Medicare Imaging Cuts Restrict Access to Care and Discourage New Technologies Which Would Benefit Patients
The ACR strongly supports the 0% freeze in the sustainable growth rate conversion factor for Medicare payments (as opposed to a 4.4% cut) contained in the Deficit Reduction Act of 2005 narrowly passed last night by the US House of Representatives.
However, the drastic Medicare reimbursement cuts for out-of-hospital medical imaging procedures in the bill may force many physicians to stop offering much needed imaging services or limit the number of Medicare patients they receive, and may force radiologists in rural areas to relocate to hospitals in larger cities.
In a move totally contrary to the good-faith effort of radiologists and other physicians regarding the increased utilization of imaging services, Congress arbitrarily capped the technical component reimbursement for physician office imaging to the lesser of the Hospital Outpatient Prospective Payment System or Medicare Fee Schedule payment.
These alarming cuts, in tandem with a Centers for Medicare and Medicaid Services (CMS) move to cut reimbursement for imaging exams on contiguous body parts in the same session by 25% in 2006, with an additional 25% reduction in 2007, will stifle research and development of new technologies that are increasingly replacing more invasive, and often more costly, procedures.
For example, starting January 1, 2007, appropriate Medicare reimbursement would be cut 38% - 69% for many cutting edge technologies such as the new 64-slice CT scanners which perform cardiac CTA (computed tomography angiography) that produce 3-D images of the heart allowing doctors to pinpoint problems without more invasive techniques. Drastically reduced reimbursement will leave many doctors financially unable to purchase such updated equipment. The reduced demand for new machines will likely reduce investment in research and development of new technologies.
"These cuts will keep physicians from investing in equipment that would save or extend lives and deny patients of the opportunity to receive the highest quality, less invasive care," said James P. Borgstede, MD, chair of the ACR Board of Chancellors. "Medical imaging is serving an increasingly large role in patient care. This bill is undercutting new technologies that can be of great benefit to current patients and denying future generations of less invasive procedures that may benefit all of mankind."
These cuts disproportionately affect radiologists, radiation oncologists, and other qualified physicians who have made a considerable investment in imaging equipment. Furthermore, this policy does not differentiate between diagnostic services and treatment planning services that are needed for cancer patients.
The Congressional Budget Office has greatly underestimated the policy's financial impact on radiologist physicians. The cuts, viewed as an offset for the $7.3 billion necessary to allow the physician payment freeze, reduce reimbursement for imaging services by $2.8 billion over five years. However, preliminary ACR analysis reveals that the cuts, primarily affecting radiologists, actually amount to nearly $1.2 billion annually or $6 billion over five years.
Congress ignored Medicare Payment Advisory Commission (MEDPAC) recommendations that lawmakers address (unnecessary) utilization of medical imaging as part of any effort to address imaging expenditures. These cuts will have little, if any, effect on the overutilization of imaging procedures.
"The ACR maintained a constant dialogue with the appropriate jurisdictional committees regarding an imaging policy based on the implementation of quality and safety standards that would have curbed inappropriate utilization growth, raised quality of care, and saved Medicare $5 billion over 10 years. These cuts are incredibly short sighted and will not only restrict access, but lower quality of care," said Dr Borgstede.
The reimbursement cuts will have a profound impact on radiology research and education. This new policy will deny patients of access to the most qualified medical imagers who are required to have four to six years of unique, post–medical school education in the supervision, performance, and interpretation of imaging tests, including radiation safety and the strong magnetic fields used in MRI.
"The ACR will educate lawmakers as to the drastic consequences of the imaging reimbursement cuts in this bill and work to mitigate the severe, if unintended, effects that this bill will have on patient care and our health care system as whole," said ACR Chair Borgstede. "The ACR urges lawmakers to take steps in the coming months to correct this disservice to patients and qualified medical imaging professionals that this bill has performed."