Cuts In Proposed CMS Rule Will Drive Radiologists From Practice, ACR Says

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Coupled with drastic cuts to imaging services over the past five years, significant and unwarranted medical imaging cuts in the Proposed Medicare Fee Schedule Rule for 2012 formulated by the Centers for Medicare and Medicaid Services (CMS) will drive many imaging providers from practice, restrict access to care even for procedures not specifically affected by the them, and may actually increase Medicare costs for many of these services, according to the American College of Radiology (ACR).

The rule, which calls for a multiple procedure payment reduction (MPPR) of 50% to the “professional component” of CT, MRI, and ultrasound services administered to the same patient, on the same day, in the same setting, would slash reimbursement for physician interpretation and diagnosis. Cuts have previously been applied only to the "technical component," or overhead costs of providing exams.

The rule would also further expand the number of physician services at risk for bundling of payment. Although potential efficiencies in physician work may exist when multiple services are provided to the same patient during the same session, a study published in a recent issue of the Journal of the American College of Radiology (JACR) indicates that these are highly variable and considerably less than policy makers contend.

“These proposed cuts are not evidence-based and simply represent blind cost-cutting,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors. “Current payments to doctors for advanced imaging interpretations are an accurate reflection of the complexity of the process and should not be arbitrarily slashed.”

Patti adds that the MPPR reduction and potential further bundling of payment contained in the MPFS Proposed Rule are premised on Medicare Payment Advisory Commission (MedPAC) recommendations “rooted in the mistaken belief that mispricing of diagnostic imaging services has led to overutilization. Physicians who need advanced imaging exams for their patients will request as many interpretations as they need from radiologists, regardless of price. “

A review of claims data by the Moran Company proves that medical imaging growth in Medicare is less than 2% per year — well in line with or below that of other major physician services. Growth in use of CT scans and other advanced imaging is roughly half of what it was even as little as three years ago, according to the ACR.

A bipartisan group of 61 Members of Congress, led by Rep. Pete Olson (R-TX) of the House Energy and Commerce Committee and Rep. Jason Altmire of the House Small Business Committee, signed and circulated a letter to congressional colleagues opposing the very imaging cuts recommended by MedPAC and now proposed by CMS. The Congressmen warned colleagues that “these payment cuts are making it extremely difficult for radiologists to keep their practices and free-standing imaging centers open for business and available to patients. Without access to these facilities, patient access to valuable community-based diagnostic imaging services could be compromised and the vast majority of imaging services may be delivered in the hospital setting, potentially at a higher cost to Medicare.”

For the rule, click here: http://www.ofr.gov/OFRUpload/OFRData/2011-16972_PI.pdf

For the abstract of the study published in the JACR, click here: http://www.jacr.org/article/S1546-1440(11)00331-0/abstract

For the full ACR press release reporting this development, click here: http://www.acr.org/HomePageCategories/News/ACRNewsCenter/2012-Proposed-C...—Julie Ritzer Ross