Radiology Digest – November 4, 2021

November 5, 2021

Radiology Digest: News from the week of November 4, 2021.

Change Healthcare, UnitedHealth Honor DOJ Info Request, Amend Timing of Merger
By Marty Stempniak | November 4, 2021 | Included in Radiology Digest – November 4, 2021

Radiology vendor Change Healthcare and UnitedHealth Group have complied with a Department of Justice request to furnish more information about their proposed merger, officials said Wednesday.

The two companies first announced their $13 billion union back in January, with the DOJ launching an investigation in March amid anticompetitive concerns. After honoring the Justice Department’s demands, Change and UnitedHealth said they entered into an amended agreement Nov. 1 dictating the timing of the deal.

“The parties have been working cooperatively with the DOJ and will continue to do so,” Change said in a Nov. 3 announcement.

Both have agreed not to consummate the merger before Feb. 22, 2022, almost a year after the acquisition was first announced. UnitedHealth—which also operates the nation’s largest commercial insurance plan—is acquiring all of Change’s outstanding shares for $25.75 apiece, cash. All told, the Minnetonka, Minnesota, firm is paying $8 billion to acquire Nashville-based Change while also assuming $5 billion more in debt.

Several parties have spoken out against the company’s proposed combination, including Change’s stockholders, the American Medical Association, the American Antitrust Institute and the American Hospital Association. Most recently, the National Community Pharmacists Association voiced its concerns, calling the combined entity a “corporate monster” that will “gobble up more market share.”

Change Healthcare said it plans to host a conference call regarding the transaction early Thursday morning.

To read more, go to Radiology Business.

Aetna Expects to Add at Least 100K Members in ACA Exchange Plans for 2022
By Paige Minemyer | November 3, 2021 | Included in Radiology Digest – November 4, 2021

CVS Health CEO Karen Lynch told investors on Wednesday morning that Aetna is expecting to add at least 100,000 new members in 2022 through its slate of plans on the Affordable Care Act’s exchanges.

The insurer has returned to the Affordable Care Act’s exchanges in eight states for 2022, and the insurer is expecting its plans, which include a co-branded offering with both Aetna and CVS, to have an immediate appeal in the individual market.

Lynch described the new plan on the company’s second-quarter earnings call as one “that combines health insurance, pharmacy, our retail presence and behavioral health services.”

Aetna fully exited the ACA exchanges in 2018 amid a mass payer exodus following significant losses. Lynch said Aetna would be re-entering the markets for the 2022 plan year during the company’s Q4 2020 earnings call.

Open enrollment on the ACA exchanges began on Monday.

In addition, Aetna is drawing interest for its newly-unveiled virtual primary care offering, Lynch said. The program, which was announced in August, is backed by Teladoc as well as services provided by CVS Health.

Members will have continuous access to a virtual primary care doctor and can connect to a number of specialists and other physicians based on their needs. They can also access a number of virtual and in-person services with a $0 copayment through CVS’ MinuteClinics.

Lynch said that the solution has 30 accounts signed on, reaching 750,000 members for Jan. 1, 2022.

To read more, go to Fierce Healthcare.

CMS Requires COVID Vaccines for Healthcare Staff by Jan. 4
By Maya Goldman | November 4, 2021 | Included in Radiology Digest – November 4, 2021

The Centers for Medicare & Medicaid Services will require COVID-19 vaccines for all employees at Medicare and Medicaid-participating healthcare facilities by Jan. 4, and the Occupational Safety and Health Administration will require all employees at businesses with 100 or more workers to be vaccinated by the same date or get tested for the virus weekly, the agencies announced Thursday morning.

President Joe Biden in September directed the two agencies to put out policies for staff vaccination requirements as part of the administration’s national vaccine strategy. Biden also required federal contractors to get vaccinated against COVID-19 in an executive order.

The CMS will require healthcare facilities that participate in Medicare or Medicaid—including hospitals, long-term care facilities, ambulatory surgery centers, dialysis facilities, home health agencies and more—to make sure all clinical and non-clinical employees are vaccinated by the Jan. 4 deadline. The interim final rule stipulates that fully vaccinated means two doses of the Pfizer or Moderna vaccine or one dose of Johnson & Johnson, meaning booster shots are not mandated.

