Zotec Partner’s Radiology Digest | October 9, 2020

October 9, 2020

Radiology Digest: News from the week of October 9, 2020.

Physician Lawmaker Introduces Bipartisan Bill to Avert $450M in Forthcoming Medicare Cuts to Radiology
By Marty Stempniak | October 7, 2020 | Included in Radiology Digest – October 9, 2020
A physician and U.S. congressman has introduced bipartisan legislation to avert hundreds of millions in forthcoming cuts to radiology and other specialties.

Rep. Michael Burgess, MD, R-Texas, and cosponsor Rep. Bobby Rush, D-Ill., are proposing to temporarily waive budget neutrality requirements for one year under the Medicare Physician Fee Schedule. Absent such action, diagnostic radiology stands to lose some $450 million in reimbursement next year alone, according to an analysis commissioned by the ACR.

Rush and congressional colleagues first placed these cuts in their crosshairs in August, calling reductions to physician pay during a pandemic “reckless” and “ill conceived.” The American College of Radiology on Wednesday said H.R. 8505 would provide a “critical reprieve” from forthcoming financial pressure.

“Introduction of the bill represents a positive step in the ongoing effort to highlight the expected negative impact of the looming cuts and spur congressional intervention before the end of the year,” ACR wrote in an Oct. 7 news update to members.

The college and numerous other provider groups have intensified pressure on lawmakers in recent weeks, hoping for action. Just Monday, ACR and a coalition representing 1.4 million physicians and other practitioners sent a stern letter to CMS Administrator Seema Verma, “strenuously” objecting to the payment changes. Others signing the note included the American Society of Neuroradiology, the Society of Interventional Radiology, and the Alliance for Physical Therapy Quality and Innovation.

The latter praised the proposal on Wednesday, noting that it would still allow scheduled payment increases for primary care and other physician office visits to go into effect. CMS has planned to boost pay for these evaluation and management services by $5 billion, requiring offsetting cuts in the 2021 budget.
To read more, go to Radiology Business.

HHS Secretary Alex Azar Reauthorizes COVID-19 Emergency; Flexibilities in Place Through End of the Year
October 7, 2020 | Included in Radiology Digest – October 9, 2020
HHS Secretary Alex Azar has reauthorized the declaration of a public health emergency (PHE), meaning the PHE and its special rules for providers remain in effect at least through the end of the year.

At the federal government’s PHE website, Azar declared on Oct. 2: “As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective October 23, 2020, my January 31, 2020, determination, that I previously renewed on April 21, 2020 and July 23, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide.”

As this is a 90-day authorization, physician practices can count on the flexibilities instituted by CMS under the authority of the PHE—such as the right to provide and bill Medicare for expanded telehealth and even telephone services regardless of site of service and expanded scope of practice for many non-physician practitioners—to continue through the end of the year.
The renewed 90-day period will cover Oct. 23 to Jan. 21, 2021. But this is no guarantee that Azar will reauthorize again in January.

It also remains to be seen whether CMS will retain the flexibilities in 2021—the recent proposed rule for the physician fee schedule suggests the agency is eager to drop at least some of them.
To read more, go to Health Leaders Media.

Cigna Becomes Third Major Payer to Restrict MRIs, CT Scans at Hospitals
By Shelby Livingston | October 7, 2020 | Included in Radiology Digest – October 9, 2020
Soon after Cigna Corp. waived prior authorization requirements and eased coverage rules to ensure patients could receive needed care during the coronavirus pandemic, the health insurer tightened restrictions in other areas.

In August, the nation’s fourth largest insurer by membership became the third major payer to restrict coverage for most advanced imaging, such as MRIs and CT scans, when performed in a hospital-based department or facility, except in limited circumstances.

The policy applies to Cigna’s members in self-funded employer plans, fully insured commercial members, and Cigna’s own employees and their dependents. Those groups make up most of Cigna’s 17 million members. The company intends to roll out the policy to individual and family plan members in January.

Cigna’s policy is similar to those put in place by Anthem in 2017 and UnitedHealthcare last year. Anthem’s controversial rule—the first of its kind—drew ire and litigation from hospitals. Providers argued that the policies threatened to sap a large source of revenue while eliminating patient choice and interfering with the doctor-patient relationship.

Like the insurers before it, Cigna said its new rules are meant to direct patients away from expensive hospitals toward lower-cost facilities, such as free-standing imaging centers or office settings. What makes Cigna’s policy stand out is it was implemented in the throes of a pandemic, when hospitals are dealing with lower-than-normal patient volumes and resulting financial losses.

