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Radiologists Push Back on Reimbursement Cuts

 |  By John Commins  
   April 12, 2013

Radiologists are complaining that their specialty has been the target of too many sticks and not enough carrots as the federal government looks for ways to control cost growth in Medicare.

The latest skirmish is pitched around the Centers for Medicare & Medicaid Services' 25% multiple procedure payment reduction to Medicare reimbursements for interpretations of advanced diagnostic imaging scans performed on the same patient in the same session. The rule, which took effect in January, applies across all physicians in a practice.

Geraldine McGinty, MD, chair of the American College of Radiology Commission on Economics, is the co-author of a study that she says refutes the government's assumptions that significant efficiencies in physician interpretation and diagnosis are gained when different providers interpret different medical imaging scans performed on the same patient.

"Medicare believes there are efficiencies so that when a subsequent service is performed, that the physician that is furnishing that subsequent service does not have to make the same effort they would have to make if there were no other services performed in the same session," McGinty says. "We don't believe that that is true and our paper clearly shows that it is not."

The study appears this week in the online edition of the Journal of the American College of Radiology.

The rule does not affect the number of scans ordered; only interpretation of scans already performed, and has been expanded to physical therapy, cardiovascular, and ophthalmology technical services as well.

McGinty's study found no intra-service work duplication when different exam interpretations were offered by different physicians in the same group practice. She says small potential efficiencies were found regarding pre- and post-service activities.

Across all scan types this corresponds to a maximum Medicare professional component physician fee reduction of only .95% – 1.87% for the same type of scan. For services from different scan types duplications were too small to quantify, McGinty's study found.

"In a practice like mine… the patient who sustains a head injury and a pelvic injury, if they had a CT scan, that would be read by the neuro-radiologist. And if they had a pelvic fracture, that would be read by a body imager or a musculoskeletal radiologist," McGinty.

"Other than the context that both physicians knowing that the patient had come from a trauma, there is no overlap in terms of what the physicians have to do. There is nothing that makes it easier for that doctor reading that complex pelvic CT… to know that a head CT was done."

McGinty says the ACR is asking CMS to rescind the rule.

"CMS said if they were given additional data to help them understand why there weren't efficiencies across the group practices they would consider it," she says. "We met with CMS on Monday and the paper was out just in time to share it with them. They agreed that they would read it carefully and consider it."

McGinty says ACR believes it's more effective to target reductions in inappropriate imaging by "helping physicians understand what test is appropriate for the clinical set of circumstances they're seeing with the patient."

"Sometimes that will be less imaging but sometimes it will be more imaging," she says. "More often it will be doing the right imaging first, as opposed to doing a test and realizing it didn't get you what you wanted, whereas if you had had the support of a radiologist and the appropriateness criteria that we developed with the ACR, you would have done the right test first."

Even with the reduced reimbursements, McGinty says physicians will continue to offer their interpretations of imaging because they put their patients' health first and foremost.

"We are doctors. I would find it hard to believe that somebody would not do an additional study because of these cuts," she says. "But again there are a lot of stresses on outpatient practices and people are trying their best to provide high quality care and invest in new technology and give jobs to their staff and balance all those things."

It is not clear what costs savings will be generated by these latest reimbursement cuts, but McGinty says this is part of larger and troubling trend to target imaging services.

"It's important to understand that radiology has been subjected to something like 12 cuts since 2006. This is just one additional cut on top of many cuts, so practices are really hurting," she says. "We are looking for incentives to provide higher quality care but there have been a lot of sticks and very few carrots for radiology."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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