The ACR Impacts Medicare Reimbursement for Radiologists
Radiologists and radiation oncologists are seeing an increase in Medicare reimbursement this year, and the congressional lobbying efforts of the American College of Radiology in 2003 helped make it happen.
The hundreds of congressional meetings conducted by ACR members who attended the Annual Meeting and Chapter Leadership Conference Lobby Day in Washington, DC, in May 2003 were instrumental in the enactment of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. A $400 billion reform package passed by Congress and signed by President Bush late last year, this landmark legislation represents an important victory for physicians. In addition, working diligently with the Centers for Medicare and Medicaid Services, the ACR was able to influence the formulation of the recently implemented 2004 Medicare Physician Fee Schedule. The MPFS now contains several provisions important to ACR members.
The prescription drug/Medicare reform bill and the MPFS impact radiologists in the following ways:
Increased Reimbursement for Diagnostic Mammography
A provision in the prescription drug/Medicare reform bill will increase the technical portion of diagnostic mammography procedures performed in hospital outpatient settings. The Congressional Budget Office calculates that this provision will increase payments to hospital outpatient facilities by $200 million over the next 10 years and hopefully will help stem the mammography facility closings that have led to the current access problem for women seeking timely mammography services. Based on 2004 reimbursement data, it is estimated that in 2005 the technical portion for diagnostic mammography performed in a hospital outpatient setting may increase from $35.86 to $41.82 (a 14 percent increase) for a unilateral mammogram and from $35.86 to $51.53 (a 30 percent increase) for a bilateral mammogram. The provision will become effective Jan. 1, 2005.
Combined with the College's earlier efforts to increase payments for screening mammography, which raised the global fee for screening mammograms from $69.23 to $84.86, radiologists and radiology facilities will actually receive a total of $750 million in additional funds over the next 10 years.
A New Sustainable Growth Rate Conversion Factor
A provision in the reform package prevented a 4.4 percent cut to the 2004 Medicare conversion factor and instead increased it by 1.5 percent over 2003 levels in both 2004 and 2005. Preliminary figures estimate this change will provide billions of additional dollars for radiological services in those years. The increased conversion factor also avoids potential access problems for Medicare beneficiaries with physicians who were thinking of not accepting new Medicare patients or not seeing Medicare patients altogether. It is, however, important to note that beginning in 2006, physicians will face four years of steep cuts to recoup the costs of the 2004 and 2005 increases unless changes are made to the physician reimbursement formula. The ACR has already begun discussions with key congressional staff and is committed to working with leaders in the House and Senate to avoid these steep cuts.
A New Floor for Physician Work GPCIs
Provisions contained in the prescription drug/Medicare reform bill reduced geographic payment disparities by placing a floor of 1 on the Geographic Practice Cost Indices. As a result, physicians who previously worked in areas where the GPCI was less than 1 will see estimated reimbursement increases of $1 billion over the next three years (2004-2007). Prior to the passage of the prescription drug/Medicare reform bill, geographic adjustments to Medicare reimbursement varied from .881 to 1.068. The ACR Economics and Health Policy Department can provide a break out of GPCIs per locality to any interested member.
In addition, physicians practicing in Medicare-designated "scarcity counties" will be the recipients of a new 5 percent incentive payment program beginning in 2005 and running through the end of 2007. The incentive program is designed to reward both primary care and specialty care physicians for furnishing services in the areas that have the fewest physicians available to serve beneficiaries. The new incentive program is estimated to provide an additional $700 million to physicians and is in addition to the current 10 percent Health Professional Shortage Area incentive payment.
Reimbursement Rates Maintained for Procedures in Nonphysician Workpool
The nonphysician workpool (NPWP) refers to a special, temporary methodology that CMS developed to determine practice expense relative value units for services that do not involve physicians and have no physician time (and therefore have no physician work RVUs). Currently radiology, radiation oncology and cardiology comprise the majority of the NPWP. Oncology services were in the NPWP prior to Jan. 1, 2004, but have since been removed as a result of CMS action and Congress' establishment of payment reform for Part B drugs.
Many in radiology were concerned that the removal of oncology services from the NPWP would have an unwarranted negative impact on the remaining codes. It was thought that the removal of oncology services would result in reimbursement values for the remaining codes that were less than costs, which would jeopardize the availability of specialty-specific procedures to Medicare beneficiaries. To avoid these problems and ensure that reimbursement levels remain steady, the ACR was able to insert "hold harmless" language in the prescription drug/Medicare reform bill.
Competitive Bidding Effort Stopped
Early drafts of the prescription drug/Medicare reform bill indicated that congressional Medicare leaders were considering including competitive bidding for radiological services as a cost-savings measure. The ACR argued that this move would adversely impact the quality of images, potentially resulting in more images being taken. This would drive up costs rather than save money. The ACR successfully stopped this effort, and competitive bidding did not make it into any of the final drafts.
Replacement of CPT® Coding System Avoided
A provision that potentially could have replaced the CPT® coding system used by physicians with the ICD-10-CM system was dropped from the prescription drug/Medicare reform bill after the ACR and other physician groups convinced legislators that such a change was not necessary and would adversely affect physician practices. The ACR argued that the costs associated with practices switching to the ICD-10-CM coding system were too prohibitive and could be considered an unfunded congressional mandate.