The administration estimates the CMS mandate will apply to more than 17 million healthcare workers at roughly 76,000 facilities.

OSHA’s rule, created as an emergency temporary standard, requires businesses with 100 or more staff to have all staff fully vaccinated by Jan. 4. Employees who are still unvaccinated at that point will need to show a negative COVID-19 test weekly and wear a face mask in the workplace. The rule doesn’t require employers to provide or pay for tests, but a fact sheet notes that other laws or collective bargaining agreements might leave employers on the hook for these costs on a case-by-case basis. Employers must provide paid time off for staff to get vaccinated under the rule.

Healthcare employees will not have the option of regular COVID-19 testing instead of getting vaccinated as a way to protect patient safety, a senior administration official said on a Wednesday night call. Medical and religious exemptions are allowed for healthcare workers under the rule, the official said.

To read more, go to Modern Healthcare.

Final Medicare Physician Fee Schedule Offers Positives, but Still ‘Disappointing’ Cuts to Radiologist Pay
By Marty Stempniak | November 3, 2021 | Included in Radiology Digest – November 4, 2021

Register for the Zotec Shares Webinar presented by Mark Isenberg, EVP, Healthcare Advocacy and Lonnie Johnson, VP, Corporate Services to find out more about the impact of the MPFS Final Rule.

The Biden administration released the final 2022 Medicare Physician Fee Schedule Tuesday, offering a mixed bag for radiologists and other physician specialists.

On the positive side, CMS is postponing the penalty phase for the Appropriate Use Criteria program by a year, to Jan. 1, 2023. First proposed in 2014, the oft-delayed effort requires physicians to consult a decision-support system before ordering advanced imaging to curb healthcare waste. But on the negative, the agency is advancing a clinical labor wage update members of the specialty say will result in reduced pay, particularly among interventional radiologists and radiation oncologists.

Docs and members of Congress have rallied to quash such changes, predicting practice closures if the Centers for Medicare & Medicaid Services failed to act.

“Despite objections from [the American College of Radiology] and others, CMS chose to move forward with implementation of clinical labor pricing updates,” the professional association said Tuesday night. “However, due to the actions of ACR and others, the updates will be phased in over a four-year period, and the payment impact to radiology and radiation oncology providers largely reduced by half.”

In an announcement, CMS said this is the first time in nearly 20 years that it’s updating clinical labor rates used to calculate practice expenses in the fee schedule. Under the changes, payments to primary care specialists who use clinical labor—family practice, geriatrics, internal medicine, etc.—will rise, driving “greater person-centered care for these services.” Due to balanced-budget requirements, rising spending in one place necessitates cuts elsewhere. Interventional radiologists and radiation oncologists—with high medical supply costs and lower spending on clinical labor—are slated to bear the brunt. However, CMS is now phasing-in such changes to “maintain payment stability and mitigate any potential negative effects on healthcare providers.”

To read more, go to Radiology Business.

Texas Medical Association Files Suit to Stop Surprise-billing Provision Opposed by Radiologists
By Marty Stempniak | November 1, 2021 | Included in Radiology Digest – November 4, 2021

The Texas Medical Association filed suit against the Biden administration on Thursday hoping to quash a radiologist-opposed provision in legislation to address surprise medical bills.

Lone Star State docs believe the feds failed to follow congressional intent in a recently released interim final rule, spelling out how to settle quarrels over out-of-network payments. Lawmakers had recommended a robust dispute-resolution process that took several factors into account. But the medical association believes the final rule places too much emphasis on the “qualifying payment amount,” set solely by health insurers.

“We are disappointed the Biden administration ignored congressional intent and essentially set up the arbitration system to operate like a casino, with health insurers playing the role of the house,” association President Linda Villarreal, MD, said Friday. “Everyone knows the house always wins. With the current rule, patients, physicians and our country lose.”

TMA filed the lawsuit in the Tyler, Texas, federal district court against the departments of Health and Human Services, Labor and Treasury, along with their current leaders. Villarreal and colleagues said they support the No Surprises Act’s intent, with their complaint only challenging the independent dispute-resolution component. They believe the proposed approach is “short-sighted” and will drive down physician payment, narrow networks, and stifle patient access.

