AHA, AMA Ask HHS for COVID-19 Emergency Extension
By Maya Goldman | May 11, 2022
Leading healthcare organizations want the federal government to maintain its pandemic posture for at least a few more months, they wrote in a letter delivered to Health and Human Services Secretary Xavier Becerra Tuesday.
The American Hospital Association, American Medical Association and fourteen other healthcare organizations urge Becerra to extend the department’s COVID-19 public health emergency until the global outbreak has subsided.
The public health emergency designation allowed federal agencies to relax numerous policies for healthcare providers and state governments, including permitting continuous Medicaid enrollment and additional Medicare reimbursement for treating COVID-19 patients in hospitals.
The emergency declaration, which can be extended in 90-day increments, is currently set to expire July 15. President Joe Biden’s administration has vowed to offer 60 days’ notice before revoking the public health emergency. Based on that, the administration could announce the impending end of the emergency soon: Next Monday, May 16, is 60 days before July 15.
To read more, go to Modern Healthcare.
Nurse Workforce Shortage Looms as More Nurses May Leave Profession
By Victoria Bailey | May 11, 2022
While nursing salaries have increased, the share of nurses considering leaving the profession is also up as pandemic-related stressors continue to impact the workplace and exacerbate the nurse workforce shortage, the 2022 Nurse Salary Research Report found.
The report assesses salary, benefits, education, and pandemic impacts for registered nurses (RNs), advanced practice registered nurses (APRNs), and licensed practical/vocational nurses (LPNs/LVNs). Nurse.com surveyed more than 2,500 nurses between November 12 and December 12, 2021.
The median salary for RNs was $78,000, marking a substantial increase from the 2020 median of $73,000. APRN salary was up $13,000 in 2021 at $120,000 and LPN/LVN was $3,000 higher at $48,000.
However, the gender pay gap for RNs widened, with male RNs making $14,000 more per year than females. In contrast, female APRNs and LPN/LVNs had slightly higher salaries than their male counterparts.
Racial disparities in salary also emerged. Nurses who identified as Black or African American and American Indian or Alaska Native reported the lowest levels of satisfaction with their salaries and reported working more hours per week than other racial groups.
Unsurprisingly, the COVID-19 pandemic significantly impacted the healthcare workforce, though not all of the effects were negative.
For example, when asked if the pandemic affected their salaries, 25 percent of respondents noted increases in their pay. RNs were more likely to report gains compared to APRNs, but LPN/LVNs were more likely to report increases than both RNs and APRNs.
Nurses between 25 and 44 years old, male nurses, acute care and long-term care nurses, Black nurses, and Native Hawaiian or other Pacific Islander nurses were also more likely to report pandemic-related increases in their salaries.
The pandemic made some nurses reassess their positions, though. The percentage of nurses considering changing employers rose from 11 percent in 2020 to 17 percent in 2021.
To read more, go to Revcycle Intelligence.
Addressing Concerns About Improper Denials in Medicare Advantage
Op-Ed by Christi Grimm and Dr. Julie Taitsman | May 11, 2022
A Medicare Advantage plan denied coverage for a walker a physician ordered for a 76-yearold patient at risk of falling. The insurance company reported denying the walker because the patient received a cane in the past five years. A cane no longer provided the support the patient required to walk safely, and no Medicare coverage requirement imposes such five year limit. Another plan denied the MRI a physician ordered to assess why a 69-year-old’s pain and weakness continued five months after a fall. The insurance company’s stated reason was that the patient did not first receive an X-ray. An X-ray could not detect the damage the physician suspected, and no Medicare rule mandates such X-ray prior to MRI.
Insurers running MA plans sometimes limit access to care that should be covered for Medicare beneficiaries. Sometimes, this poses only inconvenience. Other times, it blocks patients from getting necessary, timely care.
Our office, the Office of Inspector General for the U.S. Department of Health and Human Services, recognizes that when MA plans correctly deny payment for services not meeting coverage rules or appropriately require patients to get prior authorization before obtaining certain services, they can drive proper utilization and reduce costs. But when MA plans incorrectly use these processes, they impede access to needed services.
Recently, OIG reported that some MA organization denials of prior authorization requests raise concerns about beneficiary access to medically necessary care. We found that 13% of denied prior authorization requests and 18% of denied payment requests were for care that actually met Medicare coverage rules. Sometimes insurers said the request lacked necessary information, but all necessary documentation was there. Many beneficiaries and providers have experienced this. Some give up. Some seek alternate care or pay out of pocket. Some resubmit repeatedly. Obtaining medically appropriate care should not require such resolve.
Our recent study builds on prior OIG work. In 2018, we reported that MA appeal outcomes and audit findings raise concerns about service and payment denials. The insurance companies running MA plans overturned 75% of their own prior authorization and payment denials upon appeal. Essentially, beneficiaries or providers who persisted were mostly successful. But these individuals only appealed about 1% of denials.
Why would insurers incorrectly deny claims? The insurers generally say it is simply human error. The Centers for Medicare and Medicaid Services employs audit and other review procedures to identify insurance companies that make excessive errors or issue too many incorrect denials. Such oversight exists to prevent insurers from trying to save money by purposefully avoiding necessary expenditures, such as by broadly denying appropriate requests. Even if errors are later corrected, incorrect initial denials can be problematic. We are especially concerned that appeals processes and other complex paperwork could be harder for some beneficiaries to navigate based on factors like financial resources, health status, or education level. Many providers devote substantial effort to prior authorization requests, appealing incorrect denials, and other non-reimbursable administrative tasks. We hope that reducing unnecessary administrative barriers would decrease the burden on providers.
To read more, go to Modern Healthcare.
How Radiology Should Prepare for AUC Clinical Decision Support Reporting Requirements
By Dave Forenell | May 10, 2022
In an effort to reduce the number of inappropriate advanced imaging exams, the Centers for Medicare and Medicaid Services (CMS) plans to implement a new requirement for appropriate use criteria clinical decision support (AUC/CDS) software consultation documented on all radiology requests. These CDS systems are supposed to be in place and in use beginning Jan. 1, 2023.
CMS said after Jan. 1, 2023, claims submitted without compliance certificates from CDS will be rejected, or face a 15% payment reduction. This is a mandate written into the Protecting Access to Medicare Act of 2014 (PAMA).
The AUC/CDS mandate was a big topic of discussion at the Radiology Business Management Association (RBMA) 2022 meeting in late April. RBMA offered a session to provide a refresher on the AUC/CDS requirements and discussed methods to be prepared.
Lisa Mead PSO executive director, Strategic Radiology, spoke at the session. She reviewed the components of the AUC/CDS program mandated by PAMA, and the methods that can be utilized by practices to successfully coordinate hospitals and referring providers in program implementation. She addressed questions regarding the CDS mandate.
This requirement was originally supposed to go into effect in 2017, but its implementation has been delayed several times. Several medical imaging societies are calling on Congress to repeal the AUC/CDS mandate because they believe it will cause delays in care, involve more administrative staff time and add costs to healthcare. There are also concerns that delays in updating CDS software with new guidelines and expert consensus recommendations will cause billing issues and additional staff time to address.
To read more, go to Radiology Business.
Preserving Contrast Media Supplies: 7 ACR Recommendations
By Hannah Murphy | May 9, 2022
Since the medical industry has begun to feel the impact of the nationwide shortage of intravenous contrast media, organizations are being tasked with making serious adjustments to preserve their supplies.
With the shortage, which pertains specifically to all formulations and concentrations of GE Healthcare’s Omnipaque (iohexol), expected to last until mid-June, several organizations have alluded that conservation efforts are of critical importance. For this reason, the American College of Radiology released a statement addressing the situation, which they describe as an “emergency,” along with a list of conservation recommendations.
“The ACR Committee on Drugs and Contrast Media, within the ACR Commission on Quality and Safety, is aware of the current global shortage of iodinated contrast media,” the statement reads. “The recommendations are not exhaustive or prescriptive. They are intended as a resource for imaging providers and their institutions to continue to provide high-quality patient care during times of shortage of contrast media.”
Below are some of the following risk mitigation strategies shared by the ACR:
Though iodinated contrast is currently and will continue to be in short supply for the next several weeks, the ACR cautions that doses should not be reduced to the point of suboptimal image quality.
To read more, go to Health Imaging.