Radiology Digest – May 21, 2021

May 21, 2021

Radiology Digest: News from the week of May 21, 2021.

Imaging Advocates Report Progress Addressing Medicare PET/CT Payment Problem

By Marty Stempniak | May 20, 2021 | Included in Radiology Digest – May 21, 2021

Days after pressing the Centers for Medicare & Medicaid Services to expand PET imaging payment, radiology advocates received some good news this week.

The Society of Nuclear Medicine & Molecular Imaging and American College of Radiology recently reached out to one Medicare Administrative Contractor to express concerns about coverage. And National Government Services has responded that it’s now taking a closer look at the issue.

“We are reviewing the PET scan pricings,” Stephen Boren, MD, medical director of the of NGS, whose jurisdiction covers three states in the Midwest and seven more in the Northeast, wrote in a response to SNMMI.

“We agree that PET CT should be reimbursed higher than PET alone. We will be making some changes in reimbursement,” he added, according to a Tuesday news update from the molecular imaging group.

The original May 11 letter from radiology advocates cited a list of concerns related to payment for myocardial positron emission tomography. Those included receiving extra compensation for more complicated procedures and avoiding any new restrictions on office-based delivery of these exams.

“We strongly recommend that [National Government Services] determine appropriate rates for the myocardial PET procedures by recognizing that within the family of codes, there is a hierarchy in the complexity, time to perform and resource costs of the procedures,” the medical groups wrote last week.

Boren did not immediately respond to a Radiology Business request for comment on Wednesday. National Government Services’ jurisdiction includes Illinois, Minnesota and Wisconsin along with Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.

To read more, go to Radiology Business.

CMS Opens Review of Expanded CT Lung Screening Reimbursement

By Brian Casey | May 19, 2021 | Included in Radiology Digest – May 21, 2021

CT lung cancer screening could see expanded Medicare reimbursement soon. The U.S. Centers for Medicare and Medicaid Services (CMS) on May 18 opened up a review of its
reimbursement policies in response to recent changes expanding the number of individuals who are eligible to be screened.

CMS on Wednesday issued a national coverage analysis (NCA) tracking sheet for screening for lung cancer using low-dose CT, signifying that it has started the review process. The agency said it opened the review after receiving a formal request to reconsider its national coverage determination (NCD) for CT lung cancer screening.

The agency’s move is in response to

In its May 18 announcement, CMS noted that under federal law the agency may cover “additional preventive services” if they receive “A” or “B” ratings from the USPSTF — a standard that the expanded lung screening criteria now meet. A review of Medicare coverage was requested by the American College of Radiology (ACR), the Society of Thoracic Surgeons, and the GO2 Foundation for Lung Cancer.

In announcing its expanded criteria in March, the USPSTF noted that expanding the range of eligibility for lung screening would increase by 87% the number of people able to be screened, a number that ranged from 80% in men to 96% in women. Minorities would also see a big increase in the number of people eligible.

Despite winning approval from USPSTF in 2013 and Medicare reimbursement shortly thereafter, CT lung cancer screening has underperformed expectations. The percentage of eligible individuals who seek out screening remains at single-digit percentages in some studies, far below that of mammography, colon screening, and other more established screening procedures.

The USPSTF guideline change apparently spurred CMS into action, a move that was urged by a number of groups, including the ACR. The groups have also asked CMS to eliminate its requirement that individuals undergo a “shared decision-making process” with their physician s before starting screening — a rule that’s not required of other screening exams. CMS did not mention shared decision-making in its NCA tracking sheet.

CMS said that it is seeking public comment on the request through June 17; comments can be submitted on the agency’s website.

To read more, go to Aunt Minnie.

Task Force Recommends Dropping Starting Age for Colorectal Cancer Screening Via CT Colonography

By Marty Stempniak | May 18, 2021 | Included in Radiology Digest – May 21, 2021

The U.S. Preventative Services Task Force on Tuesday dropped the recommended screening age for colorectal cancer using CT and other methods, drawing praise from radiologists.
USPSTF now endorses checking for the disease beginning at age 45 rather than 50, while continuing to “strongly” support check-ins up to age 75. The independent advisory panel of
experts in primary care and prevention additionally voiced support for stool-based and visualization tests, the latter of which includes virtual colonoscopy performed using computed tomography.

“Far too many people in the U.S. are not receiving this lifesaving preventive service,” task force Vice Chair Michael Barry, MD, said in a statement. “We hope that this new recommendation to screen people ages 45 to 49, coupled with our long-standing recommendation to screen people 50 to 75, will prevent more people from dying from colorectal cancer.”

The American College of Radiology called the decision a “step forward” in the battle against colorectal cancer. Under the Affordable Care Act, decreasing the starting screening age will mean “millions” more Americans will receive private insurance coverage for this “vital” test. However, the college wants the Centers for Medicare & Medicaid Services to go a step further.

