American College of Radiology Highlights Imaging CPT Code Changes for 2022 and Sooner
By Marty Stempniak | May 6, 2021
The American College of Radiology on Wednesday notified providers of new CPT code changes that will affect its members beginning as soon as this summer.
Those include two Category 3 Current Procedural Terminology updates from the American Medical Association pertaining to quantitative, multi-parametric MRI. This new technology does not currently have a CPT code, but the AMA is remedying that by adding 0648T and 0649T, effective July 1.
These code additions pertain to data preparation, transmission, interpretation and reporting for mp-MRI, an exam used to analyze tissue composition, the college said.
“The ACR urges its members to review and consider how the bundled and new code changes may impact their practices,” it noted in a May 5 update.
In addition, the American Medical Association is rolling out new Category 1 diagnostic radiology codes in its 2022 set, available for reporting beginning Jan. 1. Those include four new codes for reporting trabecular bone scores, which measure the structural condition of bone micro-architecture. Two more CPT code additions next year will cover a new procedure—destruction of the intraosseous basivertebral nerve—that provides relief for some chronic lower-back pain.
You can read more about the changes from the American College of Radiology’s news post here.
To read more, go to Radiology Business.
54% of Radiologists Work in Private Practice, While Other Docs Report Lower Ownership Levels
By Marty Stempniak | May 5, 2021
About 54% of radiologists work in private practice, while the number across all physicians dropped below 50% for the first time since the American Medical Association began tracking these numbers.
The AMA’s every-other-year survey found that 49.1% of patient care physicians worked in doc-owned practices, down from 54% in 2018. President Susan Bailey, MD, noted that several factors are contributing to shifts in practice size and ownership, including mergers and acquisitions, closures, and different workplace preferences among younger docs.
The survey was conducted between September and October and included 3,500 physicians. But Bailey said it’s still too early to say how the public health crisis is impacting these numbers.
“To what extent the COVID-19 pandemic was a contributing factor in the larger than usual changes between 2018 and 2020 is not clear,” Bailey said in a statement. “Physician practices were hit hard by the economic impact of the early pandemic as patient volume and revenues shrank while medical supply expenses spiked. The impact of these economic forces on physician practice arrangements is ongoing and may not be fully realized for some time.”
Rads’ 54% mark in private practice represented an uptick from nearly 51% reported in 2018. About 37% of radiologists in this year’s survey said they are employed, and the final 8.5% identified themselves as independent contractors. Only surgical specialties landed higher on the list than radiology, with 61.5% saying they work at a physician-owned practice.
Meanwhile, only about 53% of rads said they work in a single-specialty practice; only anesthesiology reported a higher number at 55%. More than 22% said they work in a multi-specialty group, and 11% identified as a direct hospital employees or contractors. The remainder said they work in either a solo practice (4%) or identified as “other” (9%).
The overall drop in private practice represents the largest two-year change since AMA launched the survey back in 2012. You can find the rest of the survey data here.
To read more, got to Radiology Business.
The High Price of Consolidation: Spike in Imaging Volumes Pushing Medicare Costs Up $40M
By Matt O’Connor | May 4, 2021
The monthly number of diagnostic imaging exams performed at hospitals for Medicare patients sharply increases after health systems buy up physician practices, researchers reported Monday in Health Affairs.
In fact, almost immediately after such vertical integration, imaging utilization increased by 26.3 exams per 1,000 beneficiaries. At the same time, those performed in non-hospital settings dropped by 44.5 per 1,000.
And this practice-level change quickly drives up healthcare costs. The average reimbursement for five common imaging exams jumped by more than $6 over the four-year study period, translating to a $40 million increase in Medicare spending.
Some experts have argued this growing ownership trend results in better care coordination and spending on higher quality services, but first author Christopher M. Whaley, a healthcare policy researcher at RAND Corp., and colleagues suggest otherwise.
“Importantly, it is difficult to argue that the additional spending is related to better quality of care, as these specific services are likely to be highly standardized—and hence undifferentiated—across diagnostic providers,” Whaley and co-authors added in the study. “The increased payment is instead a reflection of pre-existing Medicare payment rates that reimburse hospitals more for these services than they reimburse competing providers (for example, stand-alone imaging centers and freestanding diagnostic laboratory companies).”
Many recent investigations have discovered that, along with price increases and spending, referral patterns and care setting choices change after providers are integrated into hospitals and health systems. One study published this week by Health Affairs noted inappropriate MRI referrals jumped by more than 20% following such employment changes.
Looking further at this trend, the researchers analyzed Medicare fee-for-service claims data from 2013-2016, keying in on five common CT and MR imaging exams and five routine lab tests.
To read more, go to Health Imaging.
Radiology Group Asks Lung Cancer Screening Centers for Help Persuading Insurers to Update Exam Coverage
By Matt O’Connor | April 30, 2021
The American College of Radiology is asking lung cancer screening centers to help push private insurers to update their imaging coverage policies.
