Radiology Digest: News from the week of October 21, 2021.
Bipartisan Senators Introduce Radiologist-supported Bill to Cut Prior Authorization Red Tape
By Marty Stempniak | October 21, 2021 | Included in Radiology Digest – October 21, 2021
Bipartisan members of the U.S. Senate introduced radiologist-supported legislation Wednesday to reduce the administrative burden of prior authorization in Medicare Advantage.
The Improving Seniors’ Timely Access to Care Act of 2021 follows a similar proposal in the House, which now has 227 cosponsors. Senators are aiming to simplify insurers’ use of such utilization-management tools that can delay necessary care and increase paperwork for radiologists and other providers.
Physician and Sen. Roger Marshall, MD, R-Kan., sponsored the bill, backed by Sens. Kyrsten Sinema, D-Ariz., and John Thune, R-S.D.
“This legislation cuts the red tape hindering healthcare providers across the nation from providing our seniors with quality care in a timely manner,” Marshall said Oct. 20. “The commonsense solutions we are offering were formed in partnership with hundreds of national and state organizations over the last two years, and I am honored to lead this bipartisan, bicameral effort alongside Senators Sinema and Thune.”
Remedies in Senate Bill 3018 would include establishing an electronic process to reduce paperwork, enabling real-time decisions on commonly approved services, and encouraging payers to stick to evidence-based guidelines in making their decisions. Health plans would also be required to report their use of prior authorization and denial rates.
The American College of Radiology said Wednesday that it supports both the House and Senate bills. Others such as the American Society for Radiation Oncology, Medical Group Management Association and American Hospital Association also endorsed the endeavor. One recent study found that radiology is among the medical specialties with the highest rate of services subjected to prior authorization at 91%. One-third of physicians in a recent American Medical Association survey said prior authorization has led to serious adverse events, including hospitalizations and even death.
“Physicians know the best treatment for our patients but they’re often not the ones making the final decision due to artificial barriers constructed by insurance companies,” AMA President Gerald Harmon, MD, said in a statement. “The time delays and administrative burdens associated with prior authorization continue to undermine our patients’ health.”
To read more, go to Radiology Business.
‘Proof Will Be In the Execution’: CMS Plan Focuses on Accountable Care
By Mari Devereaux | October 20, 2021 | Included in Radiology Digest – October 21, 2021
For its second decade in operation, Centers for Medicare and Medicaid Services Innovation Center is implementing strategies to drive healthcare transformation, using demographic data, industry feedback and more accessible payment models.
In a Wednesday webinar, CMS leaders outlined the agency’s five new objectives and how they will advance health equity, expand coverage and improve health outcomes going forward.
• Driving accountable care
• Advancing health equity
• Supporting innovation
• Addressing affordability
• Partnering to achieve system transformation
The agency plans to engage communities in the policymaking and implementation process, use consistent mechanisms for gathering outside input, share more data with researchers and ask federal partners for their insight and support in testing new approaches to payment and care delivery.
In the coming months, CMS will conduct listening sessions and continue to publicly share its refresh strategy.
To read more, go to Modern Healthcare.
Op-ed: Congress Needs to Address Looming Physician Reimbursement Cuts
By Rep. Larry Bucshon M.D. | October 19, 2021 | Included in Radiology Digest – October 21, 2021
For over 19 months, our nation’s doctors, nurses and other healthcare workers have been on the front lines of the COVID-19 pandemic fighting each day for the health and well-being of our loved ones. With the insurgence of the delta variant flooding hospitals across the nation with patients, our nation’s healthcare workers have been once again dealing with overcrowded hospitals, staffing shortages and equipment issues.
Now with more than 700,000 deaths in the U.S. due to the pandemic and the surges in COVID-19 cases during the past several months, it is no secret that our healthcare professionals are spread thin. This makes the decision by the Biden Administration and Democrats in Congress to not address looming physician pay cuts during a pandemic completely incomprehensible.
Due to a budget-neutrality requirement in federal law, the effect of increasing the Medicare reimbursement rate for primary-care physicians is that the Centers for Medicare and Medicaid Services must decrease the reimbursement rate for other providers. As a result, many specialists, therapists and other physicians are now facing a substantial reimbursement cut next year—up to 9% for many providers. While I am strongly supportive of increasing reimbursement for primary-care physicians, increasing the rate for primary-care physicians at the expense of other providers and surgeons is misguided and dangerous for patients.
