ACR Economics Commission Vice Chair, Staff Hold RBMA E-seminar on Effects of Deficit Reduction Act Imaging Provisions and CMS Reimbursement Changes
Bibb Allen Jr., MD, vice chair of the ACR economics commission, Pam Kassing, ACR senior director of economics, and Joshua Cooper, ACR senior director of government relations, were the primary speakers in a March 15 Radiology Business Management Association (RBMA) e-seminar regarding the effects of the imaging provision in the 2005 Deficit Reduction Act (DRA) and Centers for Medicare and Medicaid Services (CMS) reimbursement changes for 2006 and 2007.
Allen described what he called "a perfect storm" facing radiologists in the next twelve months stating, "Although we are very concerned about the adverse effects of the drastic cuts in the Deficit Reduction Act and CMS's multiple procedural discount rule, we are also working on the effects of 5 year review, implementing practice expense data, and how radiology fits into a fix for the SGR for next year."
Cooper called the DRA imaging cuts "bad policy," stating, "the disproportionate cuts threaten to restrict patient access to care, particularly in rural areas, and may discourage research and development of new technologies which could benefit patients." He added that CBO grossly underestimated the financial loss to medical imagers, which they estimated to be $2.8 billion over 5 years. Cooper says that preliminary ACR analysis reveals that the cuts, primarily affecting radiologists, amount to nearly $1.2 billion annually or $6 billion over five years.
The imaging provisions in the DRA cap the technical component reimbursement for physician office imaging to the lesser of the Hospital Outpatient Prospective Payment System (HOPPS) or Medicare Physician Fee Schedule payment (MPFS). The Members responsible for inserting the provisions have stated that Medicare should not pay more for a procedure performed out of hospital than they do in-hospital.
However, Kassing called that reasoning flawed, stating, "the data from the two payment systems are different and that one methodology cannot be used as a payment mechanism for the other." Kassing says that the ACR is working to educate lawmakers and government officials that actual cost reporting, and thus payment figures, have traditionally been arrived at differently for hospitals than those regarding in-office or free-standing imaging centers.
