Surprise Billing Talks Die Down After Provider Lobbying Offensive
By Rachel Cohrs | December 9, 2020
Last-minute efforts to reach agreement on policy to ban surprise medical bills have slowed amid a multi-front lobbying push by healthcare providers and conservative groups.
Talks on surprise billing revived in the House over the weekend, but lawmakers haven’t reached an agreement on an issue that has stubbornly divided both Democrats and Republicans for more than a year, according to lobbyists and staff familiar with the conversations.
Talks of tweaking surprise billing legislation to appease provider-friendly lawmakers have been simmering since summer, but the changes weren’t enough to win over skeptical stakeholders. Eighteen physician groups, including the American Medical Association, sent lawmakers a letter stating that tweaks to allow providers to batch claims in dispute resolution processes and allow arbiters to consider prior contracted payment rates didn’t win their support.
“We have concerns that the new proposal does not provide a fair process to resolve payment disputes between insurers and physicians. It continues to harm physicians and our patients to the benefit of insurers,” the groups wrote in October.
The American Hospital Association last week warned that talks could resume amid negotiations on year-end spending legislation and made clear its adamant opposition to the existing deal.
“We oppose legislative proposals that set a default payment rate for out-of-network services. While no legislative language has been provided, we understand the proposal would include a prohibition on balance billing and rely on rate setting to establish an initial payment, with an opportunity for providers to dispute the payment,” the AHA said in a fact sheet released Dec. 3.
To read more, Modern Healthcare.
Bipartisan COVID-19 Relief Framework Includes $35 Billion in Provider Grants
By Rachel Cohrs | December 9, 2020
A COVID-19 relief framework created by a bipartisan group of centrist lawmakers includes $35 billion in relief grants for healthcare providers.
The legislative summary, dated Wednesday, still leaves the thorny issues of liability protections and state and local aid unresolved. Prior slimmed-down COVID-19 relief bills advanced by Senate Republicans had cut out more money for the Provider Relief Fund.
HHS has distributed roughly $109 billion of the $175 billion Congress has allocated to the Provider Relief Fund as of mid-November, according to data released by the department. Some prominent health systems, including HCA Healthcare, have returned grant money.
The framework details that $7 billion of the $35 billion would be set aside for rural provider and $1 billion for tribes and Indian health organizations. The document also references changes to clarify reporting requirements for healthcare providers to keep grant money, including allowing grant money to be used for staffing and childcare. Changes to the requirements in recent months have prompted outcry by healthcare providers and concessions by HHS.
The framework proposes allowing health systems to move grant funds received in targeted distributions throughout their systems, which would provide more flexibility and potential utility of the funds.
Though Congress didn’t give HHS much guidance on how to distribute or prioritize funds, the framework would direct HHS to consider healthcare providers who have been underrepresented so far or are at “imminent risk of closure.”
Other issues of importance to the healthcare industry are that vaccine development and distribution efforts would be given $6 billion, testing and tracing efforts would get $10 billion, and telehealth flexibilities would be extended through the end of 2021.
To read more, go to Modern Healthcare.
Bipartisan Group of 50 US Senators Supports Stopping Radiologist Medicare Pay Cuts
By Marty Stempniak | December 8, 2020
A bipartisan group of 50 U.S. senators are voicing their desire to stop Medicare pay cuts for radiologists and other physician specialties set to take effect on Jan. 1.
The coalition of lawmakers shared their concerns in a letter to Senate leaders on Friday in response to the recently released 2021 Physician Fee Schedule. While supporting increased funding for primary care and other office-based visits, the group believes paying for such changes on the backs of specialists will strain the system while jeopardizing patient access.
“Healthcare professionals across the spectrum are reeling from the effects of the COVID-19 emergency as they continue to serve patients during this global pandemic,” senators wrote to leaders Mitch McConnell and Charles Schumer on Dec. 4. “The payment cuts finalized by CMS would pose a threat to providers and their patients under any circumstances, but during a pandemic the impact is even more profound.”
The lawmakers noted that pay increases for evaluation and management services necessitate these cuts to balance the budget. They closed by telling congressional leaders that they “hope to work with you to address this critical issue.”
Senators Debbie Stabenow, D-Mich., Steve Daines, R-Utah, and numerous others did not suggest how they hope to avert these cuts. Physicians lawmakers in the House have suggested granting add-on payments to providers over the next two years to offset the roughly 10% reimbursement decrease, an approach favored by radiology advocacy groups.
Sen. Susan Collins, R-Maine, previously expressed her opposition to these pay cuts back in October. The Surgical Care Coalition—representing 12 professional associations and more than 150,000 physicians—applauded the letter on Monday.
“It is irresponsible to cut healthcare spending in the middle of the pandemic, and these cuts will hurt patients by limiting their access to quality care,” the group said. “We thank the senators for their leadership, and we pledge to work with Congress and all interested parties to work toward finding a solution that will protect patients by stopping these devastating cuts.”
To read more, go to Radiology Business.
Cybersecurity Flaw Discovered in 100+ GE Medical Devices
By Jessica Kim Cohen | December 8, 2020
A cybersecurity vulnerability discovered in more than 100 medical devices from GE Healthcare could compromise patient data, cybersecurity company CyberMDX said Tuesday.
It’s the latest example of how medical devices—increasingly connected to the internet or internal hospital networks—could provide another window for hackers targeting healthcare.
The flaw discovered by CyberMDX’s research team affects 104 types of radiological devices including CT scanners, X-ray machines and ultrasound devices, across product lines like GE Healthcare’s Innova, Optima, Brivo, Definium, Precision, Discovery, Seno, Revolution, Odyssey, PETtrace, Ventri and Xeleris, according to CyberMDX.
