ACR Offers Update on Radiology Report Access Under New Information-blocking Rules
By Matt O’Connor | January 20, 2021
The Office of the National Coordinator for Health IT recently updated its guidance on forthcoming interoperability regulations to answer radiology reporting concerns first raised by the American College of Radiology.
Back in October, the ACR said it had been receiving many similar questions wondering if providers’ current practice of releasing reports via patient portals after a specified period of time would constitute information blocking.
In the ONC’s updated Jan. 15 guidance, it clarifies that providers are not required by the provision to proactively release such reports or other electronic health information (EHI) to patients who have not requested it.
The federal group did note, however, that any delay in providing patients with information they had previously requested may be in violation of the new rules.
“While the information blocking regulations do not require actors to proactively make EHI available, once a request to access, exchange or use EHI is made actors must timely respond to the request (for example, from a patient for their test results). Delays or other unnecessary impediments could implicate the information blocking provisions,” the ONC said on its frequently asked questions page.
The division of the Department of Health and Human Services also stated that, in practice, this could mean a patient would be able to access information “in parallel” to when the ordering clinician has access to results.
HHS and the ONC finalized rules in March 2020, which enact the interoperability provision of the 21st Century Cures Act. Then in October, federal regulators pushed back the compliance dates required to meet these regulations until at least April 5 in an effort to give hospitals and providers more flexibility to respond to COVID-19.
The ACR, among other groups, had long been lobbying for HHS to push back these deadlines.
Read more from the ACR about the info-blocking rules here.
UnitedHealthcare Cuts Noted Academic System Out of Network, Citing Imaging Costs 2-3 Times Local Average
By Marty Stempniak | January 15, 2021
UnitedHealthcare has cut noted academic health system Montefiore and its 85-plus radiologists out of its network, citing imaging costs 2-3 times higher than other local providers.
An ultrasound exam, for instance, runs roughly $800 more than the average in New York City, while a CT is $2,200 more expensive and an MRI $4,000 pricier. After negotiations between the 10-hospital system and the nation’s largest commercial insurer broke down late last year, UHC officially carved Montefiore out on Jan. 1.
The Minnesota-headquartered company said it offered to keep the system on board through May 31 to avoid care disruptions.
“Unfortunately, Montefiore refused, unnecessarily disrupting access to its hospitals and physicians for thousands of New Yorkers,” UHC spokesman Cole Manbeck said in a statement. “Our top priority at this time is ensuring our members have access to the care they need and supporting them as they transition to one of the dozen hospitals and nearly 7,000 physicians remaining in our network in Bronx, Westchester and Rockland counties.”
On the other side, Montefiore noted that in the “final hours” of contract negotiations on Dec. 31, UnitedHealthcare asked for an extension, “without offering any good faith progress.” The health system said the payer has stalled talks since Nov. 19 and is “refusing” to respond to their latest proposal.
“We are disappointed by United’s decision to block 60,000 patients from seeing their trusted Montefiore doctors and hospitals while the pandemic continues to surge,” the health system said in a statement. “Our goal is to reach a fair resolution that restores in-network access and prevents further patient disruption. We hope United comes back to the table to meet this goal in the interest of protecting our patients and our communities.”
UHC has set up a lengthy webpage defending its decision, labeling Montefiore as “New York City’s most expensive health system.” There, it claims the provider was seeking an almost 30% price hike over the next three years that would amount to a roughly $200 million increase in costs for New York employers and families.
On its own website dedicated to the dispute, Montefiore maintained that it has invested $300 million in supplies and infrastructure responding to the pandemic. They’ve discharged more than 5,000 COVID-19 patients and saved more than 4,000 lives. Leaders also noted that, based on CMS data, Montefiore is in the top 15% of most cost-efficient academic hospitals in the U.S.
To read more, go to Radiology Business.
CMS Approves Rule Forcing Insurers to Ease Prior Authorization
By Michael Brady | January 15, 2021
CMS on Friday, January 15, approved its plan to streamline prior authorization and improve patient and provider access to medical records.
The final rule requires payers—including Medicaid, the Children’s Health Insurance Program and exchange plans—to build application program interfaces to support data exchange and prior authorization. CMS said the changes would allow providers to know in advance what documentation each payer would require, streamline documentation processes and make it
easier for providers to send and receive prior authorization information requests and responses electronically.
“The requirements of this rule specify that each of these payers will build an API-enabled documentation requirements look-up service and make these public so providers can access documentation and prior authorization requirements from their EHR platforms. Once a provider knows what is required for each prior authorization, the next step is submitting it electronically,” the agency said in a statement.
Under the rule, Medicaid and CHIP fee-for-service and managed-care plans will have up to 72 hours to make prior authorization decisions on urgent requests and seven calendar days for non-urgent requests. All covered payers must provide a specific reason for any denial.
The changes will phase in from 2023 through 2024.
Healthcare groups criticized CMS for giving them just a few weeks to review and comment on the proposed rule and excluding Medicare Advantage plans from the requirements.
To read more, go to Modern Healthcare.
CMS has Significantly Cut Interventional Radiology Reimbursement Over the Past Decade
By Marty Stempniak | January 15, 2021
The Centers for Medicare & Medicaid Services has significantly cut interventional radiology reimbursement over the past decade. And members of the profession must help build awareness of this trend to help reverse these losses, according to an analysis published Wednesday.
Between 2012 and 2020, average unadjusted procedure pay for the specialty fell nearly 7%. But when factoring in inflation, losses leapt to almost 19%, University of Rochester Medical Center experts wrote in the Journal of Vascular Interventional Radiology.
IR certainly wasn’t alone, as neuro, plastic, general and orthopedic surgery have all demonstrated pay decreases during the same time, as has diagnostic radiology. But these numbers warrant further discussion and analysis as the subspecialty hopes to flourish in the coming years, the authors advised.
“Knowledge of these trends is critically important for practicing interventional radiologists, leaders within the field and legislators, who may play a role in formulating future reimbursement schedules for IR,” Derrek Schartz, MD, and Emily Young, MD, with URMC’s Department of Imaging Sciences, wrote Jan. 13. “These data may be used to help support more amenable reimbursement plans to sustain and facilitate the growth of the specialty.”
For the analysis, the authors utilized CMS’ Physician Fee Schedule look-up tool to pull data from 20 common IR procedures. Those included endovenous ablation of an incompetent vein, tunneled central venous catheter placement, and insertion and removal of intravascular vena cava filters, just to name a few.
They discovered that those procedures that had a change to their CPT code demonstrated a larger reduction in mean-adjusted percentage change compared to those that did not (29.4% versus 16%). Percutaneous nephrostomy tube placement experienced the biggest drop when adjusting for inflation at 43%. Meanwhile, percutaneous drain placement for visceral abscess
was the only procedure in the analysis that saw an increase in pay, at 7.5%. And across all procedures, there was a nearly 3% mean decrease each year.
The authors did not explore reasons for the declines; however, they did note that procedure bundling may have been a factor for those that underwent code changes. These declines came for IR, despite Congress implementing the Medicare Access and Children’s Health Insurance Program Reauthorization Act in 2015 to bolster physician payment.
You can read more of Schartz and Young’s findings in JVIR here.