Imaging use plunges as coding, reimbursement tightens up

From Modern Healthcare:

Medical imaging use in the U.S. has dropped significantly after years of widespread growth, leading to curtailed hiring, equipment purchases and reduced access to the technology thanks to cuts in federal reimbursement and new coding arrangements, according to a new study.

After the imaging boom of the 2000s, payers reined in reimbursements and spared a rapid reduction in providers’ imaging use. Those funding changes have forced providers to weigh carefully their hiring and patient care decisions, the study published in the April edition of Health Affairs said.

Providers may not purchase as much imaging equipment or hire additional radiologists because of the reimbursement decline, said Dr. Daniel Levin, lead author of the study, as they prepare for a future of limited or no growth in imaging use.

Limits on doctor-drug rep interactions tied to prescribing changes

From Reuters:

Policies that limit or regulate interactions between doctors and pharmaceutical company representatives may affect what drugs are prescribed to patients, according to a new study.

Drugs promoted by pharmaceutical representatives – known as detailed drugs – lost market share after hospitals enacted such policies, while drugs that weren’t detailed gained market share, researchers found.

The study’s lead author said the findings suggest institutions and organizations can play a role in relationships between doctors and the drug industry.

REDucing Unnecessary Coagulation Testing in the Emergency Department (REDUCED)

From the BMJ:

The PT/INR (prothrombin time/international normalized ratio) and aPTT (activated partial thromboplastin time) were tests developed in the early 20th century for specific and unique indications. Despite this, they are often ordered together routinely. The objective of this study was to determine if a multimodal intervention could reduce PT/INR and aPTT testing in the emergency department (ED). This was a prospective multi-pronged quality improvement study at St. Michael’s Hospital. The initiative involved stakeholder engagement, uncoupling of PT/INR and aPTT testing, teaching, and most importantly a revision to the ED order panels. After changes to order panels, weekly rates of PT/INR and aPTT testing per 100 ED patients decreased (17.2 vs 38.4, rate ratio=0.45 (95% CI 0.43-0.47), p<0.001; 16.6 vs 37.8, rate ratio=0.44 (95% CI 0.42-0.46), p<0.001, respectively). Rate of creatinine testing per 100 ED patients, our internal control, increased during the same period (54.0 vs 49.7, rate ratio=1.09 (95% CI 1.06-1.12); p<0.0001) while the weekly rate per 100 ED patients receiving blood transfusions slightly decreased (0.5 vs 0.7, rate ratio=0.66 (95% CI 0.49-0.87), p=0.0034). We found that a simple process change to order panels was associated with meaningful reductions in coagulation testing without obvious adverse effects.

CMS Update Critical Access Hospitals: Compliance with Location and Distance Requirements

From HFAP (hat tip: Dr. Sue Nedza):

Key Points:

  1. The S&C letter defines the responsibilities for Regional Offices (RO) to determine which CAHs meet the status and location requirements. The RO must complete a “CAH Recertification Checklist: Rural and Distance or Necessary Provider Verification” form and save in the respective CAH’s file.
  2. Once the RO determines a particular CAH is currently in compliance with the rural status and distance requirements, it will contact the State Agency and Accreditation Organization to advise them that a recertification or reaccreditation survey may be conducted.
  3. State Agencies (SA) and Accreditation Organizations (AO) may NOT conduct a recertification / reaccreditation survey of a CAH that does NOT meet the rural status and location requirements.
  4. A CAH may request review of its CMS’ determination that a CAH is not a necessary provider if, within 60 days of the date of a CMS letter that communicates the agency’s determination that the CAH distance requirements have not been met, it submits supplementary evidence to the CMS RO for CMS’ consideration. The burden is on the CAH to provide qualifying evidence demonstrating that necessary provider designation was made by the state prior to January 1, 2006, and that the designation was applicable to the specific facility in question.
  5. If it is determined that a CAH does not meet the rural status and distance requirements, the RO will send a letter notifying the CAH that its CAH status will be terminated. The letter instructs the CAH of its options which may include:
    1. Attempt to reclassify as rural,
    2. Convert to hospital status, or
    3. Have its Medicare participation terminated.

CMS Calls On Rural Hospitals to Join Alternative Payment Model

From RevCycleIntelligence:

CMS is seeking applicants to participate in a new round of the Rural Community Hospital Demonstration Program that tests a cost-based alternative payment model among small rural hospitals.

Lawmakers authorized a five-year extension of the demonstration under the 21st Century Cures Act. The act allowed for new applicants as well as an opportunity for previous rural hospital participants to join a second extension period if they were part of the demonstration as of the last day of the first period or Dec. 30, 2014.

The Rural Community Hospital Demonstration program first implemented the alternative payment model at rural hospitals for inpatient hospital services furnished to Medicare beneficiaries in 2004. CMS launched two other rounds in 2008 and 2010.

The alternative payment model aimed to help rural hospitals that are too large to qualify for higher Medicare reimbursement rates as a Critical Access Hospital. While the hospitals are larger, many facilities still struggled because of their size to offset lower reimbursement rates with greater patient volumes or revenue from other non-Medicare services.