|RBMA Presses CMS to Amend 2023 Physician Fee Schedule
By Dave Pearson | September 8, 2022
Warning that proposed new cuts in Medicare reimbursement could afflict U.S. healthcare with “severe and permanent damage,” the Radiology Business Management Association has presented CMS with detailed recommendations for stopping such a dire scenario from arising.
RBMA states its case in a letter it sent the agency Sept. 6, the deadline for commenting on CMS’s proposed Medicare physician fee schedule (MPFS) for 2023.
Addressed to CMS administrator Chiquita Brooks-LaSure and signed by RBMA executive director Robert Still, the nine-page communiqué urges CMS to bear in mind that any fee reduction it lays down will “resonate across the medical practice ecosystem.”
This will surely occur, RBMA notes since private health insurers and other payers use Medicare rates to calculate and negotiate their own.
Pointing to the annual rituality of the exercise, RBMA encourages CMS to “work along with the committees of jurisdiction in Congress to seek a solution to this multiple-year trend of payment cuts” to healthcare providers—not least radiologists.
Lingering COVID, Continuing Inflation, Rising Interest Rates
RBMA projects that, under the approaching arrangement comprising the 2023 PFS and related plans, radiologists would have to live with a total reduction in pay of 12.0%.
It bases this figure on the combined effect of four looming cuts—3.0% to the Medicare Conversion Factor, 3.0% to radiology RVUs, 4.0% in pay-as-you-go (PAYGO) reductions and 2% Medicare sequestration intended to align CMS’s budget with overall federal budget goals.
RBMA tells CMS a compensation drop of this magnitude is “unsustainable in the current environment.”
The organization describes several factors that will hit U.S. healthcare with particular force in 2023. These include lingering pressures from the COVID pandemic, current and likely continuing 8.5% to 9% inflation, and rising health insurance premiums for support staff as well as physicians and other clinicians.
To read more, go to Radiology Business.
|New Playbook Aims to Help Employers, Plan Sponsors Negotiate Hospital Prices
By Paige Minemyer | September 8, 2022
A new playbook aims to arm employers with the tools needed to negotiate hospital prices.
The National Alliance of Healthcare Purchased Conditions released the book on Thursday, and it offers strategies for plan sponsors to harness newly released price transparency and quality data as leverage to drive down prices. The book notes that hospitals charge commercial plans significantly more than Medicare, often with prices 140% to 200% higher than Medicare rates.
The group says a “fair price” would instead “allow for a reasonable markup from costs and a price that is competitive with peer hospitals” without price-gouging the commercial market.
“For the first time, we finally have data that reinforces what we’ve long known—hospitals prices are out of control—and we can’t rely on health systems and health plans to course correct,” said Michael Thompson, National Alliance president and CEO, in a release. “Employers not only have the right, but a responsibility as plan fiduciaries, to negotiate fair prices. Now is the time for honest discourse and action on what is reasonable to pay for services provided.”
So what can employers do in these negotiations? For one, using the data now available, they can identify what a hospital needs to earn to break even and can build potential rates from there. Once that breakeven point is determined, plan sponsors can compare prices between hospitals to get a feel for market dynamics.
The Employers’ Forum of Indiana has launched Sage Transparency, a free hospital pricing dashboard that employers can use to compare hospital pricing and quality data. The tool pulls from multiple data sources, including RAND Corporation, the Centers for Medicare & Medicaid Services and Turquoise Health.
The National Alliance says that this tool and others like it are valuable resources that employers can tap into when determining a fair market price for hospital services. And While there isn’t a one-size-fits-all solution, plan sponsors can mix and match the suggestions in the playbook to meet their local needs, the alliance said.
To read more, go to Fierce Healthcare.
|Outsourcing Reporting During Out-of-hours Shifts Benefits Staff, but is it Sustainable?
Hanna Murphy | September 7, 2022
Over the last decade, radiologists have had to adapt to a significant increase in out-of-hours reporting and, according to a new analysis, that trend does not appear to begin slowing anytime soon.
Published in Clinical Radiology, the new paper reviews the increasing demand for clinically urgent out-of-hours (OOH) CT reporting over the last 15 years, as well as the resultant impact it has had on specialty trainees and patients. Corresponding author of the paper, Paul Lyon, from the Department of Radiology at Oxford University Hospitals NHS Foundation Trust, and colleagues shared that during this time frame, requests for urgent CT reads during the evening, overnight and on the weekends has increased more than 10-fold, causing a negative ripple effect throughout the radiology workforce, especially among residents.
“The rate of increase in the demand for complex imaging continues to outstrip the rate of expansion of the clinical radiology consultant workforce and as a result, the radiology specialty is currently experiencing a workforce crisis and urgent action is needed,” the authors explained.