“CT colonography is already an American Cancer Society-recommended screening test that is less invasive than and comparably accurate to standard colonoscopy, increases screening rates where offered in the United States and abroad, and lowers costs—which can allow more providers to offer screening,” Judy Yee, MD, chair of the ACR Colon Cancer Committee, said Tuesday. “Now Medicare must follow the USPSTF lead and cover beneficiaries for this lifesaving exam.”

USPSTF’s recommendations come following a recent “alarming” rise in colorectal cancer cases among people younger than 50. The move updates the group’s 2016 recommendations while aligning them with the American Cancer Society, which started advocating for screening at age 45 back in 2018. Individuals ages 76-85 should continue to selectively seek screening on an individualized basis, experts said.

For more on the changes, you can find USPSTF’s recommendation statement, a modeling study, evidence report and several accompanying pieces in JAMA.

To read more, go Radiology Business.

Radiologists Support Bipartisan Proposal to Quash Prior Authorization Red Tape in Medicare Advantage

By Marty Stempniak | May 18, 2021 | Included in Radiology Digest – May 21, 2021

Radiologists, radiation oncologists and other docs are voicing their support for newly introduced, bipartisan legislation to eliminate prior authorization red tape among Medicare Advantage plans.

Representatives introduced the Improving Seniors’ Timely Access to Care Act in the U.S. House on May 13. Lawmakers noted that while requiring physicians to jump through these hoops can curb unnecessary care, prior authorization often erodes patient-provider interaction while delaying essential medical attention. One recent audit from the Office of the Inspector General found that Medicare Advantage plans ultimately approved 75% of requests they originally denied.

“Inefficiency within the prior authorization process creates unnecessary paperwork, lag time, and hassle for doctors that can delay lifesaving procedures for Hoosiers,” co-sponsor and
Indiana Republican Larry Bucshon said in a statement. “This bill eliminates red tape by streamlining and modernizing an outdated program for doctors, allowing them to quickly get their patients the care they need—putting patients over paperwork,” he added later.

Congressional representatives originally introduced the proposal back in 2019, drawing support from the American College of Radiology at the time. ACR confirmed Monday that it still “supports this legislation to reduce the administrative burden of prior authorization on healthcare providers,” a spokesman said. The college joins others backing the bill including the American Medical Association, American Society for Radiation Oncology, and the Medical Group Management Association.

If approved, the act would establish an electronic system and facilitate fast approval for frequently made prior authorization requests. It would also force Medicare Advantage plans to report their denial rates and encourage doc-payer collaboration to ensure these utilization-management programs are based on medical evidence. A recent survey from the American Medical Association found that 83% of physicians believe payers have intensified their use of such roadblocks during the past five years. This problem is hurting patients, too, with 87% of docs saying that prior authorization disrupts continuity of care. Another 30% even claim the practice led to serious adverse events.

“Prior authorization remains a major obstacle to achieving optimal patient care,” AMA President Susan Bailey, MD, said in a statement. “The time delays and administrative burdens continue to undermine healthcare outcomes.”

To read more, go to Radiology Business.

Radiology Groups Bristle at Notion that Providers Cannot Safely Perform PET Imaging in Office Setting

By Marty Stempniak | May 17, 2021 | Included in Radiology Digest – May 21, 2021

Radiology advocates are pushing for PET imaging payment reform while bristling at questions around whether providers can appropriately perform the procedure in an office setting.
The Society of Nuclear Medicine & Molecular Imaging, American College of Radiology and others voiced their concerns in a recent letter to National Government Services, which processes Medicare payments. SNMMI et al. believe ensuring continued access to myocardial positron emission tomography is “critical.”

To do so, however, advocates want Medicare payment codes to reflect cost differences for performing varying types of exams, such as PET with and without CT.

“We strongly recommend that [National Government Services] determine appropriate rates for the myocardial PET procedures by recognizing that within the family of codes, there is a hierarchy in the complexity, time to perform and resource costs of the procedures,” the imaging groups wrote to Stephen Boren, MD, MBA, Medicare contractor medical director for the group, on May 11.

Imaging advocates recommended using the simplest, least pricey procedure—a single perfusion study—as a starting point, establishing other more complex exams relative to this reference. A single metabolic evaluation could cost 10% more than single perfusion, they suggested, while performing a CT scan concurrent with a PET procedure would cost 28% more to cover additional equipment.

National Government Services medical directors have recently questioned whether PET procedures can be appropriately performed in the physician office setting. SNMMI, ACR and others “strongly disagree” with this line of questioning. Concerns about where PET imaging is delivered, they added, should be addressed through the coverage determination process, not rate-setting methodology.

“Office-based procedures allow patients to receive services in a more timely manner and in a more accessible setting than is often available for hospital-based services,” they wrote. “Such access is particularly important during the COVID-19 public health emergency, when hospitals are often overwhelmed treating COVID patients and when non-COVID patients may be reluctant to obtain services at hospitals for fear of exposure.”

