Moran Study: Advanced Imaging Growth Lower than Other Physician Services

(RESTON, VA - American College of Radiology)

On Oct. 14, the Access to Medical Imaging Coalition (AMIC), of which ACR is a member, released a Moran Company analysis of 2008 Medicare claims data showing that growth in the volume of advanced imaging is actually less than that of other physician services since the implementation of the Deficit Reduction Act of 2005 (DRA).

A previous Moran and Company analysis showed that Medicare spending on advanced imaging was reduced by 19.2 percent from 2006 to 2007 and volume of service grew by only 1.9 percent. Of particular note, the new analysis showed that from 2007-2008:

Use of CT, MR, PET and nuclear services grew by only 1.1 percent – even slower growth than the modest 1.9 percent growth from 2006 to 2007.

Use of mammography and DEXA (bone density screening to detect osteoporosis) both continue to decline in volume. Screening mammography volume fell nearly 30 percent (from 0.15% growth in 2006 to 2007 to -.20%), while DEXA volume in 2008 dropped 0.4 percent relative to 2007 (double the decline from 2006 to 2007).

Use of MRI decreased by -0.3 percent between 2007 and 2008 and the growth rate for CT volume was cut almost in half (4.2 % compared to 2.6%).

"Utilization of advanced imaging services continues to be slower in the post-DRA environment than in the prior period," said Don Moran, president of the Moran Company. "Contrary to the assumption that advanced imaging spending is rapidly increasing, the 2008 data appear to confirm the deceleration of imaging cost growth first observed in the 2007 data. Policymakers may wish to consider this trend when considering changes to imaging coverage and reimbursement."

Tim Trysla, executive director of the Access to Medical Imaging Coalition said: "MedPAC is ignoring imaging spending and use trends from 2006 to 2008 after the DRA went into effect. It's misleading and lacking in credibility for MedPAC to make policy recommendations while examining an environment that no longer exists. Policymakers must take into account the impact of the DRA and make public policy decisions based on up-to-date spending and use data."

Doctors Forecast Detrimental Impact of Additional Deep Cuts to Imaging

Radiologists and cardiologists who joined patients at an Oct. 14 rally for access to imaging said that they are concerned the proposed reductions to Medicare reimbursements, coupled with the excise tax and severe cuts already made in the last several years, will force them to make difficult choices that will deny seniors access to diagnostic services.

Data collected by the Radiology Business Management Association (RBMA) and the American College of Radiology (ACR) underscores this concern. According to their recent survey, if reimbursements were reduced by half:

36 percent of practices would consider limiting access to Medicare beneficiaries
25 percent would consider dropping out of the Medicare program
40 percent would consider consolidating service sites
40 percent would consider closing their center

"Another deep cut in reimbursements for diagnostic imaging will not only further curtail access to MRI and CT, but it will have the unintended consequences of curtailing access to all medical imaging including mammography," said Dr. Steve Harms, a radiologist at The Breast Center of Northwest Arkansas in Fayetteville, Arkansas.

Legislative Proposals to Further Cut Imaging Reimbursements

The proposed Medicare cuts for medical imaging procedures would come by changing what is known as the utilization assumption -- the amount of time that imaging equipment is assumed to operate during the hours a center is open. President Obama has recommended that the Centers for Medicare & Medicaid Services (CMS) dramatically recalibrate the reimbursement formula using a 95 percent utilization assumption for advanced imaging equipment instead. Legislation introduced in the U.S. House would change the utilization assumption to 75 percent for advanced imaging equipment. The current utilization rate CMS uses is 50 percent.

According to data from RBMA, neither rural, nor urban, non-hospital diagnostic imaging providers operate equipment at rates anywhere near those levels. Rather, a recent survey shows that imaging equipment in rural areas of the country operates only 48 percent of the time an office is open, on average, while equipment in non-rural areas operates just 56 percent of the time. In other words, under these proposals, few centers that offer these life-saving scans will be reimbursed at the proper level.

Regulatory Proposals to Further Cut Imaging Reimbursements

Patient access to diagnostic imaging is threatened not only via the legislative process, but also by CMS's proposed revisions to the 2010 Medicare Physician Fee Schedule (MPFS). In the Fee Schedule, CMS proposes dramatic cuts to the technical component of diagnostic imaging services. When combined with the effect of already-implemented imaging cuts and the proposed adjustments to the equipment utilization rate, these proposed new cuts would represent a total cut of approximately sixty (60%) over a five year period.

Dr. Paul Freier, a non-invasive cardiologist, from Illinois Heart and Vascular said: "CMS's rule would represent the most dramatic aggregate cut of any healthcare provider class within the Medicare program over the same period of time and will devastate access to appropriate imaging."