The American College of Radiology (ACR) and several other health care organizations are voicing increasingly strenuous objections to a multiple procedure payment reduction (MPPR) set forth by the Centers for Medicare and Medicaid Services (CMS) in its 2012 Medicare Physician Fee Schedule Proposed Rule.
CMS is calling for a 50% MPPR to the “professional component” of CT, MRI, and ultrasound services administered to the same patient, on the same day, in the same setting. This unprecedented step would slash reimbursement for physician interpretation and diagnosis. Cuts have previously been applied only to the "technical component," or overhead costs of providing exams.
In a letter sent to CMS last week, the ACR deems such an MPPR scientifically unfounded and based on flawed assumptions. The MPPR may also limit patients’ ability to receive efficient care, the ACR says.
Comments contained in the letter highlight recent purported statements from CMS Administrator Donald Berwick, MD, which the ACR believes further call into question the validity of such the reduction and serves as its final catalyst for asking CMS to exclude the MPPR from the Medicare Final Rule due out later this year. Within the context of the comments, the ACR also urges CMS to reconsider additional bundling of payments for many imaging procedures commonly performed in parallel.
Among other health care organizations that have sent similar comments to CMS, the American Medical Association (AMA) claims that the agency, in proposing the MPPR, “oversimplifies related GAO and MedPAC recommendations, misconstrues the findings of the RUC, and overlooks relevant CMS data, resulting in a proposal that is likely to increase costs to Medicare and its beneficiaries.” The Association of Community Cancer Centers (ACCC) expresses its belief that the proposed expansion of the MPPR is unjustified and “could harm access to appropriate cancer care”, while the Healthcare Business Management Association (HBMA) points to a “disconnect between CMS’ policy proposal and actual medical practice”.
Several organizations question CMS’ contention that there are similar efficiencies in the professional component of imaging to that of many surgeries. In their comments to CMS, they highlight a recent study published in Journal of the American College of Radiology, which shows that any efficiencies that exist are highly variable and exponentially less than CMS contends.
To read the ACR’s letter, click here: http://www.acr.org/SecondaryMainMenuCategories/NewsPublications/Featured...
To read the AMA’s comments, click here: http://www.ama-assn.org/resources/doc/washington/2012-physician-fee-sche...
To read the ACCC’s comments, click here: http://www.accc-cancer.org/advocacy/pdf/2012Proposed%20PFScomments.pdf
To read the HBMA’S comments, click here: http://www.hbma.org/uploads/content_files/2012_Physician_Fee_Schedule___...