You can read the full letter—also signed by the American College of Cardiology and American Society of Nuclear Cardiology—here. ACR alerted its members about the issue in a news post shared May 13.

To read more, go to Radiology Business.

46% of Radiologists Lost Income in 2020, with Some Worried Pay May Never Return to Pre-COVID Levels

By Marty Stempniak | May 17, 2021 | Included in Radiology Digest – May 21, 2021

Nearly half of radiologists surveyed said they saw their income decline in 2020, with COVID-19 the major cause. And some are concerned the extra pay may disappear permanently.
The findings are part of a new Medscape survey of more than 700 members of the specialty, published Friday. Average rad pay was $413,000 in 2020, down 3% from the previous survey. About 92% of radiologists cited COVID as the cause, including job loss, reduction in hours, or lower patient volumes.

Roughly 50% of physicians in imaging expect their income to return to pre-COVID levels in the next year, while 35% said it could take a few more turns of the calendar. About 11% believe their pay will never return to the same heights as before the pandemic.

“Many physicians’ offices closed temporarily or saw fewer patients in 2020 due to COVID-19, making it a worrisome year for physician compensation, on top of concerns about well-being of both patients and providers. Radiologists’ practices were not immune,” Medscape reported May 14. “While the worst business days are over for some physicians, others will struggle to recover.”

Radiologists on average earned about $69,000 from incentive bonuses last year, about 18% of total pay and roughly in line with 2019 (17%). On average, rads achieved 83% of their potential pay sweetener, placing the specialty ahead of the overall physician population at 68%. Radiologists said they worked an average of 49 hours per week, in line with the 50 hours put in prior to COVID-19.

Meanwhile, the majority of self-employed physicians in imaging (51%) said they believe that 1%-25% of the drop in patient volume during the pandemic is permanent. Another 46% said the drop is only temporary, while 2% said 26%-50% is permanent. About 65% of those surveyed said they feel fairly compensated, placing radiology at sixth on the list, with oncologists leading the way at 79%.

You can read more from the 2021 Medscape Radiologist Compensation Report here, and find our coverage of overall doc compensation here.

To read more, go to Radiology Business.

American College of Radiology’s Top 3 priorities for Its Upcoming Day on Capitol Hill

By Matt O’Connor | May 14, 2021 | Included in Radiology Digest – May 21, 2021

As the American College of Radiology prepares to meet with members of Congress during virtual Capitol Hill Day on Wednesday, the imaging advocate has identified three of its most pressing issues.

The college provided draft documents and other resources for the 350-plus attendees expected to participate in the meetings. Below are key takeaways.

  1. Impending Medicare E/M pay cuts
    After avoiding potentially “ruinous” reimbursement cuts to the Medicare Physician Fee Schedule for 2021, the ACR wants federal lawmakers to take action and provide added support to ensure “fiscal stability” for physicians and practices in 2022 and beyond.
    In a draft document for members, the ACR urges Congress to retain the current 3.75% increase to the MPFS conversion factor and weigh reforms to the payment schedule, including alternatives to statutory requirements for budget neutrality.
    It further suggests waiving PAYGO, or pay as you go, requirements connected to the American Rescue Plan Act that would help avoid a planned 4% payment reduction next year, according to a May 13 update to members.
    Going forward, the ACR said Congress “must recognize the need for critical reforms to the MPFS system,” notably changes to the budget neutrality system.
  2. Technical changes to imaging aspects in PAMA
    Next on its agenda is an amendment to the Protecting Access to Medicare Act of 2014, which mandates providers consult appropriate use criteria (AUC) when ordering advanced imaging exams.
    “The ACR is concerned that certain claims processing problems at CMS may further delay the program’s implementation and that existing statutory language may be unnecessarily cumbersome for today’s ordering providers,” it noted Thursday.
    As such, the college wants Congress to change language within the legislation to remove point-of-care “real-time” claims processing requirements and, instead, replace it with proof that providers consulted with AUC when ordering advanced imaging. Doing so, the ACR said, would allow such data to be collected by decision support tools and reviewed by CMS.
    Finally, the radvocate suggested excluding ordering providers working in advanced payment models and those participating in clinical trials from taking part in AUC mandates.
  3. Pass the Health Care Provider Protection Act
    The pandemic has taken a on providers around the world, including Lorna Breen, an emergency physician significant toll in New York City who committed suicide in April 2020 after weeks of caring for COVID-19 patients early in the crisis.
    Congressional lawmakers have since introduced the Dr. Lorna Breen Health Care Provider Protection Act to establish various grants and awareness programs to reduce and prevent burnout and promote mental healthcare.
    The ACR urges leadership to advance and pass this bill.
    “Ensuring clinicians can freely seek mental health treatment and services without fear of professional setback means such issues can be resolved, rather than hidden away and suffered through,” the radiology group wrote.
    To read more, go to Health Imaging.

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