Practices Most Frustrated With Prior Authorization, Then No Surprises Act
By Jacqueline LaPointe | October 12, 2022
Prior authorizations are still the top regulatory burden according to executives from group practices, while No Surprises Act compliance has debuted on the list this year as the second most burdensome regulatory.
Those are the findings from MGMA’s 2022 Annual Regulatory Burden Report, a survey of executives from over 500 group practices. Of the practices responding this year, more than three-quarters are independent and about 64 percent have less than 20 physicians. Fifteen percent are practices with over 100 physicians.
Yet again, group practice leaders say they are facing more regulatory burden compared to last year. In the 2022 report, 89 percent of respondents said regulatory burden on their practice has increased over the last 12 months. That is down just slightly from 91 percent in the 2021 report.
Meanwhile, less than one percent of respondents said regulatory burden has decreased and 11 percent said it has not changed.
Compliance with health policies and regulations is a major challenge for medical practices and one that can detract from patient care, MGMA says. An overwhelming majority of group practice executives (97 percent) agreed that a reduction in regulatory burden would allow their practices to reallocate resources toward patient care.
Some executives added that staffing shortages are making compliance even more burdensome while increasing costs coupled with decreasing reimbursement rates mean there are no resources available to put toward regulatory issues.
“In a time of runaway inflation and unprecedented workforce shortages, the federal government is layering on additional regulatory burdens that, while in theory are beneficial to patients, act more as an impediment to delivering care,” Anders Gilberg, SVP of Government Affairs at MGMA, said in a press release.
To read more, go to Revcycle Intelligence.
‘Economically Unsustainable’: How Medicare Reimbursements Hinder Adoption of Latest Mammo Technology
By Hannah Murphy | October 11, 2022
A new paper published on October 11 in Radiology highlights the relationship between race and access, or lack thereof, to evolving mammographic screening techniques.
The paper, which focused on the Medicare population from 2005 to 2020, revealed that Black women had less access to newer mammographic technology than their white peers, even when their exams took place within the same institution . Although cancer detection rates among Black and white women are similar, Black women are 40% more likely to die from breast cancer, in part, due to the stage at which their cancer is detected—an occurrence that is inevitably impacted by access to newer screening technology, authors of the new study suggested.
The analysis included more than 4 million Medicare claims during the time period, during which two significant transitions in breast cancer screening occurred—from screen-film mammography (SFM) to full-field digital mammography (FFDM), and from digital mammography to digital breast tomosynthesis. Despite these impactful technological strides, study co-author Eric W. Christensen, PhD, principal research scientist in health economics for the Harvey L. Neiman Health Policy Institute, shared that not everyone benefits from improvements that newer screening methods provide, and that insurance reimbursements could be to blame.
“Inequities result when lower payments make technology investments economically unsustainable for practices that serve higher proportions of Medicare patients,” Christensen said in a statement.
The payments Christensen is referring to are Medicare reimbursements dictated by the Centers for Medicare and Medicaid Services (CMS). Private insurers offer reimbursements 1.2 to 1.8 times higher than public insurers such as Medicare, which exacerbates healthcare disparities in underserved areas where many utilize public insurance.
According to the new data provided by Christensen and colleagues, although these gaps in care do appear to soften over time, this does not occur at an equitable pace.
To read more, go to Health Imaging.
Need Grows for Rural Rads Who Can Perform 12 Low-risk, Low-complexity Interventional Procedures
By Dave Pearson | October 11, 2022
Most if not all diagnostic radiologists should be capable of performing numerous image-guided procedures, according to a task force jointly convened by the ACR and the SIR.
These “level 1” clinical duties, 12 in number, include such potentially urgent interventions as thoracentesis, joint aspiration via arthrography and lumbar puncture for cerebrospinal fluid drainage.
The team also lists sample “level 2” procedures, with which only some diagnostic rads should be familiar (e.g., nontunneled central line placement, exchange and replacement), and “level 3” interventions that are the sole bailiwick of IR specialists.
The task force makes the recommendations in a consensus document that’s aimed not at delineating radiology competencies among practitioners but, rather, at broadening access to image-guided procedures for patient populations living in rural care settings or served by small IR practices.
Critical to achieving this aim, as task force members flesh out in a report published online in JACR Oct. 7, is recruiting, training and retaining interventional radiologists to work in small and rural practices .
No less important is ensuring basic IR education for all radiologist trainees.
“Limited data suggest that diagnostic radiology residency programs may not provide adequate training for the performance of level 1 procedures,” the authors comment.
To read more, go to Radiology Business.
Patient Costs for Imaging Skyrocket Over Last 20 Years
By Erik L. Ridley | October 10, 2022
Out-of-pocket costs incurred by patients receiving imaging studies nearly doubled between 2000 and 2019, according to research published online October 6 in the Journal of the American College of Radiology.
A team of researchers led by Eshani Choksi, a medical student at Rowan University in Glassboro, NJ, analyzed national surveys containing out-of-pocket imaging costs from over 100,000 patients between 2000 and 2019. They found that out-of-pocket costs for noninvasive imaging studies increased by a mean of 89.8% over the study period.
“As diagnostic imaging utilization increases, patient financial hardship considerations merit further attention,” wrote Choksi, corresponding author Kumar Mukherjee, PhD, of Philadelphia College of Osteopathic Medicine, and colleagues.
