Radiology Reimbursement Update: Imaging Cuts in 2012 Medicare Final Rule Unfounded and Potentially Dangerous

While the Centers for Medicare and Medicaid Services -- in response to American College of Radiology data and a furious response from the imaging community -- revised the multiple procedure payment reduction for interpretation of imaging from 50 percent to 25 percent, the 25 percent cut is still unfounded and potentially dangerous. The unanticipated Final Rule expansion of this reduction to include multiple providers within the same group practice violates the spirit of the rulemaking process and indicates that CMS fundamentally misunderstands the practice of medicine.

“This extension of the multiple procedure payment reduction to include physicians in the same group practice was not specifically included in the 2012 Medicare Fee Schedule Proposed Rule. No efficiencies in care support a funding cut when different physicians in a group practice interpret separate imaging scans for the same patient. There is no scientific support for this action. The Centers for Medicare and Medicaid Services should rescind it immediately,” said John A. Patti, MD, chair of the American College of Radiology Board of Chancellors.

There is no publicly available evidence to support a 25 percent reduction to physician interpretation payments in general. A recently published study proves that any efficiencies in the multiple procedure setting are highly variable and, at most, total one-fifth of what CMS contends.

“This multiple procedure reduction will affect the most vulnerable of Medicare beneficiaries: people suffering from multiple trauma, stroke patients and those with widespread cancer – all of whom often require multiple imaging scans to survive serious illness and injury, the interpretation of which can often require the expertise of several different radiologists” said Dr. Patti. “Congress must act to protect seniors by passing the Diagnostic Imaging Services Protection Act (H.R. 3269).This act would block this multiple procedure payment reduction until and unless Medicare produces a study that would support such a cut in care."

Medicare funding for imaging scans has been slashed $5 billion since 2007. The Obama administration recommended to the congressional supercommittee $1.3 billion more in imaging cuts. This may force many suburban and rural imaging providers to close, causing many seniors to travel farther and wait longer to receive care.

“A 2009 study conducted by the National Bureau of Economic Research showed that increased use of imaging is directly tied to increased life expectancy. Those with less imaging access don’t live as long. Continued cuts may cause more cancers and serious illnesses to go undetected until advanced stage, costing Medicare more money to treat and forcing patients to undergo more extensive treatment. These cuts may very well result in deaths that could be avoided through early diagnosis by imaging scans,” said Bibb Allen, Jr., MD, chair of the ACR Commission on Economics.

A recent national poll of 1,000 registered voters showed that nearly 90 percent of Americans believe more imaging cuts will affect early detection of medical conditions and diseases. A full 70 percent of Americans oppose further Medicare cuts to medical imaging.

For more information regarding the adverse effects of further imaging cuts on patient access to care, visit RadiologySavesLives.org.

To arrange an interview with an ACR spokesperson, please contact Shawn Farley at 703-648-8936 or PR@acr.org