Radiology Digest – October 24, 2023

October 20, 2023

Poll of Medicare Beneficiaries Shows ‘Overwhelming’ Opposition to Cutting Radiologist Pay

By Marty Stempniak | October 19, 2023

A new poll of Medicare beneficiaries released Thursday morning shows “overwhelming” opposition to cutting pay for radiologists and other physicians.

More than three-quarters of those reached (76%) said they disagree with reducing reimbursement to rads under the 2024 physician fee schedule. Another 74% disagree with paying healthcare providers less for imaging services such as mammograms.

The findings are derived from an Oct. 11-13 survey of 1,200 seniors, conducted by the Radiology Patient Action Network and the Medical Imaging & Technology Alliance.
“This data clearly shows that the American people do not support cuts to Medicare providers that could reduce access to quality care,” Bob Still, executive director of the network and the Radiology Business Management Association, said in an Oct. 19 announcement of the survey results. “We urge Congress and the administration to listen to the people and reconsider these proposed reimbursement reductions that could seriously impact patient care across the country.”

Another 53% of respondents agreed that cutting payments to providers is equivalent to cutting Medicare itself. Meanwhile, 31% are “somewhat concerned” and 49% “extremely concerned” about reimbursement reductions to radiologists and other physicians. About 73% of respondents believe the federal government should be investing more in diagnostic imaging, not less.

“Cutting reimbursements now would only further damage providers that are still recovering from COVID-19,” Patrick Hope, JD, executive director of the Medical Imaging & Technology Alliance, which represents device manufacturers, said in the announcement. “Ensuring adequate funding for imaging services that detect diseases early and save lives needs to remain a top priority.”

The survey comes after CMS released the 2024 Medicare Physician Fee Schedule in July, proposing pay reductions for diagnostic and interventional radiologists. Advocates anticipate that the federal government will release the final fee schedule in the coming weeks.

To read more, go to Radiology Business.

 

Employer Health Insurance Premiums Surge: 5 New Findings

By Erica Carbajal | October 18, 2023

Nearly 153 million Americans rely on employer-sponsored health coverage, and costs are on the rise for both workers and employers. 

KFF published findings from its 25th annual Employer Health Benefits Survey on Oct. 18, which showed family premiums for employer-sponsored health coverage reached an average of nearly $24,000 this year, up 7% from 2022 and the highest rate increase in a decade. Average annual premiums for individual coverage also increased by 7% to $8,435. 

“We’ve had this period of super-high inflation and now premiums are catching up,” Matthew Rae, co-author on the report and associate director of KFF’s healthcare marketplace program, told USA Today.

The findings are based on KFF’s survey of more than 2,100 public and private firms from January to July. 
Four more findings: This year, workers on average contributed $6,575 toward the cost of family coverage, up nearly $500 from last year. Employers covered the rest. Nearly a quarter of employers surveyed indicated they will increase workers’ premium contributions in the next two years. Relative to the 7% increase in average premiums, employee wages grew about 5.2%, and inflation grew 5.8%.In 2023, the average deductible amount is $1,375, about the same as last year. Researchers called the 7% increase in annual premiums a “big change compared to last year, when there was not a statistically significant increase from the year prior and suggests that the higher overall prices we have seen since 2022 in the rest of the economy have begun to affect premiums.” 

Access the full KFF survey findings here

To read more, go to Becker’s Payer Issues.

 

CMS Removes National Coverage Determination for Beta-amyloid PET, Expanding Access to Vital Imaging Exam

By Marty Stempniak | October 13, 2023

The Centers for Medicare & Medicaid Services announced Friday that it is removing the national coverage determination for beta-amyloid PET scans, thereby broadening access to this vital imaging exams.

CMS first hinted at the move back in July when it proposed potentially lifting the longstanding policy that restricts patients to one amyloid-detecting positron emission tomography exam in their lifetime. Friday’s elimination of the previous “coverage with evidence development” requirement allows local Medicare Administrative Contractors to dictate coverage for such exams.

Imaging advocates, who have pushed for this change for years, praised CMS on Friday.

“This decision ensures increased accessibility to this crucial nuclear medicine test for eligible patients and facilitates the targeted use of new treatments for those who can benefit,” Helen Nadel, MD, president of the Society of Nuclear Medicine & Molecular Imaging, said in a statement.

