ACR economic update

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At last, the moment you've all been waiting for -- the ACR's economic update, delivered by Maurine S. Dennis, MPH, MBA, director of economics and government relations at the ACR. The room was packed with eager attendees as Dennis began her presentation on the expected pessimistic note. (Is it just me, or has the theme of this RBMA meeting been mordant pessimism?) Dennis illustrated the reimbursement forecast simply: a big orange arrow pointing down. The assembled audience laughed, of course, but I got the sense it was a laugh-so-you-don't-weep situation.

"Just to give you an idea of how much this is a reality," Dennis said, "I heard a news account that the Mayo Clinic in Glendale will stop accepting Medicare in January. This is real. This is happening now, and people aren't waiting around for health reform to start making changes."

Regulatory changes for 2010 in the proposed Medicare Fee Schedule include reduced reimbursement for radiology, rad onc, IR, nuc med and most of all, IDTFs. Though there are no changes overall to physician work RVUs, drastic changes have been proposed to practice expense payments, especially the 90% equipment utilization rate for high-tech imaging. High-tech is defined for these purposes as any system costing over $1 million, and includes:

* CT
* MR
* Angiography suites
* Interventional suites
* Radiation treatment delivery systems
* PET

"Irrespective of anything that's happening on the legislative front, that 90% rate will be put in place January 1, 2010, assuming they don't go with our comments," Dennis noted. "I used to be an optimist about that, but I've been doing this for quite a while. Now I'm a pessimist."

Dennis explained that CMS is following MedPAC orders on the equipment utilization front. But that's not the worst news when it comes to practice expenses. Based on the results of the physician practice information survey -- which the ACR views as highly flawed and unfair to specialists -- CMS is decreasing PE RVUs on the professional component by 19%, and on the technical component by 33%. "These numbers are not insignificant," Dennis noted. "In my mind, these are the more devastating hits."

As to the issue of the national coverage determination on CTC, Dennis told the assembled group that the ACR has formed a coalition to fight for coverage of the technology. "CMS is just not going to pay for new technology anymore," she said. "It's an interesting conundrum we find ourselves in, because radiology is a technology-driven specialty."

Where MedPAC is concerned, Dennis noted that the commission is looking at the issue of self-referral, albeit using outdated data. "They're going to explore the in-office ancillary exception," she said. "They know self-referral is a problem and that it drives up utilization, but they don't want to disenfranchise other physicians. They pick and choose their issues, and there's a lot to lose politically getting involved on this issue."

Finally, Dennis said that based on a recent GAO report, the possibility still exists of payments being bundled and the multiple procedure reduction being extended to the professional component side of things. ACR and AMA have responded with letters.

"These issues are just not going away," Dennis concluded. "You have things swirling on the legislative side, but on the regulatory side the train has left the station. We have to keep dealing with these issues as best we can."