Planned Medicare Cuts Will ‘Cripple Specialty Providers,’ Radiology Groups Warn Congressional Leaders
By Marty Stempniak | October 14, 2020
Radiology groups are continuing their full-court press on congressional leaders, seeking to avert tens of millions in Medicare cuts to the specialty arriving on Jan. 1.
The latest plea came in a letter to House Speaker Nancy Pelosi and Senate Majority Leader Mitch McConnell, imploring them to waive budget neutrality requirements. Their concerns stem from a Centers for Medicare and Medicaid Services’ plan to boost pay for primary care and other providers that bill for evaluation and management services. This necessitates a corresponding cut elsewhere that falls in the lap of radiology and other specialties, the 10 societies noted.
“We do not oppose improving payments for E/M billed office visits, like primary care, but this moment is the wrong time for significant cuts to essential services,” the Society of Nuclear Medicine and Molecular Imaging, Radiology Business Management Association and others wrote Oct. 9. “The drastic budget neutrality adjustments required by CMS will cripple specialty providers unless Congress acts to waive budget neutrality.”
SNMMI highlighted the letter in a Tuesday news update, noting that nuclear medicine stands to sustain an 8% reduction in payment while radiology will see its pay drop 11%. Absent action from Congress, Medicare beneficiaries will likely see reduced access to care amid consolidation in the industry. Providers are already struggling to find a foothold during 2020’s challenging business climate, making this an “inopportune time” to reduce reimbursement, they wrote.
“Due to the COVID-19 pandemic, physicians and healthcare providers face not only an unprecedented public health challenge but serious economic ones, too,” they said.
To read more, go to Radiology Business.
CAQH Announces Development of National Directory of FHIR Endpoints
October 14, 2020
CAQH has announced the development of a centralized directory of validated payer FHIR endpoints and third-party applications. This solution will simplify how healthcare organizations and app developers connect with each other to help consumers access and transfer their healthcare information. The directory, developed with support from the technology company Edifecs, will help payers meet new Centers for Medicare and Medicaid Services (CMS) interoperability regulations that become effective in 2021 and 2022.
Earlier this year, CMS released a final Interoperability and Patient Access rule that requires CMS-regulated plans to enable consumers to access their healthcare information on a third-party app of their choice. Under the rule, consumers must also be able to transfer that information from a previous health plan to their current plan. The CMS rule requires the use of Fast Healthcare Interoperability Resource (FHIR) application programming interfaces (APIs) to share this information between plans and apps. The CMS rule is intended to facilitate better decision-making, care coordination and improved health outcomes.
The Office of the National Coordinator for Health Information Technology (ONC) FHIR at Scale Task Force (FAST) has highlighted the need for an endpoint directory as part of an overarching set of proposed solutions to advance FHIR implementation at scale.
A prototype of the CAQH Endpoint Directory that builds on the ONC FAST foundation was presented at a recent HL7 FHIR Connectathon to gather industry input and test certain portions of functionality. The feedback affirmed that development of the CAQH Endpoint Directory meets an industry need and can play a helpful role in supporting compliance with the CMS rule. Over the coming months, CAQH will continue to engage industry implementers and experts to launch the solution early in 2021 in time to enable plans to meet CMS requirements.
To read the press release, click here.
How Physician Ownership is Changing in 2020: 7 Key Insights
By Angie Stewart | October 13, 2020
Seven observations and predictions related to physician practice ownership in 2020:
78% of Women Oppose Using AI to Independently Read Mammograms Without a Radiologists’ Help
By Marty Stempniak | October 13, 2020
Almost 78% of women oppose using artificial intelligence to independently read mammograms without a radiologist serving as backstop, according to a new survey.
Another 42% disagreed with the idea of deploying AI to select breast imaging studies for a second read, versus more than 31% who agreed, and another 27% who are undecided. The findings illustrate that even if such algorithms are ready for primetime, radiology providers may have work to do convincing patients of their efficacy, Dutch experts wrote Monday in JACR.