“Numerous published studies involving thousands of patients clearly support that beta-amyloid PET scans improve the clinical management of patients with cognitive impairment,” Patrick Hope, executive director of the Medical Imaging & Technology Alliance, which represents device manufacturers, said in a separate statement. “So, it is a welcome decision to retire [coverage with evidence development] and expand access to beta-amyloid PET imaging.”

SNMMI noted that this decision will be especially beneficial for patients receiving monoclonal antibody treatments for Alzheimer’s. To ensure proper administration of such drugs, the society said individuals should receive an initial PET scan to confirm amyloid plaque buildup in the brain. Additional exams should follow to monitor reductions in plaque levels.

The nuclear medicine society said it continues urging CMS to retire or eliminate other “outdated” PET coverage determinations that “inappropriately restrict coverage.” MITA also emphasized that MACs should work with experts in neurology and Alzheimer’s disease to ensure “seamless and consistent coverage” for amyloid PET in different jurisdictions.

You can find the full national coverage determination from CMS here.  

To read more, go to Radiology Business.

 

What’s New for Medicare Open Enrollment in 2023: 5 Notes

By Rylee Wilson | October 13, 2023

Medicare open enrollment begins Oct. 15 and runs through Dec. 7. During this time, enrollees can make changes to their Medicare coverage for the upcoming year, such as switching between Medicare Advantage plans, switching from MA to traditional Medicare and choosing new supplemental coverage. 

Here are five updates to note ahead of the open enrollment period: 
 Premiums and deductibles for Medicare part B will increase slightly in 2024. Part B monthly premiums will increase by around 6 percent to $174.70, and annual deductibles will increase around 6 percent to $240. The average monthly premium for Medicare Advantage plans is projected to increase by less than $1 in 2024, according to CMS.Insurers are expanding their Medicare Advantage offerings for 2024, entering new markets and states. In addition to adding new markets, some insurers are introducing new partnerships and plan options. Alignment Health will launch a co-branded plan with grocery delivery platform Instacart, and SCAN Health plan will introduce the first Medicare Advantage plan designed for women.CMS will put new rules in place governing prior authorizations in Medicare Advantage plans in 2024. Per a final rule CMS issued in April, prior authorization policies may be used only to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary. Plans also cannot impose any prior authorizations for an active course of treatment during the first 90 days a member is enrolled in a plan. Some hospitals and health systems are dropping Medicare Advantage plans. At least one health system, Bend, Ore.-based St. Charles Health System, advised its patients to choose traditional Medicare over Medicare Advantage during the open enrollment period.Marketing for Medicare Advantage plans could look different during this open enrollment period. CMS is requiring all Medicare Advantage television advertisements to be submitted to the agency for approval before airing. The agency is also barring any Medicare Advantage advertisements that do not mention a specific plan to cut down on misleading claims. To read more, go to Becker’s Payer Issues.

 

MedPAC Commissioners Discuss Need for Medicare Payment Reform

October 13, 2023

The Medicare Payment Advisory Commission (MedPAC ) held a robust discussion on payment reform during its October meeting . This session touched on several policy points: the impact of inflation, growth in volume and intensity of clinician services, variation in site of service payments, overvaluation of services, and the incentives to participate in advanced alternative payment models.

Commissioners were presented with factors to consider when they decide if reforms are needed in the method used to annually update Medicare payment rates under the Physician Fee Schedule (PFS). The commission in recent years largely determined that Medicare’s payment rates under the PFS are adequate to ensure Medicare beneficiaries have access to services. MedPAC staff shared, though, that during times of higher inflation, concerns increase that applying the updates specified in the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015 could negatively affect beneficiaries’ access to care.

MedPAC is an independent congressional agency created to advise Congress about issues affecting the Medicare program. Payment reform will continue to be discussed by the MedPAC and be included in the MedPAC March Report to Congress.

To read more, go to ACR’s website.

 

American College of Radiology Urges Congress to Address ‘Worsening’ Physician Shortages

By Marty Stempniak | October 13, 2023

The American College of Radiology is urging Congress to address “worsening” physician shortages in the U.S.

ACR recently voiced its concerns in comments submitted to the House Committee on Ways and Means, which is exploring how to improve access in rural and underserved areas. The college pointed to a report from the Association of American Medical Colleges, estimating that the country could see a shortfall of “other specialties” (including radiology) as high as 35,600 by 2034.

“Physicians are a vital component of our nation’s healthcare infrastructure and we have seen firsthand the worsening shortage of healthcare providers surrounding the impact of the COVID-19 pandemic,” ACR Executive VP Cynthia R. Moran said in comments submitted to Ways & Means leaders on Oct. 4. “A large portion of the physician workforce is also nearing traditional retirement age, which will soon contribute to the magnitude of national workforce shortages.”

