CMS Delays Enforcement of Key Provision in No Surprises Act, Drawing Radiologist Support
By Marty Stempniak | September 2, 2021
The Centers for Medicare & Medicaid Services is delaying enforcement of a key provision in the No Surprises Act, drawing support from radiologists and other physicians.
First approved in December, the legislation is slated to ban providers from sending patients unexpected medical bills for out-of-network care beginning in 2022. The feds would also require insurers to send beneficiaries an “advanced explanation of benefits” either via mail or electronically, including a “good faith” estimate of how much the service might cost.
However, after receiving feedback about the potential challenges of such a change, CMS said it will not crack down on those who violate this part of the rule in four months.
“The Departments [of Labor, Health and Human Services] agree that compliance with this section is likely not possible by January 1, 2022, and therefore intend to undertake notice and comment rulemaking in the future to implement this provision, including establishing appropriate data transfer standards,” CMS said in a notice posted Aug. 20.
The American College of Radiology said Wednesday that it appreciates the administration’s flexibility. ACR previously pushed for provisions in the bill to help hold patients harmless in physician-insurer disputes and resolve such disagreements in an equitable manner.
“We want to ensure that explanation of benefit provisions and infrastructure are instituted correctly and in a sustainable manner that all can be happy with,” ACR said in a statement.
Both the American Medical Association and Medical Group Management Association also support the delay. The latter said it’s “relieved” by the decision amid concerns the requirement could lead to erroneous accounting of what patients owe, MedPage reported Tuesday.
“An unintended consequence of this requirement could be scaring patients out of seeking treatment due to expensive, incorrect estimates,” said Anders Gilberg, senior VP for government affairs at MGMA, which represents more than 15,000 medical practices in radiology and other specialties.
Imaging experts reported earlier this year that they expect the legislation to have a substantial impact on radiology practices, regardless of their network status.
To read more, go to Radiology Business.
Healthcare Bankruptcy Filings Hit ‘Unprecedented’ Low
By Tara Bannow | September 1, 2021
When the COVID-19 pandemic hit in early 2020, many predicted a crush of healthcare bankruptcies would follow. So far, the opposite has happened.
Billions of dollars in federal, state and local aid that’s flowed to healthcare providers has led to what the law firm Polsinelli calls an “unprecedented” drop in Chapter 11 filings in an industry that’s typically among the most distressed. In fact, Polsinelli’s second quarter report shows the lowest ever recorded distress index in the healthcare industry since 2010.
It’s not just healthcare: Bankruptcies are down economy-wide, said Aram Ordubegian, a partner in Arent Fox’s bankruptcy and financial restructuring group. The simple fact is that the outflow of stimulus spending is squeezing distress out of the system—for now.
“The bubble is going to get that much bigger and when the free money flow gets turned off, we’re going to see volume back and we’re going to be busy,” Ordubegian said.
Congress approved $178 billion in grants for healthcare providers under the Coronavirus Aid, Relief, and Economic Security Act’s Provider Relief Fund, which was designed to help hospitals, medical practices and others weather the pandemic.
Providers also got $100 billion in Medicare loans and then successfully lobbied to delay the repayment deadline. The CARES Act had other perks, too, like deferred taxes.
To read more, go to Modern Healthcare.
Imaging Advocates, Bipartisan Lawmakers Unite to Oppose ‘Misguided and Massive’ Medicare Pay Cuts
By Marty Stempniak | September 1, 2021
Imaging advocates and U.S. House lawmakers are uniting to fight against proposed pay cuts in nuclear medicine and other specialties set to hit providers in 2022.
The Centers for Medicare & Medicaid Services first revealed the reductions in July as part of its latest physician fee schedule. To help offset pay increases elsewhere, CMS is planning to reduce reimbursement for one of the most commonly used single-photon emission computed tomography codes by 12%. Other updates would drag down pay for services provided by radiation oncologists and interventional radiologists.
In an alert to members Monday, the American Society of Nuclear Cardiology urged physicians to fight such changes.
“ASNC opposes these cuts and needs you to amplify its message,” the Fairfax, Virginia-based society said Aug. 30.
Reps. Bobby Rush, D-Ill., and Gus Bilirakis, R-Fla., have also reportedly signed on to the effort. ASNC shared a letter from the two-House lawmakers, pressing others in Congress to join them in opposing “misguided and massive” cuts to physician pay. The two congressmen highlighted a planned wage increase for clinical labor staff such as mammography technologists or angiography techs. Due to budget neutrality requirements, increases in one place necessitate cuts elsewhere, spelling the SPECT reduction. Treatments such as uterine fibroid embolization and endovenous radiofrequency ablation—often used by Black and Latino patients—face reductions north of 20%, the two noted.
“These year-over-year ‘budget-neutral’ cuts, being implemented during a pandemic, are causing significant disruption to the healthcare system and are being implemented without regard to patient outcomes, actual [physician fee schedule] provider resource needs, or any other rational policy,” Rush and Bilirakis wrote in the letter slated to be sent to Meena Seshamani, MD, PhD, deputy administrator and Director of the Center for Medicare.
The two urged CMS not to finalize the clinical labor change “at this time” while also asking the agency to work with Congress on fundamental reform to the fee schedule. Both ASNC and lawmakers are also concerned about the potential impact of a proposed 3.75% reduction in the conversion factor, also tied to budget neutrality.
To read more, go to Radiology Business.
Telehealth’s Limits: Battle Over State Lines and Licensing Threatens Patients’ Options
By Julie Appleby | August 31, 2021
If you live in one state, does it matter that the doctor treating you online is in another? Surprisingly, the answer is yes, and the ability to conduct certain virtual appointments may be nearing an end.
Televisits for medical care took off during the worst days of the pandemic, quickly becoming commonplace. Most states and the Centers for Medicare & Medicaid Services temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located. Those restrictions don’t keep patients from visiting doctors’ offices in other states, but problems could arise if those same patients used telemedicine.
Now states are rolling back many of those pandemic workarounds.
Johns Hopkins Medicine in Baltimore, for example, recently scrambled to notify more than 1,000 Virginia patients that their telehealth appointments were “no longer feasible,” said Dr. Brian Hasselfeld, medical director of digital health and telemedicine at Johns Hopkins. Virginia is among the states where the emergency orders are expiring or being rolled back.
At least 17 states still have waivers in effect, according to a tracker maintained by the Alliance for Connected Care, a lobbying group representing insurers, tech companies and pharmacies.
As those rules end, “it risks increasing barriers” to care, said Hasselfeld. Johns Hopkins, he added, hosted more than 1 million televisits, serving more than 330,000 unique patients, since the pandemic began. About 10% of those visits were from states where Johns Hopkins does not operate facilities.
To read more, go to Kaiser Health News.
Imaging Did Not Contribute to an Increase in Medicare Spending Between 2009-2019
Mary Stempniak | August 30, 2021
Imaging did not contribute to an increase in Medicare spending between 2009 to 2019, despite claims to the contrary, according to a new analysis published Sunday.
Total U.S. healthcare expenditures hit $3.8 trillion two years ago, representing a fourfold increase in the sector’s share of the gross domestic product since 1960. That’s compelled efforts to reduce spending, with radiology one of the prime targets, University Hospitals Cleveland experts noted.
However, the specialty recorded the most negative compounded annual growth rate when compared to all other Medicare Part B categories during those 10 years. Imaging represented just 8% of Part B spending, 1.4% of total Medicare outlays and 0.05% of all national healthcare expenditures, researchers detailed in Current Problems in Diagnostic Radiology.
“These findings contradict statements that physician services and imaging are a significant contributing factor for the growth of expenditures and the disproportional amount the United States spends in healthcare compared to other countries,” corresponding author Keval Parikh, MD, with University Hospitals’ Department of Radiology, and colleagues wrote Aug. 29. “Further investigation of other components of the [national health expenditures] other than Part B, such as out-of-pocket expenditures and facility fees, may help clarify the total contribution that imaging has in the NHE.”
During the 10-year study period, payments per Part B service declined at a 1.4% compound annual growth rate. Imaging recorded the biggest drop at 3.5% among all categories. Within that segment, nuclear medicine saw the biggest dip at 7.4%, followed by MRI/MR angiography (-5.8%), CT/CTA (-3.5%) and ultrasound (-3.3%). Meanwhile, plain film X-rays logged a positive growth rate of 0.4%. There was a total of 5.1 billion services paid for in 2019, and imaging represented about 8% of that volume. CAGR for number of services was 2.1% during the study, and imaging recorded a 0.5% growth rate.
