggested that no Republican will vote in favor of the legislation on final passage, which will come after hours of debate and an amendment free-for-all that could drag into the weekend.
Once it passes the Senate, the legislation will have to go back to the House for final approval before being sent to Biden’s desk for his signature. House Speaker Nancy Pelosi (D-Calif.) has guaranteed the House will pass the Senate’s version of the bill, despite some changes that liberals dislike, including narrowing eligibility for $1,400 relief checks and excluding a $15 minimum wage.
To read more, go to The Washington Post.
CMS Finally Relents After Decade of Not Covering PET Imaging for Infection, Inflammation
By Marty Stempniak | March 3, 2021
The Centers for Medicare & Medicaid Services has relented after more than a decade of not covering PET imaging for infections and inflammation, advocates announced on Monday.
It was back in 2008 that the federal agency decided not to reimburse for this exam, citing scant evidence at the time. The Society of Nuclear Medicine & Molecular Imaging has crusaded to change the policy ever since. Back in December, federal officials revoked the noncoverage policy, which took effect on Jan. 1.
“This is an exciting development for patients and physicians across the U.S.,” SNMMI said in a March 1 announcement. “PET is an effective way—often the best way—to understand certain infections and inflammatory conditions and to provide earlier and better-informed diagnoses. in fact, it has become the standard of care for a number of conditions.”
The society said CMS’ decision has “severely” limited use of positron emission tomography for these conditions over the past dozen years. Following the change, local Medicare Administrative Contractors will now make determinations for PET imaging of patients with infections and inflammation.
SNMMI, the American College of Radiology and others are now working to inform MACs about the policy and urge coverage, according to the announcement. The nuclear medicine group also plans to approve new appropriate use criteria for PET imaging in these clinical scenarios.
To read more, go to Radiology Business.
House Passes $19.T COVID-19 Relief Package That Temporarily Boosts ACA Subsides, Expands Medicaid
By Robert King | February 27, 2021
The House passed an enormous $1.9 trillion COVID-19 relief package that boosts subsidies for Affordable Care Act plans and gives money for vaccine distribution.
The 219 to 212 vote early Saturday morning now sends the package to the Senate. While the package includes some key healthcare items, it does not include any new money for a provider relief fund created by the CARES Act to help plug financial holes caused by the pandemic.
Hospital groups are already lobbying the Senate in hopes of changing that. The American Hospital Association (AHA) is pressing to get $35 billion added to the package.
A key part of the package is a temporary two-year increase in the subsidies for plans sold on the ACA’s exchanges.
If signed into law, individuals making income 400% above the federal poverty level would pay 8.5% of their income on healthcare. Currently, consumers making above 400% are not eligible for any subsidies.
Lower-income customers who also make 150% above the poverty level can now get fully subsidized coverage. Currently those eligible customers pay no more than 4.3% of their income on healthcare.
The legislation also gives premium assistance to cover 85% of the COBRA continuous coverage for eligible individuals and families through Sept. 31. The boost comes as the pandemic has caused major job losses.
There are also several provisions aimed at expanding Medicaid coverage.
It would add a five percentage point increase for two years to the state’s base federal matching rate if the state expands Medicaid under the ACA. So far there are 12 states that have not expanded Medicaid.
The legislation would get rid of a cap on Medicaid drug rebates starting in 2023.
The Centers for Disease Control and Prevention would also get $7.5 billion to promote and administer COVID-19 vaccines.
Democrats are using a parliamentary procedure called reconciliation that lets a budget bill pass the Senate with a simple majority and avoid garnering 60 votes needed to break a filibuster.
Hospital and other provider groups are directing their lobbying efforts to the Senate to add more money to a $178 billion relief fund. The AHA estimated on a call earlier this week that the fund has about $4.4 billion left to give out to providers, who have faced lower revenue due to dropping patient volumes.
To read more, go to Fierce Healthcare.
Radiologists Urge Congress to Pause Medicare Sequester Cuts Until After Public Health Crisis
Marty Stempniak | February 26, 2021
Radiologists and other physicians are urging Congress to enact legislation that would pause Medicare sequester cuts until the public health crisis ends.
Lawmakers previously enacted a moratorium on the routine annual 2% reduction, but it is set to expire on March 31. U.S. Reps. Brad Schneider, D-Ill., and David McKinley, R-W.Va., however, have introduced legislation to prevent these cuts for the duration of the public health emergency. Groups including the American College of Radiology, American Society of Neuroradiology and Society of Interventional Radiology are asking congressional leaders to move forward with the bill.
“We are deeply concerned that persistently high COVID-19 rates will continue to stress the entire healthcare system, especially physician practices,” the American Medical Association wrote in a Feb. 12 letter cosigned by the three imaging groups. “To help alleviate the unrelenting fiscal demands of the pandemic, we strongly urge Congress to pass legislation that would extend the congressionally enacted moratorium on Medicare sequester cuts through the duration of the public health emergency.”
Congress previously delayed sequestration as part of the Consolidated Appropriations Act passed in December. But the extension is set to end on March 31. Schneider and McKinley believe reducing physician pay amid continued COVID flare-ups makes little sense.
“Our healthcare professionals report growing burnout and hospitals are experiencing decreased revenue as more are forced to stop elective procedures,” Schneider said in a statement. “Reinstating across the board cuts to our providers now would create unnecessary burdens at the worst possible time.”
Meanwhile, the COVID-19 public health emergency is set to also end at the end of March after former Health and Human Services Secretary Alex Azar signed an extension in January. Acting HHS Secretary Norris Cochran has indicated that the declaration may remain in place for the duration of 2021.
ACR alerted members about the issue in a Wednesday update, noting that it joined AMA in the fight to “to ensure patients retain access to high-quality imaging services.”
To read more, go to Radiology Business.