When the Centers for Medicare and Medicaid Services (CMS) expanded the Multiple Procedure Payment Reduction methodology from the technical component of imaging to include the professional component (the radiologists reading) as well, the argument was that it was a fair and valid to discount subsequent reads after the first read by 25 percent because there are efficiencies in reading multiple scans done at the same time. A new study published online in the Journal of the American College of Radiology (JACR) finds this is not so.
The study, led by Richard Duszak Jr, M.D., of the ACR’s Harvey L. Neiman Health Policy Institute, found no potential intra-service work duplication when different exam interpretations were rendered by different physicians in the same group practice.
The researchers did find small potential efficiencies in pre- and post-service activities when same-session, same-modality imaging services are rendered by different physicians in the same group practice. However, across all modalities, this would correspond to a maximum physician fee reduction of only 0.95 percent to 1.87 percent. For services from different modalities, potential savings were too small to even count.
The ACR will use the findings to support its push for a repeal of the MPPR on the professional component of diagnostic imaging. There are currently two bills in congress to do just that — the Senate bill 623 and the House resolution 846.
“This study shows that the data Medicare used to justify funding cuts was inflated by 1,200 percent and not reflective of clinical practice,” said Geraldine McGinty, M.D., chair of the American College of Radiology Commission on Economics, in a statement announcing the study’s results.
She also added that the findings “support the need for greater transparency and methodological rigor when health care regulatory actions are taken.”