AAO-HNS Submits Comment Letters to Private Payers Regarding Restrictive Policies (5/30/14)
The Academy’s Health Policy team worked with the Imaging Committee and coordinated with the IAC to submit comments to Coventry / National Imaging Associates (NIA), Humana, and Blue Cross Blue Shield of Idaho opposing their policies that restrict the use of mini-CT scans and/or limit the ability for otolaryngologists to interpret and provide imaging services. The letters incorporates language from AAO-HNSF’s position statement on point-of-care imaging to support providers who utilize point-of-care imaging when medically necessary and appropriate, in order to improve efficiency in diagnosing and managing a patient’s condition.
In addition, in response to Humana’s request for additional evidence in specific criteria where computer assisted navigation is needed, comments were submitted to Humana’s Medical Director with updated references added to the AAO-HNS/F position statement on Intra-Operative Use of Computer Aided Surgery. While their medical policy on Computer Assisted Surgical Navigation (CASN) currently does not provide payment for the service, Humana stated that they are willing to review any new information provided on this topic. While we are hopeful that these policies will be changed to allow for coverage, the Academy is appreciative of the open channels of communication with these payers.
State Advocacy Efforts in California Leads to Defeat of Bill to Remove Stark Law Exemption(4/1/2014)
At a state level, in April the AAO-HNS was approached by the CPCI regarding a sign-on letter opposing California Senate Bill 1215 which would have removed the exemption for in-office advanced imaging. The Academy’s Government Affairs team moved quickly to receive support from the California Otolaryngology Society and San Diego Academy of Otolaryngology Bergeron), as well as the AAO-HNS to sign on to the opposition letter. The California Medical Association also took action to oppose the bill. Thanks go to Board of Governors and California Otolaryngology Society leaders Marci Bothwell, MD,Christopher Bergeron, MD, and Steven Kmucha, MD, JD for their local advocacy efforts. As a result of these actions, SB 1215 was defeated in the California Senate Business, Professions and Economic Development Committee and it is dead for the year.
Physician Community Urges Congress to Preserve Stark Law Exemption(3/27/2014)
On a national level, on March 18, the AAO-HNS joined the Coalition on Patient-Centered Imaging in sending a letter to Congress urging preservation of the in-office ancillary services exception (IOASE) to the “Stark” law and rejection of the Administration’s budget proposal to restrict the IOASE. Leaders of the Senate Finance, House Ways & Means, and Energy & Commerce Committees received the letter. Click here to view the letter.
Patient Radiation Safety Mandates Gain Traction in the States (9/19/2013)
Several states, such as California and Texas, have implemented rules or laws which mandate adherence to CT and interventional radiography imaging guidelines for healthcare providers. Awareness of radiation dose safety has increased tremendously, and continues to gain momentum among state legislatures. To view further information about the law passed in Texas, click here. To view California's Information Notice on this legislation from 2010 and its amendment in 2012, click here.
In Connecticut, a bill (Raised Bill No. 2463) similar to California's legislation on this issue was proposed but was referred to the Joint Committee on Public Health and did not receive a hearing. If reintroduced for the 2014 legislative session, the bill would:
• Require providers to record CT radiation dose in patient radiology reports
• Require annual inspection of CT scanners to ensure displayed dose doesn’t deviate more than 20% from actual measured dose
• Mandate five days for reporting to the state and referring physician and 15 days for reporting to patients certain error events (e.g. repeat CT raising cumulative dose to an excessive level, wrong site, permanent damage to patient caused by dose) when dose thresholds, to be established by the Commissioner of Public Health, are exceeded
The Health Policy team will continue to monitor this issue in the coming months. If similar legislation is introduced in your state, please contact the Health Policy team.