Cuts to funding for medical imaging exams in the Medicare Fee Schedule Rule — particularly expansion of the multiple procedure payment reduction for interpretation of scans performed on the same patient, in the same session on the same day, to all providers in the same practice or hospital — are unnecessary, unfounded and undermine care for the most sick or injured.

“These cuts primarily affect care for people with immediately life threatening illnesses or injuries — those suffering from multiple trauma or heart attacks, stroke patients and people fighting cancer — all of whom often need multiple imaging exams to survive. Interpretation of these scans many times requires expertise of different physicians. These cuts discourage doctors from working as a team, which is the direction that health care is supposed to be going, and pull the rug out from under physicians working to save these people’s lives,” said Paul Ellenbogen, MD, FACR, chair of the American College of Radiology Board of Chancellors.

The Centers for Medicare and Medicaid Services (CMS) expanded not only the number of physicians affected by this policy, but the number of exams, based on a theory that has been medically debunked. No publicly available evidence supports a 25 percent reduction to physician interpretation payments. A 2011 study proves that any efficiencies in the multiple procedure setting are highly variable and, at most, total one-fifth of what CMS contends. No efficiencies in care support a funding cut when different physicians in a group practice interpret separate imaging scans for the same patient.

“This final rule expands a terrible policy that many lawmakers already oppose. More than 250 members of the House and 17 senators are co-sponsors of the Diagnostic Imaging Services Access Protection Act (H.R. 3269) which would block the original multiple procedure payment reduction on which these are based. The ACR calls on lawmakers to protect care for the most vulnerable of our nation’s seniors by passing H.R. 3269,” said Dr. Ellenbogen.

Medicare has already cut funding for imaging scans by roughly $6 billion since 2006 forcing many radiology providers to cut back services to stay in practice or close altogether. According to the FDA, there are now 200 fewer mammography facilities and nearly 1,200 fewer mammography scanners available to American women than in 2007, shortly after the first of several imaging cuts went into effect. A December 2011 study in Health Affairs found that as many as 12,000 American seniors may have suffered broken bones due to Medicare cuts in reimbursement for just one type of imaging scan used to gauge bone density in older Americans (dual energy X-ray absorptiometry — “DEXA”).

Further cuts will only further restrict access to imaging care, place more patients at risk, and do little, if anything to bend the Medicare cost curve. A recent Neiman Institute Report, study in JACR and Moran Company report show imaging use and imaging costs are down significantly. In fact, Medicare spends the same amount on imaging now as in 2003. Imaging is also the slowest growing of all physician services among privately insured Americans according to the Health Care Cost Institute.

“Since studies show that imaging exams can reduce unnecessary hospital admissions, shorten length of stay, and access to imaging is directly linked to greater life expectancy, we need quality based medical imaging policy – not blind cuts. This includes mandatory accreditation of all imaging providers, greater use of ACR Appropriateness Criteria-based order entry systems which educate providers as to which test is best for that patient’s symptoms, and federally backed efforts to incentivize and encourage integration of imaging scans into electronic health records. Short sighted imaging cuts ‘artificially’ limit care and will do more harm than good,” said Dr. Ellenbogen.

ACR will comment on other provisions in the Medicare Final rule in the coming days.