The suit urges the court to strike this portion of the rule, restoring the “fair, balanced dispute resolution process that Congress created.” It also accuses the administration of violating the Administrative Procedure Act, requiring a formal notice and comment period prior to finalizing such rulemaking. TMA—the largest state medical society in the U.S., representing 55,000 physicians and medical students—said its claims are backed by a recent letter from two powerful members of Congress, echoing providers’ concerns.

“Despite the careful balance Congress designed for the IDR process, the Sept. 30, 2021, interim final rule with comment strays from the No Surprises Act in favor of an approach that Congress did not enact in the final law, and does so in a very concerning matter,” Reps. Richard Neal, D-Mass., and Kevin Brady, R-Texas, chairman and ranking member, respectively, of the Committee on Ways and Means, wrote to the secretaries of the three agencies named in the suit on Oct. 4.

To read more, go to Radiology Business.

Hundreds of Organizations Ask Governors to Extend Telehealth Waivers
By Michael Brady | November 1, 2021 | Included in Radiology Digest – November 4, 2021

More than 230 organizations want state governors to preserve and expand state medical licensure flexibilities for telehealth until the public health emergency ends, according to a letter led by the Alliance for Connected Care, ALS Association and National Organization for Rare Disorders.

Nearly 30 states have allowed their emergency declarations to lapse in recent months, according to the Alliance. That’s led many people to suddenly lose access to telehealth services delivered by out-of-state providers as exceptions to state medical licensing rules expired alongside the emergency declarations.

It can be especially challenging for people at high risk for COVID-19, those who require specialized care, people with mobility issues and those living in rural areas or areas with provider shortages, the letter said.

“Given the urgency of the times as more states consider rolling back flexibilities enacted at the start of the pandemic, states must act now to ensure patients can access the care they need where they reside and when they need it, without having to choose between cancelling an appointment or traveling long distances and risking potential exposure to the COVID-19 virus for an in-person visit,” the letter said.

A coalition of patient advocates, hospitals and health systems, digital health companies and professional associations signed the letter, including Amazon, the American Health Information Management Association, Amwell, Epic, Mayo Clinic, One Medical and Providence.

During the COVID-19 public health emergency, the federal government suspended rules requiring physicians to be licensed where a patient is located to bill Medicare and Medicaid for medical services. Nearly all states followed suit by allowing out-of-state providers to practice without a permanent license during the pandemic. Some states waived in-state licensure requirements altogether, while others let out-of-state providers apply for temporary licenses.

To read more, Modern Healthcare.

ACR ‘Strongly Supports’ Suggested Changes to Colorectal Cancer Screening Measures
By Hannah Murphy | October 29, 2021 | Included in Radiology Digest – November 4, 2021

The American College of Radiology supports newly proposed changes to colorectal cancer screening measures.

In an announcement released Thursday, October 28th, the ACR endorsed changes to the 2022 Healthcare Effectiveness Data and Information Set (HEDIS) Health Plan Colorectal Cancer Screening measure. The changes recommended by the National Committee for Quality Assurance (NCQA) seek to include adults ages 45-49 within colorectal cancer screening measures already in place.

Currently, the age group for initial assessment sits at 50-75. In addition, the new suggested changes include adding the Medicaid product line for reporting measurement starting in 2022.

In October 2020, the U.S. Preventative Services Task Force (USPSTF) also recommended these same age adjustments for regular check-ins, and in 2017 the inclusion of computed tomography colonography was added as an additional screening option in the hopes of reaching a wider demographic of patients who might have been uneasy about a colonoscopy.

“The ACR strongly supports the USPSTF recommendation for colorectal cancer screening. Providing patients with a variety of effective screening tools for colorectal cancer including CT Colonography encourages early detection in the fight against this deadly disease and helps save lives as well as closing the gap in colorectal screening rates between whites and minority populations,” a representative from the ACR told Health Imaging over email.

You can read the full statement here.
To read more, go to Health Imaging.

Learn more about what Zotec Partners can do for your radiology practice here.