AMA backs bills to stop Medicare imaging pay cuts

The Obama administration has proposed expanding policies reducing payment for multiple imaging services to boost primary care pay rates.

By — Posted Sept. 10, 2012

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Radiologists, cardiologists and other physicians providing advanced imaging services to Medicare patients have some new ammunition in their fight to undo a program policy that pays less for multiple scans interpreted for the same patient on the same day.

On Aug. 22, the American Medical Association sent letters of support to the sponsors of House and Senate legislation that would rescind the multiple payment reduction policy applying to the professional component of certain services. The letters were a result of action at the AMA House of Delegates Annual Meeting in Chicago in June, when attendees voted in favor of such a move.

Under current Medicare policy, if a physician interprets multiple advanced imaging scans provided to a single patient on the same day, the payment for the second and any subsequent scan is decreased by 25%. Under a proposed 2013 fee schedule rule released in July, this policy would be expanded so that the reduction would apply even if two different physicians in the same practice interpreted multiple scans provided to the same patient in a single office visit.

Bills by Sen. Ben Cardin (D, Md.) and Rep. Pete Olson (R, Texas) would roll back the policy and stop its expansion by preventing Medicare from applying any pay cut to the professional component of the services unless the reduction were found to be warranted — by a national imaging specialty medical society under the House bill or by an expert panel convened by the Institute of Medicine under the Senate bill.

“Imaging services performed in physician offices have been subjected to substantial cuts over the last several years, and the AMA’s analysis of 2010 Medicare claims data suggests that advanced imaging services are already shifting from physician offices to the higher-cost hospital outpatient setting, where Medicare makes payment to the facility, as well as the physician,” AMA Executive Vice President and CEO James. L Madara, MD, wrote in the letters to the lawmakers. “Additionally, for a substantial number of imaging services, the total payment is significantly higher in the hospital outpatient setting than in a physician’s office. Medicare beneficiaries also lose in this scenario, because they are subject to higher co-payments for these services when furnished in a hospital outpatient setting.”

The American College of Radiology cheered the Association’s backing of legislation to undo the professional component payment reduction and stop its expansion in 2013.

“The support of the AMA reflects concern throughout organized medicine as to how CMS continues to make flawed physician payment policies based on little supportable data, minimal transparency and often times a basic lack of understanding as to how radiology is practiced in this country,” said Paul H. Ellenbogen, MD, chair of the ACR board of chancellors.

Physicians who provide advanced imaging to patients insisted that CMS is vastly overestimating the efficiencies that practices can realize by interpreting multiple scans provided to a single patient on the same day. They also said practices can derive virtually no added efficiency when two separate scans of a single patient must be interpreted by different physicians in the same practice.

But CMS said in the proposed fee schedule that the pay reductions were warranted, saying doctors don’t need to spend as much time reviewing patients’ medical histories and performing other aspects of the interpretation process when they are looking at multiple images for the same person.

Moreover, the agency said, the program has been overpaying for such screenings for years and underpaying for certain primary care services. In part by continuing to apply and by expanding the multiple procedure payment reduction, officials project that overall Medicare pay rates for family physicians, internists, geriatricians and pediatricians will go up by an average of 4% to 7% in 2013. Because any such administrative pay revisions must be budget-neutral to the program, if CMS were to back off the imaging policy or be required to do so by Congress, total primary care rates would not go up as much.

Cardiac, eye screens added to the mix

The proposed 2013 Medicare fee schedule also would expand the program’s policy of paying less for the technical component of certain imaging services provided to the same patient on the same day. If made final, the new provision would implement the 25% pay reduction for the professionals who administer scores of diagnostic cardiovascular and ophthalmology screenings, including many interventional radiology and nuclear medicine codes.

The American College of Cardiology is one of the groups fighting that policy expansion as well, indicating that it actually will lead to less efficiency by removing an incentive for practices to bundle the administration of separate scans into the same patient visit.

“This policy disadvantages physicians who aim for efficiency and reduces payments based on a misguided understanding of how different services, such as echocardiography and SPECT imaging, are from one another,” ACC President William Zoghbi, MD, said in a statement after the July release of the proposed fee schedule. “Furthermore, it would lead to a major inconvenience to patients.”

The proposed fee schedule is set to be finalized in November.

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What an imaging pay cut means in dollars

In its 2013 proposed fee schedule, Medicare plans to reduce pay to professionals administering certain cardiology and ophthalmology scans by 25% for the second and any subsequent scans provided to the same patient during the same office visit. It is not proposing to reduce the professional component of these particular services. Here’s what such a technical component reduction would look like for a practice providing both a tomographic myocardial perfusion imaging (SPECT) scan and a complete transthoracic echocardiography with Doppler on the same patient.

Component/payment Code 78452 Code 93306 Total current fee Total proposed fee
Technical component $427.00 $148.00 $575.00 $538.00
Professional component $77.00 $65.00 $142.00 $142.00
Global payment $504.00 $213.00 $717.00 $680.00

Source: “Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B for CY 2013,” Federal Register, July 30 (link)

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