|Tough Sledding for Patients Using Hospital ‘Transparency’ Tools to Obtain Imaging Price Estimates |
By Dave Pearson | September 21, 2022
In a recent dry run, more than three-quarters of several hundred healthcare consumers shopping for lumbar spine MRI succeeded in navigating to cost estimation tools within four hospital websites.
However, less than 28% of the compensated patient stand-ins completed the full mock assignment at hand: Obtain out-of-pocket price estimates from all four.
Mulling the gap, radiology researchers behind the project surmise many hospitals have much work to do before their online cost estimators progress from merely present for the public—and satisfactory for CMS compliance—to the point at which they become truly helpful for patients.
Corresponding author Gelareh Sadigh, MD, of Emory University and colleagues describe the experiment in a study published online Sept. 20 by JACR .
The team recruited 476 qualified English-speaking surrogate patients through Amazon’s Mechanical Turk (MTurk) platform, which matches project hirers with at-home gig workers.
Prior to posing as self-pay patients seeking non-contrast MRI of the low back, the MTurkers viewed a three-minute video presenting the basic how-tos of digital estimator tools in healthcare.
Participants also completed a survey on their health literacy, prior imaging experience and so on.
On the back end, the cohort would be asked to grade the estimators using a system usability scale (SUS).
Patients Grade Estimators No Higher than C+
Reviewing the results after the surrogates completed the grading exercise as well as the tool-engagement task, Sadigh and co-researchers found nearly 10% of the field could not locate any of the four hospitals’ online cost estimators.
Further, while 67.4% found at least one cost estimator across the hospital websites, only 27.7% came back with the correct price from all four.
As for the grading of the estimators’ usability on a scale of a possible 100, the average SUS ranged from 62.4—which would be a failing grade in high school—to 77.5 (C+).
On this the authors comment that there’s room for improvement “if the goal of these tools is for patients to use them.” Unsurprisingly, a hospital whose estimator closely resembled one shown in the tutorial video had the highest SUS. The authors further report that the surrogate consumers achieved higher price accuracy as they progressed through experiment, suggesting practice might eventually pay off.
To read more, go to Radiology Business.
|Now is the Time to Shape Future Good Faith Estimate Rulemaking |
By Amada Norris | September 20, 2022
The departments of the Treasury, Labor, and Health and Human Services released a request for information regarding the No Surprises Act.
The departments recently released a lengthy request for information for revenue cycle leaders to inform future rulemaking to implement advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements under the No Surprises Act.
The request asks commenters to share their expertise on a range of issues and even poses specific questions to help inform the development of future regulations. Some of these questions include:
What issues should the departments and office of personnel management (OPM) consider as they weigh policies to encourage the use of a fast healthcare interoperability resources-based application programming interfaces (API) for the real-time exchange of AEOB and GFE data?
What privacy concerns does the transfer of AEOB and GFE data raise, considering these transfers would list the individual’s scheduled (or requested) item or service, including the expected billing and diagnostic codes for that item or service?
How could updates to this program support the ability of providers to exchange GFE information with plans, issuers, and carriers or support alignment between the exchange of GFE information and the other processes providers may engage in involving the exchange of clinical and administrative data, such as electronic prior authorization?
What, if any, burdens or barriers would be encountered by small, rural, or other providers, facilities, plans, issuers, and carriers in complying with industry-wide standards-based API technology requirements for the exchange of AEOB and GFE data? Comments are due in 60 days and electronic comments on this regulation can be submitted on its website.
To read more, go to HealthLeaders Media.
|AHA, AMA Drop Surprise Billing Lawsuit, Plan Further Legal Action |
By Maya Goldman | September 20, 2022
The American Hospital Association and the American Medical Association have ended one legal challenge to the federal surprise billing arbitration process but have plans to try again, the organizations announced Tuesday.
“We have serious concerns that the August 2022 final rule departs from congressional intent just as the September 2021 interim final rule did. Hospitals and doctors intend to make our voices heard in the courts very soon about these continued problems,” the AHA and AMA said in a joint statement.
The AHA and AMA’s fellow plaintiffs–UMass Memorial Health Care of Worcester, Massachusetts, Renown Health of Reno, Nevada, Dr. Stuart Squires and Dr. Victor Kubit–also dismissed their claims against the government.
The two healthcare associations filed a lawsuit against the federal government in December, contending the surprise billing arbitration process would harm providers by leading to underpayment for out-of-network services. The interim regulation required arbiters to pick the offer closest to the insurer’s median contracted in-network rate.
In February, the U.S. District Court for the Eastern District of Texas ruled in favor of providers in a separate lawsuit over the arbitration process. The decision is reflected in regulators’ final rule on the process, which requires that arbiters consider both an insurer’s median contracted in-network rate and additional information when deciding the payment for a surprise bill.
The AMA and AHA’s current lawsuit is moot after regulators released a final rule on the surprise billing arbitration process in August, an AHA spokesperson said.
Still, providers aren’t happy with the final rule, and plan additional legal action over the arbitration process.
The AHA and AMA did not respond when asked their specific concerns. The AMA and AHA’s lawsuit was consolidated with a complaint from the Association of Air Medical Services over the same process in February. The Association of Air Medical Services is not listed as one of the plaintiffs dismissing their claims Tuesday and did not respond to a request for comment.
