RBMA Data on Reimbursement for Advanced Imaging

(WASHINGTON, DC) - According to the Radiology Business Management Association (RBMA), "Actual imaging use far below president's recommended 95 percent utilization rate for Medicare Based on Medicare reimbursement assumptions, rural imaging centers operate equipment at a 48 percent rate"

President Obama and MedPAC (Medicare Payment Advisory Commission) are working to use a 95% utilization rate in the calculation of radiology reimbursement rates. Based on this latest data, 95% is inaccurate and is above the actual rates. An overestimate on utilization rate will then therefore reduce reimbursements based on the current Medicare equation.

Per the RBMA, imaging equipment operates only 48% of the time during office hours in rural regions and 56% of the time during office hours in urban regions. President Obama recently recommended CMS base its reimbursement formula on a 95 percent utilization rate for advanced imaging equipment.

Potential cuts in imaging will have a destructive impact on access to advanced imaging in rural regions of the country and force many patients to return to imaging in the hospital settings.

"Spending on advanced imaging has decreased significantly since 2005 and imaging use has essentially flattened. When it comes to imaging, the curve has already been bent," Tim Trysla, executive director of the Access to Medical Imaging Coalition (AMIC) said. "Any further deep imaging reimbursement cuts will severely disrupt patients' access to diagnostic services. Bureaucratic red tape including long waits for appointments, delays in the waiting room and patients driving long distances will be typical if Medicare spending is reduced by levels proposed by President Obama or MedPAC."

"If policymakers want Medicare's reimbursement formula to mirror actual imaging equipment utilization rates in both urban and rural practices, our data demonstrate CMS' current use rate assumption is more accurate than what Congress and the Administration are proposing," said Michael Mabry, executive director of RBMA. "Since MedPAC's utilization rate survey was based on only six urban regions, we understand policymakers' need to continuously collect accurate use rate data to inform their reimbursement decisions. RBMA is committed to collecting and providing those data on an ongoing basis."

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RBMA represents nearly 2,400 radiology practice managers and other radiology business professionals. Radiology practice managers are responsible for the day-to-day operation of radiology group practices. RBMA is the leading professional organization for radiology business management, offering quality education, resources and solutions for its members and the healthcare community.

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