“These findings are somewhat surprising, because recent work has shown AI to be of great promise for mammography screening, even outperforming radiologists,” Yfke Ongena, with the Center of Language and Cognition at the University of Groningen, Netherlands, and colleagues wrote Oct. 12. “Therefore, from the population’s perspective, it is too premature to leave the interpretation of screening mammograms completely up to independently operating AI algorithms.”
To reach their conclusions, Ongena et al. surveyed 922 Dutch women between the ages of 16 and 75 in two separate waves—earlier this year and back in December 2018. Their aim was to gauge the general population’s views on AI in breast imaging, hypothesizing that most would have positive perceptions, given favorable reporting in the lay press.
But they were surprised to find that public attitudes still have a long way to go before AI hits the mainstream. Just 17% of respondents explicitly objected to using AI as a second reader, the team noted, presenting an opening to use the technology in tandem with a physician leading the way, Ongena and colleagues wrote.
“Improved information supply and education about the development, possibilities, and limitations of AI algorithms in screening mammography may potentially overcome some of the perceived obstacles and increase acceptance of this new technique in clinical practice,” the authors advised.
Read much more on their findings in the Journal of the American College of Radiology here.
CMS Amends Repayment Terms for Accelerated, Advance Payments
By Jacqueline LaPointe | October 13, 2020
CMS recently announced new repayment terms for payments issued to providers under the Accelerated and Advance Payment Programs at the start of the COVID-19 public health emergency.
In an announcement late last week, the federal agency stated that repayment will now start one year after the issuance date of each provider or supplier’s accelerated or advance payment.
Recoupment under the programs usually starts 120 days after providers receive the first payment. But a continuing resolution signed into law at the start of the month directed CMS to amend the repayment terms to give providers flexibility.
“In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” CMS Administrator Seema Verma said in the announcement. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors. While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal.”
During the COVID-19 public health emergency, CMS provided more than $98 billion in accelerated payments to over 22,000 Part A providers. In addition, more than $8.5 billion in advance payments were paid to over 28,000 Part B suppliers, including physicians, non-physician practitioners, and durable medical equipment suppliers.
New repayment terms also state that, after the first year, CMS will automatically recoup the payment by holding back 25 percent of Medicare reimbursements otherwise owed to the provider for 11 months. Then, recoupment will increase to 50 percent of Medicare reimbursements for another six months.
Any outstanding balances on the accelerated or advance payments at the end of the period will be subject to an interest rate of 4 percent. CMS will send a letter requiring repayment within 30 days of the date of the letter.
Providers and suppliers who are unable to repay the accelerated or advance payments because of financial hardships will be able to request an Extended Repayment Schedule (ERS).
According to CMS, an ERS is a debt installment payment plan that gives providers up to five years to repay balances owed to CMS. Most providers will be given three years to repay the accelerated and advance payments, CMS noted. Only providers facing extreme hardship are granted five years.
The agency encourages providers and suppliers to contact their Medicare Administrative Contractor (MAC) for more information.
CMS also clarified in the new repayment terms that providers could use payments issued under the Provider Relief Fund to pay back accelerated and advance payments.
To read more, go to Revcycle Intelligence.
HHS Officially Extends COVID-19 Public Health Emergency Again Ahead of Upcoming Expiration Date
By Marty Stempniak | October 12, 2020
Health and Human Services has officially extended its COVID-19 public health emergency declaration for another 90 days ahead of the Oct. 23 expiration date.
Secretary Alex Azar recently shared news of the renewal, which comes with several policy implications for physicians that would have disappeared by the end of the month. This is the third such extension and will maintain the emergency declaration into January of 2021.
“We will continue our whole-of-America response to the virus and continue our work to ensure Americans have access to the care they need,” Azar tweeted on Oct. 2.
HHS last renewed the declaration in July at the urging of the American College of Radiology and other provider groups. ACR highlighted the extension in an update to members posted on Monday, noting that it comes with crucial implications related to telehealth, Medicare and Medicaid blanket waivers and interim final rule policies.
“We need to ensure all physician practices have access to continued federal public health emergency protections to reassure patients that they will continue to have uninterrupted access to these valuable services,” Cynthia Moran, ACR’s executive VP of government relations, economics and health policy, told Radiology Business back in June ahead of the second renewal.
To read more, go to Radiology Business.