CMS Delays Radiation Oncology Payment Model Following Fierce Opposition From Physician Community
By Marty Stempniak | October 22, 2020
The Centers for Medicare and Medicaid Services has decided to delay the start of its mandatory radiation oncology bundled payment model following fierce opposition from the physician community.
CMS had planned to launch the effort on Jan. 1; however, the go-live date will now move to July 1, 2021, Administrator Seema Verma announced Wednesday.
“The [CMS] team and I have listened to the feedback from [the American Society for Radiation Oncology] and the radiation oncology community regarding the start date of the new Radiation Oncology Model and understand that more time is needed to prepare,” she tweeted Oct. 21, calling the initiative “an important part of our strategy to strengthen Medicare and improve cancer care for patients across our country.”
The American College of Radiology had also expressed “alarm” over the initiative, concerned that CMS was rushing the rollout and including too many small practices. ASTRO said Wednesday that it “appreciates” CMS’ decision to postpone, calling the announcement “an important recognition of the radiation oncology community’s concerns.”
“We are hopeful that the delay represents the first step toward full, open engagement with ASTRO on ways to ensure that the RO Model achieves our shared goals of higher quality, lower cost cancer care,” Theodore DeWeese, MD, chair of the society’s board of directors, said in a statement. “We remain seriously concerned with excessive payment cuts in the model that will cause significant financial strain on practices and risk patient access to radiation treatments.”
The Centers for Medicare and Medicaid Services first finalized the long-awaited RO model on Sept. 18. Its goal is to create more predictable payments in cancer care, incentivize the use of cost-effective treatments, and save the agency $230 million over the next five years. The model will do so by providing bundled payments during a 90-day episode of care to radiotherapy providers treating one of 16 different cancer types. It will require participation from physicians in randomly selected geographic areas that contain about 30% of all eligible Medicare fee-for-service radiotherapy episodes nationally, a number that also raised concerns for ACR earlier this month.
To read more, go to Radiology Business.
Physician Lawmakers Intensify Pressure to Avert Millions in Medicare Cuts to Radiology By Marty Stempniak | October 21, 2020
Physician members of the U.S. House are intensifying pressure to avert tens of millions in Medicare pay cuts to radiology and other specialties.
Reps. Ami Bera, Larry Bucshon, Raul Ruiz and Roger Marshall—all MDs—championed the letter to House leaders, addressed on Monday. In it, they called the matter “of great urgency,” highlighting substantial cuts set to hit the Medicare Physician Fee Schedule in 2021.
“In order to safeguard beneficiaries’ access to care during this pandemic, we as Congress should examine possible bipartisan solutions to address excessively steep cuts,” Bera and more than 200 cosigners wrote to House leaders Oct. 19. “We encourage you to incorporate the resulting policy changes in any upcoming legislation moving through the House. 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.”
There has been a flurry of activity on this front in recent weeks, with the American College of Radiology, Society of Nuclear Medicine and Molecular Imaging and Radiology Business Management Association all writing their own letters. The latter also surveyed its members, estimating that the Medicare reductions could compel 50% of providers to reduce staffing.
In response, Rep. Michael Burgess, MD, R-Texas, introduced bipartisan legislation to temporarily waive budget neutrality requirements for a year.
ACR highlighted Monday’s letter in a news update to its members, praising physician lawmakers for keeping the topic front-and-center.
“The 40,000-member ACR looks forward to working with Congress, the Centers for Medicare and Medicaid Services and other medical societies to make necessary Medicare adjustments that preserve access to care for America’s seniors. We thank these congressional leaders for advancing this crucial effort,” Howard Fleishon, MD, chair of the college’s board of chancellors, said in a statement.
To read more, go to Radiology Business.
Lack of Medicare Coverage for CT Colonography Dragging Down Screenings, with Black Patients Hit Harder
By Marty Stempniak | October 19, 2020
A lack of Medicare coverage for CT colonography imaging is dragging down use in the older population, and likely hitting black patients harder, according to an analysis published Sunday.
The Affordable Care Act mandated that commercial payers cover such CTC exams. However, the federal payment program for seniors has failed to do the same. Wanting to better understand how this impacts use, a team of experts analyzed data representing a 13-year period ending in 2020.
Bottom line: Between the ages of 52 and 64, the number of CTC exams increased by 5.3%. But the number of screenings plummeted by an average of 6.9% per year of age after 65, researchers reported Oct. 18 in JACR.
“The association between the use of CTC and Medicare-eligible age varied for white individuals as compared with Black individuals and other racial minorities, suggesting that the lack of Medicare coverage may be more negatively impacting racial minorities,” concluded Emory University’s Courtney Moreno, MD, chair of the American College of Radiology’s CT Colonography Registry Committee, and colleagues. “Medicare coverage of screening CTC is needed so that Medicare patients who cannot afford to pay for this test out of pocket can undergo screening CTC.”