The parties are scheduled to have a status hearing before Judge Richard Leon of the U.S. District Court for the District of Columbia on Wednesday.
To read more, go to Modern Healthcare.
|1 in 5 Households Carries Medical Debt, Risks Falling into ‘Downward Spiral of Ill Health and Financial Precarity’ |
By Dave Pearson | September 19, 2022
Insured or not, few Americans are immune to medical debt. And when a budget-busting event comes, it can significantly worsen such basic social determinants of health (SDOH) as housing security and food affordability.
These are among the findings of researchers at City University of New York who explored possible associations between SDOH and medical debt. JAMA Network Open published the research online Sept. 16.
David Himmelstein, MD, Steffie Woolhandler, MD, MPH and colleagues analyzed three years’ data from the U.S. Census Bureau’s annual Survey of Income and Program Participation (SIPP).
The data reflected responses from almost 136,000 nationally representative participants.
The researchers found that, from 2017 through 2019, 18% of households and 11% of individuals were saddled with medical debt.
U.S. residents with middle-class or low incomes “bear the brunt of this debt burden,” the authors comment. “[O]nly the highest-income and most educated segments of society are relatively spared” .
The team did not examine specific sources of medical debt, but a study published earlier this year found many patients worry about their wherewithal to pay for advanced imaging, with some 15% risking their health by foregoing ordered CT or MRI exams .
Other key findings from Himmelstein, Woolhandler, et al.:
Persons with low and middle incomes had similar rates of burden—15.3% of uninsured persons carried debt, as did 10.5% of the privately insured.
In 2018 the mean medical debt was $21,687 per debtor.
Acquiring medical debt between 2017 and 2019 was associated with worsening SDOHs, with odds ratios of 2.20 for becoming food insecure, 2.29 for losing ability to pay rent or mortgage, 2.37 for losing ability to pay utilities and 2.95 for eviction or foreclosure in 2019.
The team further found that living in a Medicaid-expansion state was protective against accruing medical debt. By contrast, losing coverage, becoming disabled or experiencing a new hospitalization all correlated with acquiring medical debt. Similarly budget-draining were having private high-deductible coverage, coverage by Medicare Advantage or no coverage at all.
To read more, go to Radiology Business.
|Employers, Researchers Struggle to Glean Insights From Deluge of Insurer Data – Can CMS Help? |
By Frank Diamond | September 16, 2022
Everybody knew the storm was coming. Health insurance plans in July released a blizzard of data about what they charge employers and providers for covered services. Stakeholders knew that the volume could be overwhelming.
That’s why the data were not meant to be used by consumers—insurers must release that sort of patient-facing data next year under an Affordable Care Act mandate that’s enforced by the Centers for Medicare & Medicaid Services (CMS).
CMS encouraged intermediary computer experts to jump in and interpret the information for everybody else, saying that the situation would “offer third-party developers and innovators the ability to create private sector solutions to help drive additional price comparison and consumerism in the healthcare market.”
Yet, computer experts who followed that advice have yet to make sense of the insurer data.
“They expected that it would be for the app developers out there to take these files and turn them into consumer-oriented products,” Kosali Simon, Ph.D., said in an interview. “It would be for the large health systems and large employers to see what the prices are like.”
But even the computer whiz intermediaries aren’t having much success. “We have had a team of data science masters’ students analyzing the data here at Indiana University,” Simon explains. “Even to download one tiny, tiny part of it is a giant task, let alone open the file or understand the data.”
Simon is a nationally known healthcare economist at Indiana University. She’s generally considered to be the expert who’s taken the deepest dive into the insurance industry data. Simon believes that CMS should have fielded the insurer information rather than having them post it on their websites.
To read more, go to Fierce Healthcare.
|Intelerad’s $500M Investment Creates Image-sharing Network Managing 80B Images |
By Dave Pearson | September 16, 2022
Suggesting the move will significantly advance radiology’s specialty wide imperative to “ditch the disk,” Montreal-based Intelerad Medical Systems has announced it is acquiring a longtime competitor in the image-exchange space.
That would be Life Image of Newton, Mass.
Intelerad says the purchase creates the single largest medical image-exchange network in the world, following as it does not long after Intelerad’s acquisitions of PenRad Technologies earlier this year and Ambra Health last year.
In fact, the company tells Radiology Business that the approximately half-a-billion dollar investment mentioned in a Sept. 15 announcement “includes this acquisition of Life Image, Intelerad’s acquisition of Ambra, and the company’s R&D/additional spend and investment in image exchange.”
In the announcement, Intelerad suggests the addition of Life Image accelerates the inevitable demise of the CD across medical imaging worldwide. Mike Lipps, the company’s CEO, ties this aspect of the development to the #ditchthedisk drive promoted by the ACR, RSNA and SIIM.
“Today’s transaction reflects one of the most important steps we could imagine in reaching that vision,” Lipps says. The announcement quotes Geraldine McGinty, MD, MBA, a past president of the ACR.
“As an advocate for radiology’s critical role in health equity, I am so encouraged by the announcement of this expanded network and its commitment to interoperability,” McGinty says. “Patients and physicians alike need an easy way to share images, and this is an important first step toward enabling vendors to work together as they should.”
To read more, go to Radiology Business.