Specific to radiology, Moran noted that, of the nearly 21,000 radiologists engaged in active patient care, 53% are age 55 or older. Radiology also ranks fifth out of 23 surveyed specialties in reported rates of burnout. Further complicating the situation, radiology also is facing shortages of technologists and other support personnel.

“With concerns about physician shortages, looming new shortages and the threat of burnout leading to more physicians leaving the workforce, investments to increase the number of physicians [are] sorely needed,” she added.

The Consolidated Appropriations Act of 2021 added 1,000 new Graduate Medical Education slots—the first such increase in a quarter century. But advocates believe further action is needed in response to the growing physician deficit and aging population.

Moran highlighted two recent policy proposals that could address this issue, urging the 118th Congress to pass them. Those include the Resident Physician Shortage Reduction Act, which would add 14,000 Medicare-support medical residency positions over a seven-year period. The bipartisan Specialty Physicians Advancing Rural Care Act also could further address shortages by creating a student loan repayment program for specialists practicing in such communities.

“Addressing the healthcare workforce challenges that we face requires educating and training enough physicians to meet the country’s needs,” Moran wrote. “A long-term investment is needed by Congress. ACR is committed to working with lawmakers and optimizing the radiology workforce as we explore legislative solutions to bring vital and innovative medical care to patients.”

You can find the full comments, which touch on several other topics, here and an Oct. 12 news summary from ACR here.

To read more, go to Radiology Business.

 

Federal Government Resumes Independent Dispute Resolution for Single Claims

October 12, 2023

ACR Decries Continued Pause of Batched IDR Claim Processing

The Centers for Medicare and Medicaid Services (CMS) announced Oct. 6 that the portal for providers and insurers to file payment disagreements related to the No Surprises Act (NSA) is again open for the initiation of new single claim disputes. CMS temporarily suspended the independent dispute resolution (IDR) process Aug. 3, following the U.S. District Court for the Eastern District of Texas’ decision in the lawsuit known as Texas Medical Association (TMA) IV; that decision vacated regulations related to batching provisions and the administrative fee that must be paid to file a disputed claim.

The IDR portal notably remains unavailable, however, for providers who wish to submit multiple claims in a batch, and previously submitted batched claims remain on hold.

The American College of Radiology® (ACR®) strongly opposes the continued pause of the IDR process for batched claims, as many imaging claims eligible for dispute are less than the current $50 administrative fee required to be paid to initiate the process.

The guidance by the U.S. Departments of Health Human Services, Labor, and Treasury, and the U.S. Office of Personnel Management on the reopening of the IDR process for single claims also includes detailed information about extensions of deadlines to initiate the IDR process. If the initiation deadline for a claim is between Aug. 3 and Nov. 3, parties have until Nov. 3 to initiate a new dispute.

Federal Government Disagrees With Court in Disputed Claims Calculation Ruling, Intends Appeal

In a separate decision in the case known as TMA III, the court determined that the government incorrectly permitted insurers to use a faulty methodology when calculating their median in-network rate, also known as the qualifying payment amount (QPA).

The federal government in separate guidance  addressed the TMA III decision to vacate regulations related to the QPA calculation methodology. The departments state that they disagree with this decision and the Department of Justice intends to appeal. While the government recognized that the court decision remains in effect during the appeal process, the departments state that insurers are required to calculate QPAs “in a manner consistent with the statutes and regulations that remain in effect.”

The government did not provide specific instructions to insurers on a new calculation methodology, but rather indicated that they are “expected to calculate QPAs using a good faith, reasonable interpretation of the applicable statutes and regulations.” In addition, the departments state that they will “exercise their enforcement discretion” for insurers that continue to use QPAs calculated under the now vacated guidance for at least the next six months and possibly until Nov. 1, 2024. The departments also encouraged states that operate IDR processes under their own laws to similarly use enforcement discretion with regard to QPAs.

The ACR is also disappointed in the absence of QPA recalculation guidance, and the government’s intention to allow insurers to continue to use QPAs calculated using the now vacated methodology. The College continues to monitor whether and how the government decides to enforce a federal court’s decision.

The TMA rulings do not impact the patient protections included in the NSA that the ACR advocated for and continues to fully support, nor do they raise patient out-of-pocket costs.

To read more, go to ACR’s website.