There’s no evidence to suggest malicious hackers have exploited the vulnerability.
However, a hacker potentially could use it to disrupt the devices, gain access to patient health data held in the devices or even alter such data, said Elad Luz, CyberMDX’s head of research.
That earned the flaw a severity score of 9.8 on the National Infrastructure Advisory Council’s 10-point scale for assessing cybersecurity vulnerabilities, according to an advisory that the Cybersecurity and Infrastructure Security Agency—a federal agency that’s part of the Homeland Security Department—published Tuesday.
To read more, got to Modern Healthcare.
FDA Eases Inspection, Quality Regulations for Mammography Facilities Struggling During COVID Crisis
By Matt O’Connor | December 4, 2020
The U.S. Food and Drug Administration on Friday issued new recommendations to ease quality regulations for mammography facilities struggling to keep up during the ongoing pandemic.
Under the Dec. 4 policy, the FDA said it will grant some leeway to mammography centers that can’t meet requirements normally mandated under the Mammography Quality Standards
Act. A chief goal of this new guidance, it noted, is to increase exam availability during the ongoing crisis.
“This guidance provides FDA’s current thinking in response to questions received from mammography facilities about compliance with the MQSA quality standards during the COVID-19 public health emergency to help facilitate the availability of mammography services in light of operational challenges during the public health emergency,” the administration said on Friday.
This new document is an update to its March guidance, which suspended in-person inspections and allowed regulatory flexibility for providers facing varying circumstances. The FDA, in May, said it was devising a “phased approach” to resuming in-person inspections.
In its update, the administration acknowledged that travel restrictions, quarantine and facility closures may have prevented providers from scheduling their annual on-site medical physicist surveys required under the MQSA.
As a result of these “unavoidable” scenarios, the FDA said it anticipates a large backlog once COVID-19 measures are lifted. With this in mind, the administration said it “generally” won’t object to facilities completing the survey beyond MQSA timelines. It does, however, encourage facilities to do so “as soon as possible,” specifically within six months of the 14-month date of their original survey and with documented information about the delay.
Groups that have not had an annual survey over the past 20 months should call the MQSA hotline as soon as possible to determine their plan. Such instances will be reviewed on a case-by-case basis, the FDA said.
Additionally, the FDA offered guidance on facilities struggling to meet additional MQSA requirements, including planned training, moving workstations off-site and medical physicist equipment evaluations.
“In light of these unavoidable challenges … FDA generally does not intend to object to the continued operation of facilities that have faced difficulty in complying with certain aspects of the quality standards when these facilities do not create an undue risk to patient safety or mammography quality and where the facility had no control over the events and actions that led to the noncompliance,” the administration said on Friday.
Read the entire document from the FDA here.
CMS Officially Delays Radiation Oncology Payment Model, Citing COVID-19’s Economic Strain
Marty Stempniak | December 4, 2020
The Centers for Medicare and Medicaid Services has officially delayed the start of its radiation oncology payment model amid worries it could further hobble physicians already reeling from the pandemic.
CMS originally planned to kick off the mandatory bundled-payment program Jan. 1 but will now postpone the go-live date to July. Administrator Seema Verma had hinted at the delay on social media back in October, with the 2021 Hospital Outpatient Prospective Payment System final rule released Wednesday making it official.
The federal agency has received numerous comments in recent months, voicing concerns about revenue losses, decreased patient volumes, and layoffs.
“[Radiation oncology] participants have limited capacity to operationalize RO Model requirements this year because of the unprecedented [public health emergency] that continues to strain healthcare resources,” CMS wrote in the 1,312-page final rule. A six-month delay, it added, will avoid “potentially hindering the delivery of safe and efficient healthcare to beneficiaries receiving radiotherapy services.”
The American College of Radiology had expressed “alarm” over the initiative earlier this year, concerned that CMS was rushing the rollout and including too many small practices. Officials first finalized the long-awaited RO model in September in a bid to save $230 million over the next five years. It would do so by bundling payments to radiotherapy providers treating one of 16 different cancer types, requiring participation from physicians in randomly selected geographic areas.
Radiologists Find More Evidence DBT Enhances Breast Cancer Screening
By Matt O’Connor | December 4, 2020
Digital breast tomosynthesis detects more cancers and lowers false-negative rates during breast cancer screening compared to digital mammography, according to a new study.
Yale University School of Medicine researchers analyzed more than 380,000 exams for their retrospective study, published Tuesday in Radiology. Their findings build on prior investigations that have shown DBT to improve screening outcomes.
“With DBT, you can really feel like you’re combing through the breast tissue instead of just looking at flat pictures,” lead author Melissa A. Durand, MD, associate professor of diagnostic radiology and biomedical imaging at Yale, said in a statement.
When imaging with digital breast tomosynthesis, an x-ray camera travels in an arc over a patient’s breast, gathering images from multiple angles. Those are then processed into a near 3D image, which helps radiologists see cancers that would normally hide under overlapping tissue.
After comparing DBT scans to conventional digital mammograms, Durand et al. found screening with the former bolstered sensitivity and specificity for breast cancer, while also spotting more invasive disease cases with fewer distant metastases.
“With DBT, we show we are detecting more invasive cancers, but they are cancers with favorable prognostic criteria, which means these patients would have more treatment options,” Durand explained.
What’s more, DBT was advantageous in women with dense breasts, resulting in significantly lower recall rates compared to digital mammography.
“Together with reduced recall rates and, thus, less patient anxiety, I would anticipate that DBT will continue to move forward as the standard of care to replace regular mammography,” Durand said.
Read the entire study in Radiology here.