“Policies such as these restrict patient access to care without regard to the quality or coordination of care,” said Molly Smith, vice president for coverage and state issues forum at
the American Hospital Association. “It is particularly disturbing to see these kinds of unilateral steps to diminish patient access to care during a global pandemic.”
Health insurers have long decided what to cover based on whether they think a service is medically necessary for a patient. Only more recently have they begun dictating where that patient should get that service, as they try to tamp down claim costs.
To read more, go to Modern Healthcare.

50% of Radiology Practices Plan to Reduce Staffing If ‘Catastrophic’ Medicare Cuts Move Forward in 2021
By Marty Stempniak | October 7, 2020 | Included in Radiology Digest – October 9, 2020
More than 50% 0f radiology practices plan to terminate or furlough existing employees if Congress fails to act soon, advocates said this week.

Another 82% said they expect Medicare cuts slated to take effect Jan. 1 will result in decreased imaging access for patients, while nearly 68% said they’ll delay hiring new physicians. The Radiology Business Management Association highlighted some of these findings from an “extensive” survey of its members, shared Oct. 3 in a letter to the Centers for Medicare and Medicaid Services.

RBMA and others are intensifying pressure this month, hoping to avert some $450 million in anticipated cuts to diagnostic radiology next year. In a balanced-budget world, the reductions are needed to offset corresponding pay increases in primary care and other specialties, experts say. And imaging advocacy groups want Congress to waive budget-neutrality requirements, given the current economic climate.

“The RBMA expresses our extreme concern over CMS’ proposed revaluation of the evaluation and management coding that will greatly hinder the ability of radiology physician groups throughout the country to deliver high quality and timely diagnostic testing to Medicare participants,” RBMA leaders wrote Saturday. “We see increased issues with access and a potential reduction in the timely diagnosis and treatment of major illnesses. Coupled with the reduction in revenues due to the COVID-19 pandemic these cuts may become catastrophic.”

The Fairfax, Virginia-based trade group polled 155 imaging practices online between late August and early September for the survey. Respondents represented 40 of the 50 states, in hospital-based practices and freestanding imaging centers, large and small.

Here’s a quick look at some of the other findings:

  • 30% said they’ll offer early retirement options to physicians if the Medicare cuts move forward.
  • 66% said they’ll restructure doc salaries and bonuses.
  • 70% would reduce or restructure operating overhead, including benefits, ancillary staffing levels and outsourced business services.
  • 64% would delay equipment purchases and replacements.
  • 34% would close or reduce hours at their imaging centers, while 51% would restrict services to Medicare beneficiaries treated in an outpatient setting.

And while these cuts only pertain to the federal payment program for seniors, RBMA also cautioned that they’d have a spillover effect on other care. A whopping 82% of respondents said they have commercial payer contracts linked to Medicare, and both Tricare and many Medicaid plans also tie reimbursement to Medicare rates.
To read more, go to Radiology Business.

Nearly 8M Americans in Danger of Losing Job-based Insurance, Commonwealth Fund Analysis Finds
By Robert King | October 7, 2020 | Included in Radiology Digest – October 9, 2020
A new study found that as many as 7.7 million Americans lost jobs that offer employer-sponsored insurance due to the COVID-19 pandemic, and nearly 7 million dependents could also lose coverage.

The study, released Wednesday from the Commonwealth Fund, comes as providers worry about an adverse payer mix due to the pandemic as patients move away from commercial plans that pay higher reimbursement rates to government programs that offer lower rates.

“This study illustrates how the country’s predominately job-based health insurance system leaves workers and their families at risk of losing coverage during a severe economic downturn,” said Sara Collins, Commonwealth Fund’s vice president for healthcare coverage, access and tracking.

The study does not say how many of the nearly 14 million actually lost health insurance, as it remains unclear how many of the job losses are permanent.

There are several factors that could decide whether the loss of insurance is permanent. These include whether the job loss is temporary or permanent and whether the worker continues to get insurance during a furlough.

Another factor is whether the worker gets coverage through COBRA, the Affordable Care Act’s insurance exchanges or Medicaid after losing employer-sponsored insurance.
“Only with time will we know how many job losses are ultimately permanent and result in loss of [employer-sponsored insurance],” said Stephen Woodbury, co-author of the report and a senior economist with the Upjohn Institute, in a statement.

Commonwealth Fund looked at the proportion of workers with employer-sponsored insurance compared to the number of workers that lost jobs from February through June, as the COVID-19 pandemic forced major economic shutdowns across the country.

The analysis comes as hospitals are worried about a change in their payer mix, which could contribute to an already precarious financial position due to COVID-19.

