Radiology Business Leaders Want Feds to Postpone Surprise-billing Ban by 1 Year, to 2023
By Marty Stempniak | September 8, 2021
Radiology business leaders are urging the federal government to delay the launch date for legislation banning providers from sending “surprise” medical bills—set to start in less than four months.
Health and Human Services released its interim final rule in July, beginning the process of implementing the No Surprises Act created through congressional action. Tuesday was the final deadline for radiologists to submit comments on the legislation, with several groups in the imaging industry voicing their concerns.
The Radiology Business Management Association is pressing the administration to push back the go-live date for physicians to 2023. Health plans do not have the same launch period, and the Fairfax, Virginia-based advocacy group is concerned this could create patient confusion and an uneven playing field.
“With the continuing pandemic emergency, the effective date should be January 1, 2023,” Executive Director Robert Still wrote in comments submitted to the secretaries of HHS and the departments of treasury and labor on Sept. 2. “We don’t believe there is adequate time for providers or health plans to develop and put the necessary systems and procedures in place to comply with the rules by January 1, 2022, especially since some pertinent regulations have not yet been issued.”
Both RBMA and the American College of Radiology also criticized how the administration plans to determine “qualifying payment amounts” under the legislation. Currently, the No Surprises Act defines this amount as the median contracted rate recognized by the insurer on Jan. 31, 2019, with annual updates for inflation. ACR noted that this figure will be used both as part of criteria to settle payment disputes between insurers and providers, and to calculate patient cost-sharing amounts.
“We are concerned that attempts to establish the [qualifying payment amount] as the primary factor in [independent dispute resolution] determination would convert a balanced, arbitration-based law into a benchmark-style law that favors insurers at the expense of patients and providers,” ACR Chief Executive Officer William Thorwarth Jr., MD, wrote in Sept. 7 comments submitted to the Centers for Medicare & Medicaid Services. “While the vast majority of radiologists practice in-network and do not engage in out of network billing, the ACR is concerned that the [No Surprises Act] could be used to reduce network contracting and lower in network payment rates, impacting patient’s access to medical imaging.
The Radiology Business Management Association voiced similar unease around the QPA. It’s urging the administration to require health insurers to disclose how they determine qualifying payment amounts and believes details on this calculation are “extremely vague.” “RBMA strongly suggests that CMS define a more meaningful methodology for determining the QPA,” Still wrote.
Imaging experts said earlier this summer that they believe the No Surprises Act could have a “substantial” impact on radiology practices, regardless of their network status. Meanwhile, the feds just recently delayed enforcement of one key provision of the law last month, drawing support from the specialty.
To read more, go to Radiology Business.
Imaging Consortium Releases First-of-its-kind Database to Help Fight Lung Disease
By Matt O’Connor | September 8, 2021
A new collaboration between academic, industry and patient groups has released a first-ofits-kind repository with high-resolution scans and clinical information for interstitial lung diseases.
The Open Source Imaging Consortium Data Repository currently houses nearly 1,500 anonymous CT scans with corresponding health data, the 501(c)(3) not-for-profit announced Tuesday. Lead by radiologists, pulmonologists and AI experts, the goal is to enable quick, open-source solutions to fight deadly respiratory diseases.
Advances in AI-driven medical image analysis have historically been held back by the need for large, diverse datasets. OSIC has some 5,000 additional scans in its quality control queue and plans to vet approximately 15,000 by the first quarter of 2022, the group noted.
“Being able to reliably predict how pulmonary fibrosis will progress in an individual patient would allow doctors to initiate appropriate treatment at the earliest opportunity and slow disease progression,” radiology project leader Simon Walsh, MD, of the Imperial College London’s National Heart and Lung Institute, said Sept. 7. “It remains one of the most urgent challenges for effective management for patients with fibrotic lung disease.”
The new database is three years in the making and each scan has been vetted by two global GDPR/HIPPA privacy firms. OSIC is seeking additional scans from government agencies, advocacy groups and via direct patient outreach.
A long list of organizations and partners are supporting the endeavor, including Siemens Healthineers, the American Lung Association and the University of Vienna, among many others.
“The future of medical research depends heavily on our ability to collate significant amounts of data and make that data available for detailed and open scientific investigation,” computational science lead David Barber, PhD, with the University College London said. “It’s a proud moment that OSIC is at the forefront of this movement.”
To read more, go to Health Imaging.
The Partnership Strategy Medicare Advantage Plans Are Banking On
By Nona Tepper | September 7, 2021
The booming Medicare Advantage market has become a strategic focus for major insurers and retailers to band together and grow their businesses.
Insurers partnerships are reflective on the growing population of enrollees. Over the past few years, the number of Medicare Advantage enrollees has exploded, thanks to an increasingly diverse, cost-conscious and aging population that prefers the extra benefits not offered in traditional Medicare.
The latest federal data show that 26.8 million people were covered by Advantage plans as of July, up more than 41% from 2017. During that same time, the number of those eligible for Advantage plans rose 10.3%. Approximately 10,000 Americans turn 65 every day. Anthem has said 200,000 of its existing beneficiaries reach Medicare-eligibility annually.
That’s led to big partnerships between insurers and retailers. Anthem and The Kroger Co. in July announced they planned to launch a joint Medicare Advantage plan in Atlanta, Louisville, Cincinnati and southern Virginia come 2022. Walmart teamed up with Nashville, Tennessee based Clover Health in November to offer a joint Medicare Advantage plan in Georgia, although that partnership has ended. Walmart also offers a joint, co-branded Medicare Part D plan with Louisville, Kentucky-based Humana, which it launched in 2010.
Humana counts the second-most of Medicare Advantage enrollees in the nation; UnitedHealth Group is the largest Medicare Advantage insurer.
To read more, go to Modern Healthcare.
6 Key Challenges Radiology Faces Following the COVID-19 Pandemic
By Marty Stempniak | September 7, 2021
There are six key challenges radiology departments must face following the COVID-19 pandemic, according to a new perspective piece published Sunday.
The Association of University Radiologists just recently held its fifth annual roundtable for leaders in academia and the imaging industry. Those in attendance represented top trade groups (RSNA, the American College of Radiology), academic institutions, and radiology vendors such as Sectra, Siemens, Philips, GE Healthcare and Fujifilm. All told, 16 radiologists and 14 vendor execs attended the virtual event in May.
Several important themes emerged, with a particular focus on solutions to sustain clinical productivity, innovation and physician well-being.
“The coronavirus disease (COVID-19) has resulted in unprecedented effects upon healthcare practice, with major resulting changes that will affect all medical specialties,” Omer Awan, MD, the University of Maryland School of Medicine’s associate vice chair of education, and colleagues wrote Sept. 5 in Academic Radiology. “The need for social distancing, with consequent need to promote the practice of teleradiology, has challenged both academia and industry to reevaluate optimal delivery and access to patient care.”
Here’s a quick rundown of six important themes that emerged from the event:
“Through continuous collaboration and conversations between academia and industry, many of these proposed solutions can be refined and hopefully realized in the era to come after the pandemic,” the authors concluded.
To read more, go to Radiology Business.
Hospital Financial Turnarounds Aren’t Waiting for the Pandemic to End
By Tara Bannow | September 7, 2021
Even as COVID-19 rages on, many health systems have strengthened their financial footing this year.
The combination of patients returning for medical care and continued government support have boosted some operating margins past 10%, a significant shift after what had been a challenging 2020. And while the ongoing COVID-19 surge has hit some states particularly hard, others aren’t seeing the same caseloads, which makes it easier for hospitals in those areas to resume normal operations.
“Some of that pent-up demand because of the uncertainties back in 2020 is coming forward in 2021 and we’re seeing that return of volumes,” said Rick Kes, a partner and healthcare senior analyst with RSM. “Obviously, that’s been good financially for the healthcare providers in 2021.”
Many of the strong performers this year so far are concentrated in the Midwest and Northeast, where COVID-19 cases are relatively less common. Rochester, Minnesota-based powerhouse Mayo Clinic posted an 11.3% operating margin in the quarter ended June 30, having generated $451 million in operating income on almost $4 billion in revenue. The Mayo Clinic’s operating margin was 3% during the same period last year.
The Mayo Clinic’s volumes in the first half of 2021 have surged from the same period in 2020, which isn’t surprising as that stretch includes the pandemic’s first wave and mandated procedure suspensions. Surgeries are up 3.4% in the first half over the same period in 2019, indicating that the company is chipping away at pent-up demand. Admissions and outpatient visits are still down from 2019, however.
To read more, go to Modern Healthcare.