The group studied annual cost data for 229,010 noninvasive imaging exams (mammography, radiography, ultrasound, and CT or MRI) from 102,717 patients included in the Agency for Healthcare Research and Quality (AHRQ) Medical Expenditure Panel Survey (MEPS) from 2000 to 2019. The MEPS is a patient-centered U.S. household survey.
After calculating the total cost of all imaging studies performed during all encounters, the researchers then estimated mean overall expenditures and mean out-of-pocket costs for each year by summing the respected costs incurred by all respondents reporting imaging in that calendar year and then dividing by the number of respondents.
Furthermore, they estimated the mean overall expenditures and mean out-of-pocket costs for each of the four modalities by assessing encounters with a single imaging exam. They then indexed all costs to 2020 dollars after adjusting for inflation.
Overall, the mean patient out-of-pocket costs for imaging studies increased from $97.97 in 2000 to $185.91 in 2019, up 89.8%.
To read more, go to Aunt Minnie.
VIDEO: Issues With the Great Resignation and Lower Reimbursements in Breast Imaging
By Dave Fornell | October 7, 2022
Stamatia Destounis, MD, FACR, a radiologist and managing partner at Elizabeth Wende Breast Care in Rochester, New York, chair of the American College of Radiology (ACR) Breast Commission, and member of the Public Information Advisors Committee for Radiological Society of North America (RSNA) and Society of Breast Imaging (SBI) Communication Committee, discusses post-COVID-19 economic issues facing breast imaging centers, including static problems from the “Great Resignation” and lower reimbursements making it difficult to attract experienced radiologists.
“We are dealing with some issues in staffing with COVID-19, but we are trying to open up our doors and allow patients to come back in again full steam ahead for their screenings,” Destounis said. “However, we are having some concerns because we do have a reduced number of technologists, call center staff, reception and even physicians because of the situation with our economy.”
How an outpatient breast imaging center adjusted to the post-COVID staffing issues
The Great Resignation, which started during the pandemic and is still ongoing, has made many physicians rethink what they want from a job. Many have realized they can move to locations with more opportunities for their families and to warmer climates.
Teleradiology also enables many to live wherever they want and not necessarily need to be at a brick-and-mortar healthcare facility. Destounis said this new mindset, combined with lower reimbursements and rising costs, has impacted her ability to attract and retain radiologists in upstate New York.
Burnout from working at medical facilities during is also playing a major role in clinicians’ decisions to leave medicine or change jobs.
To read more, go to Radiology Business.
September’s Strong Jobs Gain Brings Healthcare Back to Pre-pandemic Employment, Federal Data Shows
By Dave Muoio | October 7, 2022
Healthcare employment saw major gains in September and jobs numbers not seen since February 2020, according to the U.S. Bureau of Labor Statistics’ monthly report released Friday morning.
The preliminary data show hospitals, ambulatory healthcare services and nursing and residential care facilities added roughly 60,100 jobs last month, accounting for more than a fifth of all jobs gained across the U.S. economy.
Employment in the sector had picked up over the summer with 56,700 jobs added in June, 69,600 in July and 48,200 in August, according to BLS. The healthcare industry is up by about 489,800 jobs since September of last year.
The month’s growth was largely split between hospitals and ambulatory care, with the former picking up 27,500 jobs and the latter adding 28,100.
“It’s a pleasant surprise, but I would caution against operators reading too much into it,” Matt Wolf, director and healthcare senior analyst at consulting firm RSM US, told Fierce Healthcare. “We’ve also seen unemployment decline, labor force participation rates decline as well, which further supports the narrative that we’ve seen that the hospital operators just simply aren’t going to be able to hire their way out of this situation.”
Economy-wide unemployment dipped from 3.7% in September to 3.5%, according to BLS, while labor force participation inched down a tenth of a percent to 62.3%.
While healthcare has returned to its pre-pandemic employment numbers, Wolf noted that demand hasn’t spent the past two and a half years waiting around.
To read more, go to Fierce Healthcare.
Patients Digging Deeper into Household Budgets for Imaging Exams that Aren’t Mammography
By Dave Pearson | October 7, 2022
Why are patients paying far less out of their pockets for mammography now than two decades ago—while shelling out a lot more for other common imaging exams?
That’s an easy pop quiz for many radiology watchers. In 2010 most health insurers began paying the full tab for women 40 and older who got screened for breast cancer. The payers had to do so, thanks to the Affordable Care Act.
Here’s a harder question. Why did out-of-pocket costs for ultrasound skyrocket 123% over the same period while climbing a steep but comparatively cheap 61% for CT and MRI?
The authors of a study published online Oct. 6 in JACR surmise the difference owes in no small part to targeted and steady reimbursement cuts for CT and MRI in the value-based payment era .
“[W]e believe it most likely that these have disproportionately slowed the growth of costs for those services (as well as patient share of these costs),” the researchers write.
The team pursued out-of-pocket spending trends on major imaging modalities between 2000 and 2019 by analyzing healthcare consumer data in the Medical Expenditure Panel Survey (MEPS). This is conducted each year by HHS’s Agency for Healthcare Research and Quality (AHRQ).
Led by corresponding author Kumar Mukherjee, PhD, of Philadelphia College of Osteopathic Medicine and senior author Richard Duszak Jr., MD, of the University of Mississippi Medical Center, the authors of the present study turned up some illuminating findings.
To read more, go to Radiology Business.