Government

CMS targets imaging services for fee cuts

Radiologists warn that a proposal to reduce Medicare payments for multiple services could be a precursor to more cuts.

By David Glendinning — Posted Aug. 22, 2005

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Washington -- The Centers for Medicare & Medicaid Services may have fired the opening salvo in the struggle to rein in the rise in spending on physician services.

Tucked away in the nearly 800 pages of a recently released CMS proposed rule on the 2006 physician fee schedule is a new plan to reduce reimbursements for certain imaging services when performed on one patient during a single session. For instance, the government currently pays full price for magnetic resonance imaging of the abdomen and the pelvis when a physician administers both scans during the same visit. The federal proposal, though, would reduce payment for the second procedure by half.

The Medicare Payment Advisory Commission provided the inspiration for the move last March when it recommended new, lower-paying reimbursement codes for multiple imaging services. The commission said it believes that is fair, because much of the physician's work in setting up the patient for the first scan does not need to be repeated for subsequent scans.

CMS agreed with MedPAC's assessment and concluded that doctors' ability to achieve such operational efficiencies warrant lower reimbursements. But Medicare officials might have been shortsighted when they came to this conclusion, said James Borgstede, MD, chair of the American College of Radiology's board of chancellors.

"We're not convinced that the way they're doing this is appropriate, particularly on nuclear magnetic resonance and ultrasounds," said Dr. Borgstede, a radiologist in Colorado Springs, Colo. "In nuclear magnetic resonance, for example, when you do contiguous scans, oftentimes you have to take the patient out of the scanner between parts, you have to change some of the technical equipment that you're using on that scanner and you also have to do repeat localizing images before you can do the second part."

After accounting for the extra work that the doctor does, the theory that bundling multiple imaging services produces cost savings of more than 50% to the physician might no longer be valid, he said. Radiologists also worry that CMS' strategy to make up for the reductions by funneling the government's savings into other areas of the imaging reimbursement system would result in unpredictable payments for doctors.

A harbinger of more cuts?

In addition to harboring concerns that this particular proposal could provide a financial hit to physicians, some doctors worry that the restriction would mark only the beginning of the federal government's interest in the outpatient medical community.

In recent months, CMS has set its sights on imaging, which has experienced spending growth over the last decade that is roughly three times the average increase for all physician services. Supporters of the proposed change predict that it will cut down on the financial incentive to order unnecessary imaging services on contiguous body parts.

While doctors would support reforms that legitimately limit spending on truly excessive procedures, they balk at proposals that would slice more broadly, Dr. Borgstede said.

"This is akin to, or at least the first cousin of, across-the-board cuts for imaging reimbursement," he said.

Such moves toward spending restraint might not be confined to the imaging field. Medicare officials also have highlighted office visits and minor surgical procedures as primary contributors to a recent surge in Medicare spending on physician services. Although it has not suggested cuts in those payments so far, CMS continues to look for areas in which this increased utilization could be suspect.

Federal interest in the physician arena already has prompted the American Medical Association to take a stand against potentially aggressive attempts to limit spending on doctors' services. Delegates at the AMA Annual Meeting in June passed a resolution calling on the Association to oppose efforts by any payer to control utilization of any medical service unless policy-makers can demonstrate that the move will improve quality without interfering with patient access.

The Association's explanation that legitimate clinical reasons might explain much of the spending increases has caught the attention of Medicare officials.

"The AMA has provided us with several illustrations of recent trends in medical practice that it believes contribute to the overall growth in spending on physicians' services," CMS said in the proposed rule. Such trends include growing encouragement from payers to assess heart function using echocardiograms and to prescribe statin therapy for increasingly older patients.

CMS is accepting comments on the imaging plan and other proposed changes to the physician fee schedule through Sept. 30. The regulations are available online (link).

The agency is scheduled to release a final rule later this year.

Back to top


ADDITIONAL INFORMATION

How Medicare will pay

For radiologists and other physicians, reimbursements for some imaging services may drop significantly next year. Here are some other changes doctors can expect under the proposed fee schedule rule:

  • CMS will pay about $56.5 billion to 875,000 physicians and other outpatient health care professionals.
  • Doctors will sustain a 4.3% cut in their Medicare pay absent congressional and/or administrative intervention.
  • The glaucoma screening benefit will expand to include Hispanic-Americans 65 and older.
  • CMS will start reimbursing drugs and biologicals furnished by end-stage renal disease facilities at the average sales price plus 6%.
  • The interim dispensing fee for inhalation drugs administered using nebulizers will decrease.

Source: Centers for Medicare & Medicaid Services

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn