HHS Changes Revenue Calculation for Keeping COVID-19 Relief Funds
By Rachel Cohrs | September 23, 2020
HHS again has changed the rules regarding how to document Provider Relief Fund grants and it could cause headaches for healthcare stakeholders.
HHS recently released reporting guidelines that changed how healthcare providers are supposed to calculate lost revenue from the COVID-19 pandemic, complicating accounting for more than$100 billion in grant funds.
Prior guidance from HHS had indicated that healthcare providers could calculate lost revenue by comparing 2020 revenue with budgeted revenue or with revenue from 2019, but the new notice says providers have to use net operating income instead. The document also puts a cap on how much lost revenue providers can claim.
Both of these changes are sending providers back to the drawing board as they figure out how to account for Provider Relief Fund grants and insulate themselves from False Claims Act liability and other potential consequences.
Revenue figures would have been simple to report, consultants and accountants who work with providers said, but net operating income is a more complex calculation that takes expenses into account.
“When you start adding in all of these expenses over course of the year, you are diluting what would have been a single metric. Will it always work out the same way? No,” said Polsinelli healthcare operations chair Colleen Faddick.
The guidance would also cap lost revenue providers can claim to their net 2019 gain, or net zero if the provider had a negative net operating income last year.
The formula limits providers to their 2019 financial performance if they want to qualify for the grant funds to help with lost revenue, Faddick noted.
To read more, go to Modern Healthcare.
Will Medicare Reimbursement Propel Radiology AI Market?
By Erik Ridley | September 23, 2020
The decision by the U.S. Centers for Medicare and Medicaid Services’ (CMS) earlier this month to provide its first-ever reimbursement of a radiology artificial intelligence (AI) algorithm was a significant milestone for the industry, raising hopes that it could set the groundwork for broader coverage of imaging AI software.
Effective for a three-year period beginning in the 2021 fiscal year, CMS has granted new technology add-on payment (NTAP) status for use of Viz.ai’s ContaCT (Viz LVO) AI algorithm, which analyzes CT angiography (CTA) exams after acquisition and alerts an institution’s stroke specialist team if it detects a large vessel occlusion (LVO) stroke.
For Viz.ai, the NTAP award was the culmination of a two-year process that involved several clinical studies, numerous conversations with CMS on the research data, and support from a number of societies, advocacy organizations, and leading stroke researchers, according to co-founder and CEO Dr. Chris Mansi.
NTAPs are granted by CMS for new and high-priced technologies that provide a substantial clinical benefit and aren’t currently covered under a Medicare Severity-Diagnosis Related Group (MS-DRG). In their clinical studies, Viz.ai was able to demonstrate that the technology provided time savings, improved outcomes, and increased access to care, Mansi said.
Under the NTAP, CMS will now reimburse 65% of the estimated loss for a hospital — up to $1,040 per patient — for Medicare patients with suspected stroke who have been analyzed by the firm’s Viz LVO algorithm and whose estimated costs to use the software exceed the DRG.
The company estimates about half of the Medicare patients with suspected ischemic stroke patients who receive Viz LVO analysis will qualify for payment. There is no maximum annual payout cap for an institution. Importantly, the standard radiology interpretation of the CT scans is not affected by the NTAP; the payment is an add-on for the DRG.
To read more, go to Aunt Minnie.
House Passes Government Funding Bill, Including Plan to Extend Medicare Loan Repayments
By Rachel Cohrs |September 22, 2020
The House Tuesday night passed a bipartisan bill that will fund the federal government through Dec. 11 and relax Medicare loan terms for healthcare providers.
Lawmakers passed the deal—359 to 57—after negotiating through the day to reach a consensus. The package is designed to avoid a shutdown on Oct. 1. While House Democrats and the White House decided to separate the funding bill from COVID-19 relief legislation, some policies that healthcare providers asked for were included.
Hospitals have implored Congress to forgive or relax repayment terms for $100 billion in COVID-19 relief loans that Medicare gave out in the spring. CMS was supposed to start recouping the funds by cutting providers’ Medicare fee-for-service reimbursement starting in August, but that hasn’t happened.
The bill would give providers one year after the Medicare Accelerated and Advance Payment Program loan was issued before recoupment would begin, an extension from 120 days under current law. The recoupment rate would also be lowered from its current 100% level to 25% for the first 11 months of repayment, and 50% for the six months afterward. Hospitals would have 29 months after payments to begin to pay back the funds in full before interest would begin to accrue. The interest rate would be lowered from the current rate of 9.6% to 4%.