And Part B expenditures totaled $115.6 billion by 2019, with a modest growth rate of 0.6%. That was driven by drugs (up 5.9%) and procedures (0.9%), at a time when imaging dropped 3%.
Despite these numbers, the federal government has targeted imaging spending for cuts on several occasions. Parikh et al. are concerned about the impact of continued pressure on imaging pricing.
“If price control leads to decrease in reimbursements to unsustainable and unfair levels, it may cause unintended consequences such as shortages of physicians and physician services, rationing, deterioration of quality (e.g., burnout), the creation of additional fees to patients and/or the increase in out-of-pocket expenditures,” the authors noted. “In fact, there is evidence that patients very commonly pay coinsurance when undergoing advanced imaging, both in and out of the network. This could be a sign of the unintended consequences of reduction in fee services beyond the equilibrium point for suppliers of Imaging services.”
To read more, go to Radiology Business.
Quality Experts Urge CMS to Fold Imaging Appropriate Use Criteria Program Into Other Value Initiatives
By Marty Stempniak | August 27, 2021
Healthcare experts with several noted institutions are urging the Centers for Medicare & Medicaid Services to combine the agency’s long-delayed imaging Appropriate Use Criteria Program with other already-running quality efforts.
First established in 2014, the initiative requires physicians to consult a decision-support system before ordering MR, CT and other advanced imaging to help curb healthcare waste. But it’s been plagued by postponements, with CMS most recently pushing the penalty phase back another year, to Jan. 1, 2023.
In a Health Affairs blog published Thursday, quality experts with Johns Hopkins, Harvard and Weill Cornell advocated for potentially folding the AUC program into other similar endeavors. Their request comes after members of Congress in July instructed CMS to reexamine the quality mandate, created seven years ago under the Protecting Access to Medicare Act to curb growing spending on imaging.
“In the years since PAMA was enacted, CMS’ quality initiatives have begun to move the U.S. healthcare system toward value over volume, and toward patients over paperwork,” Andrew Menard, JD, Johns Hopkins Health System’s chief administrative officer—radiology, and co-authors wrote Aug. 26. “As a result, the clinical problem and opportunity for taxpayer savings that motivated Congress to instruct CMS to design and implement the PAMA AUC program have diminished significantly.”
Menard and colleagues suggested folding appropriate-imaging use into the federal agency’s broader Quality Payment Program initiatives. This approach, they wrote, would best serve patients, taxpayers, clinicians and CMS, with the latter recently considering paring down payment models to ease reporting requirements. As a second, “less effective” alternative, Menard and co-authors advised Congress and CMS to simplify PAMA, which they believe will improve the AUC program’s clinical, operational and administrative value.
Physician groups such as the American Society of Nuclear Cardiology have railed against the imaging quality initiative, advocating for its repeal, or a pause for re-examination. In a blog post this month, the society labeled AUC as “complex, administratively burdensome, unnecessary, [and] unworkable.” ASNC has helped lead a coalition of more than 30 medical societies that pushed for lawmakers to authorize a review of the program prior to July’s request from the House Appropriations Committee.
“Congress’ concerns with the AUC program are well-founded, and we suggest that CMS and Congress consider [these] two legislative approaches,” Menard et al. advised.
To read more, go to Radiology Business.
HHS Announces Webinar to Help Radiologists, Other Clinicians Maneuver Info-blocking Rules
By Matt O’Connor | August 26, 2021
The Office of the National Coordinator for Health IT will be hosting an upcoming webinar to help clinicians comprehend and comply with recently enacted federal interoperability and information blocking rules.
ONC has scheduled the online session for Sept. 14 at 1 p.m. ET, according to an announcement posted Thursday by the American College of Radiology. Presenters will
highlight basic requirements and exceptions of the rules but are unlikely to discuss enforcement topics that have yet to be determined by HHS.
The regulations, part of the 21st Centuries Cures Act, went into effect on April 5 after HHS and ONC previously pushed back the go-live date. ACR has expressed frustrations with the process after fielding many similar questions from members detailing anxieties around changes to radiology report access.
The college last sent an update on the topic in March, noting ONC’s clarifications have only muddied prior guidance on report access under the regulations.
Current practice dictates waiting a specified period of time before releasing imaging results to properly coordinate care, but the new guidance requires providers share reports when they are available. HHS has yet to finalize enforcement rules and penalties for information blocking.