The ramifications of allowing such a reimbursement cut to go into effect would only further strain our healthcare system that is already under unprecedented stress from the pandemic, threatening patient access to medically necessary services.
Physicians are among the everyday heroes keeping our families healthy, our communities out of harm’s way, and our livelihoods protected during this pandemic. Now is not the time to ask them to take a reimbursement cut.
To read more, go to Modern Healthcare.
RBMA Launches Coalition of Doc Groups to Fight $5B in Pay Cuts
By Marty Stempniak | October 19, 2021 | Included in Radiology Digest – October 21, 2021
The Radiology Business Management Association launched a coalition of doc groups on Monday hoping to fight $5 billion in pay cuts facing the profession.
RBMA’s board of directors approved the new Radiology Patient Action Network during the group’s annual conference in Las Vegas, which started Oct. 17. They’re working to quash reimbursement reductions in the 2022 Medicare Physician Fee Schedule, which advocates said could cripple practices and prevent patients from accessing imaging.
“Radiologists across the country are facing dire cuts to funding that will inevitably result in furloughs of staff and reductions in services for patients who need mammograms, cancer screenings and other lifesaving diagnostic services,” RBMA Executive Director Bob Still said in a statement. “[The new patient action network] will fight to ensure that patients get the care they deserve, and that Congress understands the need for federal funding to these services.”
Still and colleagues said they hope to build on the success of the association’s grassroots “Don’t Cut Docs” advocacy campaign to avert similar Medicare changes in 2021. RBMA estimated that radiology practices face a potentially “devastating” decrease of 11.75%. The action network is urging Congress to extend a temporary 3.75% Medicare pay bump into 2022 along with extending the sequestration mortarium to avoid losing $5 billion in payment reductions for vital services.
“Failure to extend this relief will create further consolidation of imaging providers and force severe reductions in vital healthcare staff that could disproportionately impact the most vulnerable of patients,” the group said in its announcement.
RBMA estimated that about 500 radiology business professionals are attending this year’s PaRADigm conference, which required vaccination against COVID-19. The show is slated to conclude Wednesday morning with a talk titled “Nine Months into Democratic Control in Washington and the Effects on Radiology.” Association lobbyist Shea McCarthy will discuss the forthcoming Medicare cuts, along with the recently released No Surprises Act interim final rule and other issues impacting imaging on the Hill.
To read more, go to Radiology Business.
HHS Proposes Withdrawing Trump ‘Good Guidance’ Rules
By Jessie Hellman | October 19, 2021 | Included in Radiology Digest – October 21, 2021
The Biden administration on Tuesday announced plans to withdraw Trump-era rules that make it harder for regulators to punish individuals and organizations for not following Health and Human Services Department guidance.
The rules, issued in the final months of the Trump administration, ban HHS from penalizing individuals and organizations for noncompliance with agency guidance and requires the agency only carry out civil enforcement actions using standards that are publicly stated.
HHS proposed withdrawing the rules Tuesday, arguing it creates “unnecessary hurdles” to issuing guidance and bringing enforcement actions and is inconsistent with the goals of the Biden administration.
To read more, go to Modern Healthcare.
American College of Radiology Proposes 5 Imaging-related CPT Codes for Re-evaluation
By Matt O’Connor | October 14, 2021 | Included in Radiology Digest – October 21, 2021
The American College of Radiology has proposed five Current Procedural Terminology codes for re-evaluation they may be updated as soon as 2023.
ACR presented the CPT codes at the American Medical Association/ Specialty Society Relative Value Scale Update Committee (RUC) held Oct. 6-9. The college said the codes are associated with X-ray contrast of the knee, 3D rendering with interpretation and report, ultrasound guidance and two codes related to fluoroscopic guidance.
In an update sent out Thursday, ACR said it collaborated with a wide-ranging number of organizations to fine tune the proposals. Those groups include the American Society of Neuroradiology and the Society of Interventional Radiology, along with non-radiology specialties such as the American Society of Anesthesiologists, American Academy of Pain Medicine, and American Academy of Physical Medicine and Rehabilitation.
Additionally, several new evaluation and management codes were discussed at the meeting, but those are confidential and “cannot be shared,” according to the college.
The AMA plans to send the recommendations to the Centers for Medicare and Medicaid Services for review. If accepted, they will be implemented in the 2023 Medicare Physician Fee Schedule.
“CMS may accept the RUC’s recommendations or propose their own values based on their internal review of the material,” ACR said Oct. 14.
To read more, go to Health Imaging.
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