House Energy & Commerce Chair Frank Pallone (D-N.J.) and Ways & Means Chair Richard Neal (D-Mass.) on Tuesday wrote to HHS and CMS accusing the administration of expanding
the Medicare Accelerated and Advance Payment Program beyond its congressionally authorized scope and failing to provide requested information to lawmakers. Pallone and Neal also asked CMS to provide clarity as to when the Medicare loans would begin to be recouped.
The legislation also creates a new deadline for funding for several healthcare policies, including delaying cuts to Medicaid disproportionate-share hospital payments and extending funds for programs such as the Money Follows the Person demonstration, diabetes programs and community behavioral health clinics. The policies are set to expire on Nov. 30.
To read more, go to Modern Healthcare.
CMS’ Mandatory Radiation Oncology Model ‘Goes too Far,’ Say Provider Groups Pushing for Delay
By Marty Stempniak | September 22, 2020
The Centers for Medicare and Medicaid Services’ mandatory Radiation Oncology Model “goes too far for an untested model,” and should be shelved for further reform, provider advocates said this week.
CMS on Friday finalized the long-discussed payment model, which would cover about 30% of RO episodes beginning Jan. 1. Groups including the American Society for Radiation Oncology were quick to condemn the final rule. Moving to value-based method of paying for care is a “longstanding goal of ASTRO,” however, the final rule “fails to address many of the radiation oncology community’s key concerns.”
“Requiring practices to participate and then forcing them to start the model on January 1, 2021, is untenable for practices already enduring staff shortages and other challenges due to the COVID-19 pandemic,” the society said Friday, Sept. 18. “ASTRO strongly urges CMS to significantly delay the start date rather than foster unnecessary chaos and burden for the practices this model is designed to support,” it added later.
The American College of Radiology said Monday that it “strongly supports” ASTRO’s call for a delay. Both groups had previously urged CMS to grant physicians at least half a year to prepare following the final rule’s release. But providers are left with just three and a half months, and the 30% of eligible episodes—while an improvement from the 40% previously proposed—still “goes too far” for such an unproven model, they wrote.
For its part, CMS said the new model will help to create more predictable payments, incentivize cost-effective treatments, and save $230 million over the next five years. Administrator Seema Verma said radiotherapy payment should be tied to results, rather than the number of treatments and where they were delivered.
“That’s why the Trump administration has developed a new innovative model that allows patients and providers to focus on better outcomes for patients,” she said in a statement.
The RO model will provide 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.
You can read more on the final rule in this fact sheet from CMS here.
Walmart Health has ‘Bold Ambitions’ to Ramp Up Expansion into Imaging and Other Care
By Marty Stempniak | September 21, 2020
After a successful first year dabbling in healthcare, Walmart Health has “bold ambitions” to further expand its footprint in imaging and other services, the retail giant said Thursday.
Sept. 17 marked the one-year anniversary of the Arkansas-based company opening its first health hub in Dallas, Georgia. Since then, Walmart has expanded to six such locations—offering numerous services including x-rays and diagnostics—with the latest arriving Sept. 16 in Cartersville, Georgia.
The experiment has gone well, and company officials are now eyeing rapid expansion, recently inking a partnership with medical module maker Blox to launch centers more quickly. They’re already planning to open two Walmart Health locations in the Chicago area this fall, seven more in Georgia by the end of the fiscal year, and another seven in the Jacksonville, Florida, area in 2021. And conversations are underway for further expansion in Orlando and Tampa, said Lori Flees, senior VP and chief operating officer of Walmart U.S. Health and Wellness.
“Our experience this year has made two things clear: Walmart Health is having a real impact on increasing access to care in our communities, and there are more neighbors who need our help,” Flees said a Sept. 17 announcement. “The past few months in particular have exposed the vulnerabilities of our healthcare system and left many without access to adequate health resources. We know our customers need us now more than ever, which is why we’re announcing an expansion of Walmart Health today.”
Flees further noted that the Blox partnership will allow Walmart to more efficiently scale its healthcare model while requiring fewer resources. The recently opened center in Newnan, Georgia, is the first such center built using the new construction method.
Survey data from Walmart Health’s first year has also proven positive, Flees added. More than 50% of visits were booked by returning patients, and 96% said they “felt cared for” and had their needs met during the encounter. About half of visits were for primary care, with the other half were for specialty services including optometry, dental and behavioral health. Primary care at the very first location is seeing a shift toward the management of chronic conditions, “as the patient population responds to the quality and convenient care offered at Walmart Health.”
To read more, go to Radiology Business.