Bipartisan Bill Aims to Boost Medicare Patients’ Access to Diagnostic Imaging Agents
By Marty Stempniak | March 2, 2023
Bipartisan members of the U.S. House have introduced legislation aimed at bolstering Medicare beneficiaries’ access to diagnostic imaging agents.
Currently, the federal payment program only reimburses for radiopharmaceuticals through a packaged system. But this can create a “significant barrier” for those who need newer nuclear imaging agents, advocates note.
The Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2023 would eliminate this obstacle by requiring HHS to issue a separate payment for imaging agents, using a per-day cost threshold of $500.
“As a practicing surgeon, I know firsthand how essential accurate testing and imaging diagnostics are—not only when screening for disease but also for evaluating treatment efficiency or monitoring disease progression,” Rep. Greg Murphy, MD, R-N.C., who introduced the bill on Feb. 27 alongside 14 other co-sponsors, said in a statement. “By appropriately paying for newer radiopharmaceuticals, the FIND Act improves access to advanced technology by more closely aligning reimbursement with procedure cost.”
Supporters note that the bill is budget-neutral and would help to improve access to imaging in the early stages of cancer, neurological disorders, and cardiovascular disease. Industry trade groups such as the Medical Imaging & Technology Alliance and the Council on Radionuclides and Radiopharmaceuticals expressed their support for the bill this week.
“Passage of the FIND Act will help to ensure that all Medicare beneficiaries have access to these precision diagnostic radiopharmaceutical drugs by addressing a longstanding Medicare reimbursement flaw which currently limits patient access,” Michael J. Guastella, executive director of the council, said March 1.
Members of Congress also have previously introduced versions of the FIND Act, including in 2021. A year ago, numerous organizations—among them, the American College of Radiology and American Society of Neuroradiology—urged congressional committees to hold hearings to consider the legislation.
To read more, go to Radiology Business.
6 Ways Radiologists Can Use ChatGPT
By Jessica Kania | March 1, 2023
From passing medical school exams to publishing articles in academic journals, it’s no secret that ChatGPT is taking the medical world—and the world at large—by storm. While that’s sparked some concerns about the right balance of using AI in medicine, it’s also opened up a whole new world of opportunities for radiology practices that take pride in being on the cutting-edge of technology.
In a Feb. 28 paper for Diagnostic and Interventional Imaging, the authors—who reveal that ChatGPT itself wrote most of the paper—explore ways that radiologists can use ChatGPT. They largely focus on academic writing, but also note some practical ways for reading radiologists to capitalize on the AI-powered tool’s abilities. 
Here, we highlight and expand upon possible ways that all types of radiologists can use ChatGPT: to research and write academic papers, enhance clinical decision-making, and improve patient communication and care.
ChatGPT for clinical radiologists
Implement ChatGPT as a chatbot for patient inquiries.
One of ChatGPT’s most groundbreaking abilities is its natural language processing, which allows it to skillfully handle text-based chat sessions and respond with natural-sounding language.
Practices can consider putting a chatbot on their website to be a “first line of defense” when fielding patient inquiries (which requires the right plugin and may take some technological prowess to get it right). The paper’s authors note that ChatGPT can answer questions about medical procedures and examinations (“How should I prepare for an MRI? Can I get a CT scan while I’m pregnant?), results, and follow-up recommendations. Additionally, practices can even train a chatbot to answer questions about the practice, such as opening hours, contact numbers, and fees.
If successful, staff can spend less time answering emails or phone calls and more time focusing on patient care.
To read more, go to Radiology Business.
2021 Medicare Policy Changes Dragged Down Radiologist Pay, New Study Confirms
By Marty Stempniak | February 28, 2023
As members of the specialty feared, 2021 Medicare policy changes appear to have dragged down radiologist pay, according to a new study published Tuesday in JAMA .
The Centers for Medicare & Medicaid Services made the recent modifications in a bid to redistribute reimbursement from procedural specialists to primary care. Among nearly 181,000 physicians included in the study, repricing of 2020 Medicare services led to a 3.3% drop in reimbursement for the median radiologist (or about -$4,557), assuming year-over-year patient volumes stayed constant.
Meanwhile, family physicians saw the largest positive change at 11% (or $3,683). But the changes were not enough to meaningfully narrow the payment gap between PCPs and specialists, Hannah Neprash, PhD, with the University of Minnesota School of Public Health, and co-authors concluded.
“In part this is because many non-primary care specialties provided many E/M services and had opportunities to increase coding intensity,” the study noted. “Nevertheless, specialties that provided fewer E/M services, such as radiology and general surgery, did see payment declines.”
To reach their conclusions, Neprash et al. performed a retrospective, observational analysis of office-based physicians in specialties with 5,000 or more members billing Medicare. Those who met the study criteria also had 50 or more fee-for-service Medicare visits both before and after the E/M policy change. To ensure an apples-to-apples comparison, the team simulated payment amounts, assuming no changes in volume or service mix. Authors also analyzed the extent to which relaxing documentation rules possibly altered billing patterns across specialties.
Most physician specialists in the study absorbed an increase in total Medicare payments between the period before (July to December 2020) and following (July to December 2021) the E/M update. Family practitioners (12%) and otolaryngologists (9.9%) experienced the largest gains, while the median physicians in general surgery (-4.2%) or radiology (-2.1% or $1,927) recorded the largest drop. Almost every physician type in the analysis (including radiology) saw a concurrent increase in E/M coding intensity following the policy change, the authors noted. (However, the 25th percentile of radiologists billed 0% of their E/M visits at level 4 or 5, the highest intensity of services.)