To compensate for the increased demand for CT interpretations outside of normal working hours when resources were limited at Oxford University Hospitals NHS Foundation Trust, an option to outsource acute CT on an ad hoc basis was introduced in 2020. By the end of 2021, approximately 22% of exams were outsourced during a 12-hour night shift, leaving close to 78% of exams to the specialist trainee on staff.
Residents who most often reported during OOH shifts answered surveys before and after the option to outsource reads was offered. The results of said surveys revealed a significant increase in job satisfaction after the option to outsource during especially busy shifts was available to use.
To read more, go to Health Imaging.
|How Signify Health Fits into CVS’ Healthcare Strategy
By Paige Minemyer | September 6, 2022
CVS Health has taken the first step in its bid to branch further into healthcare services with its acquisition of Signify Health, executives said Tuesday.
CVS announced late Monday that it will buy home health company Signify in a deal valued at about $8 billion in cash. The retail healthcare giant beat out a number of competitors including big names like Amazon and UnitedHealth Group to snap up Signify.
Bringing Signify into the fold advances the company further into both the home health and the managed service organization (MSO) markets, Sree Chaguturu, M.D., CVS Health’s chief medical officer, told Fierce Healthcare. It also builds on the foundation CVS has built in retail health through its pharmacies and MinuteClinic locations.
“Our relationship with Signify Health helps us meaningfully advance that strategy in two of the three verticals, MSO and home health, so we’re really excited about that,” he said. In addition to home health and value-based care, CVS flagged primary care as a focus for its expansion efforts. On its second-quarter earnings call, executives said that the company was eyeing a major play in the primary care market by the end of this year.
To read more, go to Fierce Healthcare.
|Private Equity Investors Sharpen Focus on Specialty Healthcare
By Caroline Hudson | September 6, 2022
Healthcare private equity deals in 2022 aren’t living up to last year’s red-hot performance, but investors still want in on specialty care.
More than 740 deals occurred in healthcare services in the first half of the year, down 20% from the same period in 2021 but an increase of 16% from 2019, according to an Oliver Wyman report. Private equity deals continue to play a significant role in healthcare, even as inflation and higher costs change the landscape.
Investors’ interest in physician practices began years ago, starting in areas such as urgent care, dermatology and anesthesia. Healthcare’s recession resilience is attractive to investors. There is also money to be made on such a large portion of the economy – about 20% of U.S. gross domestic product, according to the Centers for Medicare & Medicaid Services.
Investors today are increasingly interested in the “-ologies,” higher-level care services including cardiology, neurology and radiology, said Ashraf Shehata, partner and U.S. national sector leader for healthcare and life sciences at consultancy KPMG. Orthopedics is another area garnering attention.
To read more, go to Modern Healthcare.
|Video: 3D Mammography is Becoming the Standard-of-Care in Breast Imaging
By Dave Fornell | September 2, 2022
Society of Breast Imaging (SBI) President John Lewin, MD, associate professor of radiology and biomedical imaging, and division chief, breast imaging, at the Yale School of Medicine, explains breast tomosynthesis (also called 3D mammography) has already become the default standard in mammography today.
Breast imaging centers are adopting the newer 3D mammography technology because it has the ability to view the breast in slices, similar to the CT scan. This allows areas that appear to have a mass can be viewed layer by layer to see if the suspicious area is just overlying dense breast tissue. Users say this helps a lot in determining is a patient should be called back for additional imaging, biopsy, or if the area of concern is just overlapping tissue.
Full-field digital mammography (FFDM) has been the standard modality for breast imaging for about two decades, but digital breast tomosynthesis (DBT) systems are rapidly growing in numbers by more than 1,000 new systems installed per year. According to the U.S. Food and Drug Administration (FDA) Mammography Quality Standards Act and Program (MQSA) statistics, DBT now makes up 46% of the accredited mammography systems in the United States. Looking at the growth pattern the past few years, it is set to overtake FFDM systems within the next couple years.
Lewin said there may be more FFDM systems, but he believes DBT is already the new stand of care.
“From my experience, tomosynthesis is now default breast imaging modality,” Lewin said. “I suspect there are still some centers doing only full-field digital mammography, but I think they are far and few between.”
He said a lot of centers have FFDM systems, but they are using their newer DBT systems as their front-line imaging workhorse systems. Lewin said he does not see many centers in his area using FFDM much anymore. Certaining at the larger academic centers and breast centers he has worked with in recent years or referrals, be in daily receiving DBT exams to review.
“Even though it is more time-consuming to read the tomosynthesis screenings, it is becoming the standard-of-care. And I have to say, there is extra reimbursement if you do a mammography and a tomosynthesis, and that definitely has had an effect on adoption,” Lewin said.
To read more, go to Health Imaging.