• NSA I-Tact

  02.22.24 Meeting Summary

  Posted by name on February 22, 2024 at 6:10 pm

  02.22.24 AI meeting summary:

  • The group discusses recent reports from CMS regarding reimbursement rates for different specialties, with emergency medicine dominating and radiology seeing significant increases. Patrick Velliky raises concerns about using QPA as an indicator of network rates, while Ed emphasizes that QPA is meant to be an approximation of in-network rates. They also discuss the implications of IDR awards and how they may be misinterpreted as inflationary by some parties. Ed presents data from Fair Health showing a decline in in-network rates over time, contradicting claims of inflationary effects. The conversation ends with a mention of groups needing to go through the IDR process to reach pre-NSA implementation reimbursement levels.

  • Jeff Bettinger suggests that the QPA (Quality Payment Adjustment) won by providers may be close to 300%. Ed Gaines agrees and emphasizes the need for further study and consideration of the recently issued reports. Ed also asks if there is valuable information in the reports that can be used for Q and A sessions with Becerra during budget hearings. Randy Pilgrim discusses the limitations of relying on Fair Health data, which is voluntary and not peer-reviewed.

  • The discussion then shifts to using machine-readable files from OpenCare as a more accurate source of information, although it comes at a higher cost. Matt Tamez confirms that OpenCare has comprehensive reimbursement data from various payers, including the Blues. The conversation continues with discussions about leveraging transparency rules, legislative mandates for participation, and how Opencare’s aggregated data can be useful in negotiations with payers. Andrea Brault raises questions about qualitative measurement before NSA implementation and mentions her interaction with Rand regarding recommended data sources. Greg Hufstetler explains the details of EDPMA’s deep dive survey launched on February 1st, which includes multiple variables related to awards, complaints filed by providers through portals, contract manipulation by plans during renewals after NSA implementation, and cash per visit for out-of-network services pre-NSA.

  • Greg Hufstetler discusses the lack of data sets received for a report. Randy Pilgrim informs that he sent an email to GAO people regarding the interview, providing them with relevant studies. Ed Gaines discusses various work groups and projects, including identifying violations, reviewing CMS reports, and developing regulatory advocacy. Jennifer Brown talks about data needed for an amicus brief related to private equity in healthcare and cost share shift post determination in favor of providers. The filing process for IDRs is discussed, with some claims being tied up due to lack of timely filing or slow responses from IDREs.

  • Ed Gaines discusses the impact of high administrative fees on radiology claims. The discussion then shifts to scheduling and calendar changes. They also discuss the need for a unified voice and clear messaging in response to industry narratives. Jennifer Brown emphasizes the importance of using data to support their arguments, including the low percentage of out-of-network claims.

  Action items:

  • Coordinate with Greg on completing the survey by February and provide preliminary results at Summit in March

  • Discuss potential pearls from reports to use in advocacy during budget hearings with Becerra

  • Provide updates on EDPMA’s involvement with ASA ACR survey (18:36)

  • Responsible Person(s): Patrick Velliky, Kathy Reep, Stephanie Caruso

  • Develop a repeatable process for identifying violations of NSA by health plans

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