On Friday, the ACR published a form letter for freestanding care centers to send to state and local private insurers. The two-page document urges payers to revise their lung cancer screening policies to match the United States Preventive Services Task Force’s March update, which qualified millions more for such exams.
Specifically, the ACR wants reimbursement policies to mirror the USPSTF grade B recommendations that lower the annual screening low-dose CT age to start at 50 and smoking pack-year eligibility from 30 pack-years to 20.
Under the 2010 Patient Protection and Affordable Care Act, payers are afforded up to one year from the start of the next plan year to update their coverage determinations after the USPSTF makes changes. But the college says quick action will spare many unnecessary deaths.
“Given the magnitude of lung cancer deaths across the United States population, and that lung cancer has the highest cancer death rate, this underscores the urgency to move expeditiously with a responsible and equitable plan for expanded coverage of screening for the at-risk populations,” the ACR explained in its form letter.
The nation’s foremost radiology advocate has been hitting the pavement hard to lobby for these changes. Following the USPSTF’s March 9 update, the ACR quickly called on the federal Centers for Medicare & Medicaid Services to update its own coverage policy.
Since then, the GO2 Foundation for Lung Cancer and the Society of Thoracic Surgeons co-signed a letter to the nation’s top five private insurers urging for coverage policy updates.
You can download the ACR’s form letter here.
To read more, go to Health Imaging.
‘Profoundly Negative Impact’: ACR asks Insurer Anthem to Reconsider Imaging Payment Restriction
By Marty Stempniak | April 30, 2021
Imaging advocates are asking commercial insurer Anthem to reconsider a payment restriction they believe will have a detrimental impact on patient care.
The American College of Radiology and Society for Pediatric Radiology expressed frustration with the Indianapolis-based payer in a recent letter. Their “significant concerns” stem from an Anthem policy that directs children aged 10 and older away from hospital-based imaging departments.
They’re asking Anthem to revise medical necessity criteria, allowing kids up to age 19 to undergo high-tech imaging procedures such as CT and MRI at hospital-based sites. This would grant patients access to experts in pediatric imaging, the two argued.
“We believe this policy has a profoundly negative impact on the quality and safety of pediatric care for children and adolescents undergoing advanced outpatient imaging studies,” ACR and SPR wrote in an April 22 letter to John Whitney, MD, Anthem’s VP of medical policy. “We strongly believe that pediatric specialists make a substantial difference in the safety accurate clinical decision-making and, most importantly, improve outcomes for the pediatric patient,” the groups added later.
ACR and the pediatric society called the 10-years-old cutoff arbitrary, noting that many childhood diseases extend into adolescence. They’re asking Anthem to reimburse for such nonemergent, high-tech imaging in hospitals for patients up to age 19. Other insurers, such as Cigna and UnitedHealth, have amended their site-of-care imaging policies to include children in this age group, the letter writers noted.
“Economic steerage of pediatric patients, disregarding their optimal care, is neither appropriate nor in the patient’s best interest,” the letter concluded.
Anthem was one of the first in a line of health insurers to implement restrictions around hospital-based imaging, hoping to steer patients toward cheaper freestanding options. ACR alerted members about this issue in an update published Thursday.
To read more, go to Radiology Business.
CMS: Obamacare Cost-sharing Change Cuts Out-of-pocket Costs by $400
By Nona Tepper | April 30, 2021
CMS on Friday significantly changed how Affordable Care Act exchanges will run next year, intending to lower out-of-pocket costs for Obamacare customers, streamline enrollees’ user experience and update how insurers are paid for the risks they take on their members.
In its second update to the annual benefit and payment parameters rule, the agency announced consumers’ maximum out-of-pocket costs will be limited to $8,700 for individuals and $17,400 for plans that cover multiple people. The update is $400 lower than previous caps, CMS said.
Officials said they curbed cost-sharing parameters by citing the National Health Expenditure Accounts’ projections of per-enrollee, employer-sponsored insurance premiums. CMS said this was the measure used for benefit years 2015 through 2019.
“Families deserve to have access to healthcare coverage that doesn’t break the bank. That’s why today we’re acting to lower consumers’ maximum out-of-pocket costs by $400 and why President Biden has a plan to reduce families’ healthcare costs for the long run,” HHS Secretary Xavier Becerra said in a statement.
CMS said it was also finalizing a few provisions aimed at helping consumers gain coverage. During this special enrollment period, CMS said 80,000 individuals have already enrolled in plans.
By allowing enrollees to change marketplace plans if they don’t receive advance payment on premium tax credits; allowing those age 30 and over to apply for catastrophic coverage; enabling beneficiaries who aren’t notified of triggering life events to enroll in plans 60 days after they learn about their eligibility; and permitting COBRA beneficiaries to sign up for marketplace coverage if the employer or government contributions to their plan end, the agency aims to slow the growth in healthcare costs and cut the uninsured rate.
To read more, go to Modern Healthcare