Whitney Palmer

Healthcare. Politics. Family.

Radiology Leadership: Proposed Reimbursement Cuts “Arbitrary”

Published on the July 12, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

A new round of potential cuts to radiology reimbursement has many in the industry expressing anger and frustration. Radiology leaders have called the proposals “arbitrary” and “unfounded,” and all agree the reductions will negatively impact practice management and patient care.

CMS this week released its proposed Medicare Physician Fee Schedule for 2013, calling for a 4 percent to 19 percent drop in radiology reimbursement rates. The proposal would also extend a contentious policy that governs imaging conducted by a single physician during one patient encounter.

“The most important thing to remember is these are the latest in a series of arbitrary cuts to radiology reimbursement that started with provisions back in 2006,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors. “We’ve long argued that CMS has flawed data, and they continue to single out radiology based on the perception that imaging is a growing market with run-away costs. That’s simply not the case. Imaging and the associated spending levels are back to early 2000s levels.”

According to the proposed rule, many radiology services would see reimbursement levels drop: 19 percent in radiation therapy centers, 15 percent in radiation oncology, 8 percent in diagnostic testing facilities, and 4 percent in nuclear medicine. These cuts would be reallocated as 7 percent reimbursement increases to family medicine physicians and other primary care providers.

The quality of patient care, particularly in outpatient radiation therapy centers, could decrease if these proposed reimbursement cuts take effect as-is, McGinty said. Many of these centers would likely close their doors, limiting patient access to this type of high-quality, cost-effective care.

The industry’s strongest outcry, however, stems from a measure to expand the current 25 percent multiple procedure payment reduction (MPPR) on provider services for CT, MRI, and ultrasound. Currently, the MPPR applies to imaging services rendered by the same physician to the same patient during the same encounter. The new proposal would extend the MPPR to other physicians within the same group practice who performed subsequent procedures in those same patient encounters.

If this proposal becomes permanent, it will have a chilling effect of how providers work together, said Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors.“These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people’s lives,” he said in a written statement.

There’s also a chance expanding the MPPR will have a significant, negative impact on work flow, said Mike Mabry, executive director of the Radiology Business Management Association. It’s unclear whether smaller or more rural radiology practices would be able to effectively and efficiently change their billing strategies.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/news/display/article/113619/2090032


July 13, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , | Leave a comment

JAMA: Imaging Use Up in HMOs; Industry Leaders Disagree

Published on the June 14, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

Changes to Medicare reimbursement and other financial incentives designed to control the use of diagnostic imaging services aren’t working as expected, even in clinical settings without a fee-for-service payment model, according to a study published earlier this week in the Journal of the American Medical Association. However, not all industry leaders agree that imaging utilization is on the rise.

A retrospective study of up to 2 million electronic health records from 1996 to 2010 from six health systems with health maintenance organizations (HMOs) revealed the number of diagnostic imaging studies performed increased between nearly 8 percent to 57 percent during that time period.

The findings, compiled by researchers at the University of California-San Francisco (UCSF), showed the number of ultrasounds doubled, CTs tripled, and MRIs quadrupled during those 15 years. These results indicate that financial disincentives, such as lowered reimbursement or added cost to the patient, aren’t enough to eliminate unnecessary testing, as once was the hope, researchers said.

“Some people are just unrealistically enamored with diagnostic tests. There’s a perception that there’s no harm to these tests, so we can do them and think about the results later,” Rebecca Smith-Bindman, MD, UCSF radiology and biomedical imaging professor and lead study author, said in an interview. “The pictures are extraordinary, and some patients receive enormous benefits from having these tests. But others receive no help at all — they face high radiation doses, false positives, and more unnecessary downstream testing.”

Fear of facing malpractice suits and of missing a malignancy also pushes providers to order diagnostic studies for which there is no true medical indication, she said. If these problems were resolved, she said, radiologists and referring physicians could likely avoid 30 percent to 50 percent of diagnostic studies.

Even an industry-wide shift to an accountable care organization (ACO) or bundled payment model is unlikely to be enough to drive down imaging utilization, she said. Instead, medical imaging should invest in comparative effectiveness studies to better understand when imaging is appropriate. Industry leaders can, then, use that information to create clinical guidelines.

However, several groups, including the American College of Radiology (ACR), the Medical Imaging and Technology Alliance (MITA), and the Access to Medical Imaging Coalition (AMIC) said the study’s findings actually supported existing evidence that imaging use is decreasing.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/low-dose/content/article/113619/2083399

June 18, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


%d bloggers like this: