Radiology societies join initiative to fight payer restrictions around key interventional service
Radiology associations have joined a multisociety initiative to fight payer restrictions around a key interventional imaging service.
The American College of Radiology recently touted the effort in a news update published Nov. 13. It joins the Society of Interventional Radiology, American Society of Neuroradiology, American Society of Spine Radiology and others, altogether representing over 100,000 physicians.
They recently wrote joint letters to 5 of the 7 Medicare Administrative Contractors, urging them to rescind proposed reimbursement restrictions for peripheral nerve blocks and related procedures, used to treat chronic pain. Such treatments typically involve using ultrasound or X-ray guidance to insert a needle near a nerve to inject an anesthetic or corticosteroid.
ACR et al. recently sent identical letters to 5 of the 7 MACs, asking them to rescind planned local coverage restrictions related to such injections. They’re concerned restricting pain-management options could increase opioid use among Medicare beneficiaries while also increasing healthcare costs and reducing quality of life.
“The proposed policy would broadly eliminate coverage for procedures integral to the practice of pain medicine, physical medicine and rehabilitation, anesthesiology, neurology, radiology, neurosurgery, orthopedic surgery, and sports medicine, specifically for the treatment of chronic musculoskeletal and neuropathic pain,” the societies wrote to MACs on Nov. 7. “These interventions have decades of clinical use, are supported by peer-reviewed literature, demonstrate well-established mechanisms of action and favorable safety profiles, and provide substantial real-world value when used appropriately,” they added.
Medicare Administrative Contractors targeted included CGS Administrators, National Government Services Inc., Noridian Healthcare Solutions, Palmetto GBA, and WPS Insurance Corp. Meanwhile, other physician groups signing the letters included the American Society of Anesthesiologists, American Academy of Pain Medicine, and the Congress of Neurological Surgeons among others. They are “strongly” urging CMS and its contractors to rescind these restrictions as quickly as possible. If immediate reversal is not possible, ACR is asking for postponement of the coverage change so that MACs can work with radiologists and other physicians to tailor restrictions so that they’re more in line with the latest research and medical evidence.
“Eliminating coverage not only contradicts CMS’s opioid-reduction and value-based care goals but will inevitably lead to increased overall program costs through higher utilization of less effective or more expensive alternatives,” the societies wrote.
Comments were due to the five MACs on Nov. 8, except for WPS, which has a deadline of Nov. 22. In its own news update the American Society of Interventional Pain Physicians noted that the changes will result in the “elimination of almost all peripheral nerve blocks from coverage policy.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.