“Nearly all specialties took advantage of the eased documentation requirements, billing more intense E/M services in 2021 compared with 2020,” Neprash et al. wrote. “While family practice specialists were in the top five specialties with large increases in coding intensity, coding intensity increased more for the median psychiatrist, orthopedic surgeon, urologist and otolaryngologist.”
To read more, go to Radiology Business.
Bailed Out by Taxpayers: Data Shows Big Insurance Profiting Massively from Medicare Privatization
By Jake Johnson | February 28, 2023
A new analysis released Monday shows that insurance giants are benefiting hugely from the accelerating privatization of Medicare and Medicaid, which for-profit companies have infiltrated via government programs such as Medicare Advantage.
According to the report from Wendell Potter, a former insurance executive who now advocates for systemic healthcare reform, government programs are now the source of roughly 90% of the health plan revenues of Humana, Centene, and Molina.
Over the past decade, Potter found, the seven top for-profit insurance companies in the U.S.—the three mentioned above plus UnitedHealth, Cigna, CVS/Aetna, and Elevance—have seen their combined revenues from taxpayer-backed programs soar by 500%, reaching $577 billion in 2022 compared to $116.3 billion in 2012.
“The big insurers now manage most states’ Medicaid programs—and make billions of dollars for shareholders doing so—but most of the insurers have found that selling their privately operated Medicare replacement plans is even more financially rewarding for their shareholders,” Potter wrote. “In addition to their focus on Medicare and Medicaid, the companies also profit from the generous subsidies the government pays insurers to reduce the premiums they charge individuals and families who do not qualify for either Medicare or Medicaid or who work for an employer that does not offer subsidized coverage.”
Potter noted that the top insurance giants, a group he dubbed the Big Seven, now control more than 70% of the Medicare Advantage market, which has grown rapidly in recent years. According to the Kaiser Family Foundation, more than 28 million people were enrolled in a privately run Medicare Advantage plan last year—nearly half of the Medicare-eligible population.
An ardent critic of Medicare Advantage, Potter said in an interview with The American Prospect on Monday that the program “is a big contributor to the excessive spending” in Medicare.
“It needs to be ended,” Potter, executive director of the Center for Health and Democracy, said of Medicare Advantage, whose major players frequently overbill the federal government and deny patients necessary care. The program is run by private insurers with government money.
In his analysis, Potter observed that Medicare Advantage enrollment among the Big Seven increased 252% between 2012 and 2022.
To read more, go to Salon.com.
CMS Says Surprise Billing Arbitration Can Resume for Some Disputes – Others Remain on Pause
By Samantha Liss | February 27, 2023
Arbiters can resume resolving payment disputes between providers and payers involving cases in which care was delivered prior to Oct. 25, the CMS said Friday.However, the arbitration process to is still on hold for disputes regarding services delivered on or after that date, following a federal judge’s decision earlier this month.The CMS is continuing to work on new guidance in light of the February decision that ruled against the government’s implementation of the surprise billing ban and threw a wrench in the third-party process to resolve payment disputes.Dive Insight:The federal government’s ban on surprise bills took effect at the start of 2022 in effort to protect patients from being stuck with hefty medical bills when providers and payers fail to agree to pricing terms.
To remove patients from being stuck in the middle, the law set up a process for how providers and payers can resolve pricing disputes. Unable to come to pricing terms, payers and providers both submit one offer to a third party, known as an arbiter, who is then supposed to select one offer.
But how the federal government chose to implement that process has generated numerous lawsuits, especially from providers who allege that it unfairly benefits insurers.
The Texas Medical Association has filed suit multiple times over the implementation of the No Surprises Act. A federal judge in Texas has sided with TMA twice in separate lawsuits brought by the medical association.
The central issue in both cases is how much arbiters should rely on a metric known as the qualified payment amount, or the median in-network rate, when resolving pricing disputes.
The judge first sided with the TMA last February and said it was unlawful for the government to instruct arbiters to start with the “presumption” that the qualifying payment amount, or QPA, is the correct payment amount.
As a result of the ruling, regulators went back and nixed the “presumption” language from the final instruction to arbiters.
It still wasn’t enough, as Judge Jeremy Kernodle said in his latest ruling that regulators, “have not relinquished their goal of privileging the QPA, tilting arbitrations in favor of insurers, and thereby lowering payments to providers.”
The latest ruling has disrupted the arbitration process as regulators head back to the drawing board to come into compliance with Kernodle’s most recent opinion.
Meanwhile, the federal government said it has been inundated with requests from providers seeking to enter arbitration since it opened the arbitration portal.
To read more, go to Healthcare Dive.
Proposed Bills in Several States Would Bolster Coverage for Breast Imaging Services
By Marty Stempniak | February 26, 2023
Bills across several states would bolster coverage for breast imaging services, cancer care advocates announced recently.
The Susan G. Komen organization has lobbied for the proposals and recently touted them in a series of separate announcements. States impacted would include Oregon, Montana, Kentucky, Kansas, Tennessee, Arizona, California, Florida, and Maryland, the Dallas-based group has highlighted throughout the month of February.
In Wisconsin alone, nearly 5,500 individuals will be diagnosed with breast cancer this year while 720 will die, Susan G. Komen said in a Feb. 23 announcement.
“This legislation can make an immediate impact for thousands of people who require diagnostic or supplemental breast imaging yet are unable to afford it and often forego the tests,” Molly Guthrie, VP of policy and advocacy at Susan G. Komen, said in a statement announcing the Badger State proposal, with the same quote used in several others. “Everyone should be able to access the care they need and afford it, especially when it could mean the difference between a person’s life and death.”
Guthrie and colleagues said these bills will help to eliminate out-of-pocket costs for medically necessary breast imaging. One recent study commissioned by the group found that patients pay anywhere from $234 for a diagnostic mammogram to over $1,000 for a breast MRI.
To read more, go to Radiology Business.