Radiology Digest – November 21, 2023

November 16, 2023

Radiology Digest: News from the week of November 21, 2023.

US Senate Passes Stopgap Funding Bill to Avert Government Shutdown

By David Morgan and Moira Warburton | November 16, 2023 | Included in Radiology Digest – November 21, 2023

The U.S. Senate took the risk of an impending partial government shutdown off the table on Wednesday as it passed a stopgap spending bill and sent it to President Joe Biden to sign into law before a weekend deadline.

The 87-11 vote marked the end of this year’s third fiscal standoff in Congress that saw lawmakers bring Washington to the brink of defaulting on its more than $31 trillion in debt this spring and twice within days of a partial shutdown that would have interrupted pay for about 4 million federal workers.

The last near-miss with shutdown led to the Oct. 3 ouster of Republican U.S. House of Representatives Speaker Kevin McCarthy that left the chamber leaderless for three weeks.

But lawmakers have bought themselves just a little more than two months’ breathing room. The Democratic-majority Senate and Republican-controlled House of Representatives’ next deadline is Jan. 19, just days after the Iowa caucuses signal the start of the 2024 presidential campaign season.

To read more, go to Reuters.


No Surprises Act Purportedly Pushing Providers in Radiology and Other Specialties ‘to the Brink’

By Marty Stempniak | November 15, 2023 | Included in Radiology Digest – November 21, 2023

The No Surprises Act and its slow-moving dispute-resolution process may be pushing some healthcare bond holders “to the brink,” according to a Bloomberg report published Monday.

The ban helped to trigger a few of the year’s biggest bankruptcies, including radiology provider Envision Healthcare, with investors now eyeing other debt-laden provider groups that could be vulnerable.

Bloomberg specifically cited imaging industry giant Radiology Partners, which has $2 billion in debts due over the next two years. Others on its list include KKR-backed ambulance company Global Medical Response (in talks to push back $4 billion in debts maturing in 2025) and Blackstone-supported staffing firm TeamHealth ($2.5 billion due next year).

“The No Surprises Act certainly puts pressure on healthcare companies that have that [out-of-network] exposure,” Clare Moylan, a co-founder of consulting firm Gibbins Advisors, told Bloomberg. “If you’re tight on margin already, and you lose that margin, then you have to find it elsewhere.”

For its part, Radiology Partners emphasized that it has “ample liquidity” and its earnings have not been materially impacted by the NSA, a spokesperson told the outlet. As of March, about 5% of Rad Partners’ business was out-of-network, with some risk that percentage could increase, S&P Global Ratings estimated at the time.

Earlier this year, Rad Partners was submitting out-of-network claims to the independent dispute resolution process and winning about 85% of cases. Yet, only 15% had actually been resolved and paid. That’s because the IDR process is running “very slow,” taking more than 250 days to settle disputes, and leading to a “significant” postponement in the receipt of payment, S&P noted.

“While this only affects a small part of Radiology Partners’ revenue, the delay in cash collections is weighing on liquidity and reducing the capacity for further operational challenges in the short term,” analysts said at the time.

Fitch Ratings estimates that providers initiated about 110,000 claim disputes under the NSA in Q4 of 2022, with about 31,700 resolved. That’s up from 71,900 initiated in the previous quarter and 20,700 resolved.

Such numbers leave investors “increasingly concerned about the impact on corporate cash flows,” Bloomberg noted.

To read more, go to Radiology Business.


Regulatory Burdens in Healthcare Take Away from Patient Care

By Jacqueline LaPointe | November 15, 2023 | Included in Radiology Digest – November 21, 2023

Regulatory burdens in healthcare, such as prior authorizations, surprise billing requirements, and audits and appeals, are taking resources away from patient care as practices face more oversight.

MGMA’s latest “Annual Regulatory Burden Survey” polled executives from over 350 group practices, including independent practices. This year’s survey reaffirmed the burden policy and regulation in healthcare have on group practices.

Approximately 90 percent of respondents said the overall regulatory burden on their medical practice has increased over the past 12 months. Meanwhile, less than 1 percent said overall regulatory burden decreased and about 9 percent said it has not changed.

The regulatory requirement burdening practices the most was once again prior authorization, with about 89 percent of respondents reporting prior authorization as very or extremely burdensome. Audits and appeals followed with 68 percent of executives saying they are very or extremely burdensome and Medicare’s Quality Payment Program, including the Merit-Based Incentive Program (MIPS) and Advanced Alternative Payment Models (APMs), with 67 percent of executives in the very or extremely burdensome bucket.

Other regulatory requirements with a higher proportion of respondents selecting very or extremely burdensome included surprise billing and good faith estimate requirements (63 percent), Medicare Advantage chart audits (61 percent), and lack of EHR interoperability (47 percent). Other options included translation and interoperation requirements and credentialing for Medicare and Medicaid.

While each regulatory issue carries its own burdens, together, the rules and requirements placed on providers are diverting time and resources away from patient care, the survey indicated.

For example, prior authorizations and other utilization management tools — which have topped the list of most burdensome regulatory issues for years — have shifted resources in group practices. Nearly all respondents (92 percent) said their practice has hired or redistributed staff to work on prior authorizations due to the increase in requests. Even more respondents (97 percent) said their patients have experienced delays or denials for medically necessary care due to prior authorization requirements.

The top challenges associated with prior authorizations include inconsistent payer payment policies, requests for routinely approved items and services, and delays in decisions, the survey found.

If group practices did not have to overcome these challenges and other regulatory issues, they might have more time to focus on patients, the survey suggested.
An overwhelming majority of respondents (97 percent) agreed that a reduction in regulatory burden would allow their practices to reallocate resources toward patient care.

“Reducing regulatory requirements that do not improve patient care will assist group practices in focusing on patient care and allow them to invest resources in initiatives that improve healthcare delivery, further clinical priorities, and reduce costs,” the survey report stated.

In addition to the patient care issues associated with prior authorizations, practice leaders also called out Medicare’s Quality Payment Program for having little benefit on patient care.

Almost three-quarters of respondents (72 percent) said the move toward value-based payment initiatives in Medicare and Medicaid have not improved the quality of care for patients. Significantly more respondents (94 percent) also said this move has not lessened the regulatory burden on their practices.

Only about a third of executives (32 percent) said the move toward value-based payment has been successful to date.

Practice leaders see MIPS, a track within the Quality Payment Program, as a “a complex compliance program that focuses on reporting requirements rather than an initiative that furthers high-quality patient care,” MGMA reported.

To read more, go to Revcycle Intelligence.


House Lawmakers Slam Administration’s ‘Unacceptable’ Implementation of the No Surprises Act

By Marty Stempniak | November 14, 2023 | Included in Radiology Digest – November 21, 2023

House lawmakers are sharply criticizing the Biden administration’s implementation of the No Surprises Act, urging for reforms to make the landmark law more in line with its original intent.

Republican representatives voiced their “serious concerns” in a Nov. 9 letter to leaders in the departments of Health and Human Services, Labor and Treasury. The House Ways & Means Committee recently held a hearing on the legislation’s roll out, in which providers complained of long delays in processing claims and an arbitration process skewed in favor of insurers.

“The biased interpretation of the qualified payment amount has created serious consequences for medical providers of all sizes,” the 25 Republican members of the committee wrote. “Small medical practices in rural and underserved communities that had been in-network with health insurers are now receiving network cancellations. Even larger providers, like hospitals, are suffering similar consequences from the downward pressure of reduced reimbursement from the skewed QPA.”

Lawmakers urged the departments to “swiftly revisit the final rule,” ensuring that it aligns with the law as written. They also want the administration to take “immediate steps” to ensure that the NSA’s transparency provisions are a “reality for patients.”

“We are glad that millions of Americans have been protected from surprise medical bills, but we remain disappointed with the outstanding challenges that face all aspects of our healthcare system,” House representatives wrote. “We cannot emphasize strongly enough the depths of the departments’ failure to implement the No Surprises Act as written in statute and as Congress intended.”

The letter comes after the departments recently issued a proposed rule aimed at strengthening the dispute-resolution process under the NSA. If finalized, the rule would seek to improve communication between health insurers, physicians and the independent entities that arbitrate disagreements over out-of-network payments.

The federal government also wants to adjust timelines for the independent dispute resolution process, along with establishing new criteria for “batching” together similar IDR requests. Officials also would seek to change the administrative fee structure, hoping to “improve accessibility of the process.”

On Nov. 10, the American College of Radiology issued a detailed summary exploring the pros and cons of the proposal. ACR said it is “encouraged” that the rule change would provide expanded batching regulations, reduce the administrative fee for certain claim disputes, and require insurers to provide claim eligibility info with initial payments.

“These are positive changes recommended by many specialty societies, including ACR,” the trade group said in a Friday news update. “The college still has issue with some details within the proposed rule, including limiting batching to 25-line items in a single dispute,” it added
ACR said it plans to submit feedback to the administration within the 60-day comment window.

To read more, go to Radiology Business.


HPSA Program Did Not Affect Physician Shortages or Health Outcomes

By Victoria Bailey | November 14, 2023 | Included in Radiology Digest – November 21, 2023

Although health professional shortage area (HPSA) designations aim to improve access to care by alleviating staffing challenges, a Health Affairs study found that most HPSA counties remained physician shortage areas for at least ten years after their designation.

Poor distribution of physicians in underserved areas may be a driver of geographic disparities in healthcare access. The HPSA program encourages healthcare professionals to relocate to shortage areas by providing incentives such as student loan forgiveness or higher Medicare reimbursement.

Stakeholders have voiced concerns about the program, including questioning whether the algorithms effectively identify shortage areas, whether the incentives are strong enough to impact physicians’ decisions about where to practice, and whether the incentives are sufficient to address geographic inequities.

Furthermore, the significant number of shortage areas may reflect a nationwide shortage of physicians rather than unequal distribution.

Researchers out of Yale University used a publicly available data set of primary care HPSAs, the CDC Wide-ranging Online Data for Epidemiologic Research Compress Mortality files, Area Health Resources File data, and US census data to assess the impact of the HPSA program between 1978 and 2015.

To read more, go to Revcycle Intelligence.


AMA Debates Resolution Seeking Federal Ban on Corporate Practice of Medicine

By Marty Stempniak | November 14, 2023 | Included in Radiology Digest – November 21, 2023

The American Medical Association has been debating a resolution urging for a federal ban on the corporate practice of medicine.

Florida emergency physician Vicki Norton, MD, submitted the resolution and helped compile a 70-page white paper on the topic, the American Prospect reported Monday. The proposal was nearly tabled, landing on a list of resolutions “not for consideration” at the AMA’s interim House of Delegates, which concludes Tuesday.

However, a radiologist unaffiliated with the reformers’ campaign gave an impassioned speech on the topic, appealing to have the resolution presented for debate, with the motion granted.

“We are being picked clean by private equity,” New Jersey radiologist Christopher Gribbin, MD, said, according to the report. “There are people who don’t know where their next paycheck is even going to come from because their groups have been flipped so often … [This resolution] is protecting both physicians and patients, it is preserving physician autonomy and preventing burnout.”

The fate of the resolution has not yet decided at the time of the report. American Prospect said the likeliest scenario is the resolution will be referred to a committee or AMA staff for further analysis.

To read more, go to Radiology Business.

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