A survey of health system and hospital executives released last month found that 70% expect to see an uptick in self-pay and Medicaid patients alongside a drop in commercial plan reimbursement.
To read more, go to Fierce Healthcare.

Trump Administration to Renew Coronavirus Emergency Declaration
By Rachel Roubein | October 3, 2020 | Included in Radiology Digest – October 9, 2020
The Trump administration is renewing the public health emergency declaration for the coronavirus, ensuring key resources for fighting the pathogen will be in place well past Election Day.

The news, which HHS Secretary Alex Azar announced in a Friday afternoon tweet, comes just hours after President Donald Trump announced he tested positive for the coronavirus.

The background: The declaration unlocks critical powers that have helped the administration boost telehealth, enabled increased Medicaid funding and allowed cash-strapped local health departments to reassign federally funded personnel to respond to the virus.

This is the third time Azar is extending the emergency declaration, which must be renewed every 90 days. The latest renewal comes without weeks of speculation over whether the administration would let the declaration lapse.

Earlier this summer, governors and health groups for weeks had urged the administration to renew the powers, worried that they would expire — despite Trump officials’ assurances they would extend the declaration. This time, Azar announced the renewal nearly three weeks before the declaration was set to end, providing certainty to local health officials and health industry groups preparing for the virus to rebound this fall.

What’s next: The renewal will take effect Oct. 23, and the emergency declaration is now scheduled to lapse right after the next presidential inauguration.
To read more, go to Politico.

A ‘Drastically Different’ Pinktober for Breast Radiologists and Patients Than Years Past
By Marty Stempniak | October 2, 2020 | Included in Radiology Digest – October 9, 2020
The conclusion of September holds special meaning in breast imaging, but this year’s Pinktober is “drastically different” from previous iterations, experts say.

Widespread shutdowns of mammography screening services during the COVID-19 pandemic have left thousands of women in danger. One recent analysis out of the United Kingdom’s largest breast cancer charity estimated a backlog of 1 million women requiring screenings across the country. Another predicted upward of 10,000 excess deaths in the U.S. due to postponed colon and breast cancer imaging.

All of this has radiology advocacy groups urging the field to be on high alert during 2020’s Breast Cancer Awareness Month.

“Although we will continue to experience ‘Pinktober’ for the next 31 days, thanks to the COVID-19 pandemic, October 2020 will look drastically different from years past,” Dana Smetherman, MD, chair of the American College of Radiology’s Commission on Breast Imaging, wrote Thursday. “As the pink October spotlight shines on breast cancer, I urge radiologists to use this opportunity to encourage patients to #ReturnToCare and get back on track with all of their other preventive screening and wellness activities,” she added later.

To aid in this effort, the ACR released a new mammography toolkit on Thursday. The free package includes a patient safety infographic, breast cancer risk assessment handout for patients, and a template letter for primary care physicians and other providers.

“While we help our practices recover from the Centers for Disease Control and Prevention-recommended shutdown, it is crucial that we also help our referring clinicians reconnect with women ages 40 and older and encourage them to schedule yearly mammograms postponed by the pandemic,” ACR said in an Oct. 1 news item.

Several radiology providers this week highlighted initiatives they’re undertaking to bolster breast imaging rates. Radiology Associates in Texas, for one, is providing free screenings at a local mall. Others are touting mobile mammography units, while a university in Australia just released an animated video highlighting breast density’s impact on screening.
To read more, go to Radiology Business.

Radiologists Get Reprieve After Senate; Trump Finalize Bill to Extend Medicare Loan Repayment Terms
By Marty Stempniak | October 1, 2020 | Included in Radiology Digest – October 9, 2020
The U.S. Senate has approved legislation that will extend repayment terms of Medicare advances granted to physicians during the coronavirus pandemic. President Donald Trump signed the measure late Wednesday, just after a midnight deadline to avoid a government shutdown.

Following the 84-10 Senate vote and Trump’s signature, the bill will extend funding for the feds through Dec. 11, the Associated Press reported. The U.S. House previously passed the measure on Sept. 22, drawing praise from the American Medical Association.

Radiologists and other providers will now have one year after the Medicare Accelerated and Advance Payment Program loan was originally issued before recoupment begins, Modern Healthcare reported. CMS first launched the lifeline back in March to help smooth over cash flow concerns for providers hobbled by the COVID-19 pandemic. But the original due date was set to arrive in August for those receiving loans first. AMA recently called those previous terms an “economic sword hanging over physician practices.”

Provider groups expressed relief Wednesday following the bill’s final approval.
To read more, go to Radiology Business.

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