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Proposed Medicare Physician Fees' Winners and Losers

Cheryl Clark, for HealthLeaders Media, July 15, 2013

"We're looking for fair treatment from Medicare, and some of the cuts that have come recently, such as those for (certain) procedures, really seem quite illogical."

In a statement, ACR said that CMS' other proposed rule, affecting the Hospital Outpatient Prospective Payment System, would "establish separate cost centers for CT and MRI, distinctly separate from the diagnostic radiology cost center in the inpatient setting. And that "would not only cut hospital outpatient payments for CT and MRI studies by 18% to 38%, but the technical payments would fall below the rates in the Physician Fee Schedule causing these cuts to affect in-office imaging as mandated by the Deficit Reduction Act."

Peter Hollmann, MD, speaking for the American Geriatric Society, said some parts of the proposed rules are "harmful to geriatricians on their overall practice" even though the fee schedule shows that geriatricians are overall winners, with an average payment increase of 2%.

Hollmann emphasized, however, that he does not consider the changes any reflection that the federal government is valuing the work of geriatricians more, only that it has reconsidered the value of other services, such as imaging, and downgraded those.

"We're the innocent bystander, who instead of getting collateral damage, is getting a collateral reward." Hollmann added that the overall policy shift reflects CMS' effort to "look at all services, and more appropriately value them than they have in the past."

A key change in the way Medicare beneficiaries imaging services will be paid has to do with an adjustment in equipment utilization, which goes from an assumption the machines are being used 50% of the time to being used 90% of the time. That will tend to dramatically reduce payment for imaging services.

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