Colorectal cancer is the second leading cancer-related cause of death in the U.S.—killing 53,000 individuals annually—and it’s preventable with proper screening. Yet only 61% of those ages 50-64 report being up to date on their exams, versus 71% in the 65-and-up population, the authors noted.
To conduct their study, Moreno et al. used data from the ACR’s CTC registry, representing 12,648 screening exams. They noted that the majority of patients undergoing such imaging were female (62%) and white (at 91% of the 8,682 who disclosed their race). The average cost of a CTC scan not covered by health insurance lands at about $2,400, the team noted, and can range as high as $5,000, underlining the importance of Medicare payment. Further investigations are needed to better understand Black patients’ obstacles to regular screenings.
“The goal of cancer screening is for as many people to be screened as possible, and the best way to accomplish this is to reduce barriers to all methods of colorectal cancer screening including CTC,” the team wrote.
Read much more in the Journal of the American College of Radiology here.
Patients More Likely to Choose LDCT Lung Cancer Screening After Meeting with Radiologists Versus Other Clinicians
By Matt O’Connor | October 19, 2020
Patients who sat down with a radiologist to discuss low-dose CT lung cancer screening more often chose to follow through with the exam than those who met with another type of clinician, according to new research.
In fact, Medicare enrollees who participated in a shared-decision making (SDM) visit with an imaging expert were nine times more likely to undergo low-dose computed tomography screening.
At the same time, University of Texas Medical Branch at Galveston authors found lower LDCT screening rates following SDM visits between patients and doctors who were familiar with one another.
“The decision to undergo LDCT lung cancer screening varies substantially by the clinician participating in the SDM,” the authors wrote Monday in JAMA Network Open. “Ideally in SDM, one might expect that all the variation in choice of LDCT would be because of differences between individual enrollees in perceived risk of cancer, willingness to undergo surgery if recommended, and personal values.”
James S. Goodwin, MD, and Shuang Li, PhD, both with the university’s Department of Internal Medicine, suggested some clinicians who were unknown to patients may have been affiliated with LDCT screening centers, which could have influenced the meetings.
To read more, go to Health Imaging.
HealthCare.gov Premiums to Fall 2% in 2021
By Michael Brady | October 19, 2020
Health insurance premiums for benchmark Affordable Care Act exchange plans will decrease in 2021 for the third year in a row, and most shoppers will have more plan choices, CMS said Monday.
The average premium for the benchmark health insurance plan on HealthCare.gov for a 27-year-old will decline by about 2% to $369 per month compared with plans sold this year. For a family of four, premiums will decrease 2% to $1,486, though most people shopping on the exchanges receive subsidies to help afford the premium costs.
But “middle-income Americans continue to struggle to afford coverage,” CMS said in a statement.
The number of health insurers selling plans in 2021 will increase to 181 insurers from 175 in 2020.
The lower premiums and added insurance companies show the federal insurance marketplace continues to stabilize after a rough few years of regulatory uncertainty, premium hikes and dwindling choice of health plans.
Even so, the Senate is on schedule to confirm Judge Amy Coney Barrett before the justices hear arguments on Nov. 10 in California v. Texas, a case in which Republican attorneys general and the Trump administration argue the entire ACA should be struck down because Congress zeroed out the individual mandate. The lawsuit threatens to topple the ACA and eliminate health insurance for nearly 11 million people enrolled in exchange coverage and millions more with insurance under Medicaid expansion.
Open enrollment for 2021 coverage begins on Nov. 1 and ends Dec. 15 in states that use the federal HealthCare.gov exchange.
To read more, go to Modern Healthcare.
4 Emerging Challenges Holding Teleradiology Back From Ensuring Widespread Imaging Access
By Matt O’Connor | October 16, 2020
Teleradiology has evolved from a potential threat to traditional imaging to an accepted practice improving patients’ access to care. Many departments now utilize some form of outside reads, but experts believe it has yet to reach its full potential.
The ongoing pandemic has only cemented teleradiology’s important role in radiologic care, allowing social distancing while also tackling volume surges, a group of six radiologists wrote Wednesday in AJR.
And in the current era of value-based care, utilizing remote reading will only grow more important.
Tarek N. Hanna, with Emory University School of Medicine’s Department of Radiology and Imaging Sciences, and colleagues highlighted a few challenges standing in the way of wider adoption.
Read more from the study, including upcoming opportunities in teleradiology, in the American Journal of Roentgenology here.