Speakers Present Tools for Fairer Payment System
Economic issues took center stage yesterday on the third day of the American College of Radiology's 84th Annual Meeting and Chapter Leadership Conference, as members focused on the complicated world of medical reimbursement. A series of forward-thinking speakers offered tools and ideas for ways that radiologists can fight for a fairer payment system.
Patti: Billing Concerns
"Radiology and imaging reimbursements are still at great risk," John A. Patti, M.D., told the members as he launched a discussion of the ACR's major economic concerns.
Among them are growing questions around how to bill radiology assistants' (RA) time. The rules governing what procedures RAs can do, how they should be supervised, and how practices will be paid for their work is unclear. "If this continues the same way, billing for radiology assistants is going to become a complicated morass," said Patti, chair of the ACR Commission on Economics.
ACR has proposed a single universal modifier for the use of a radiology assistant, but CMS cannot implement the suggestion without specific legislation, Patti said. ACR is working to find a congressional bill to which such legislation could be attached.
ACR also supports Medicare rules requiring physicians to be financially independent of facilities to which they refer patients. Such rules might prevent kickback schemes as the one alleged to have occurred in Illinois, which surfaced earlier this year. In that case, the Illinois Attorney General claims that doctors paid imaging centers one amount for procedures but billed insurers for a larger amount, pocketing the difference.
Duszak: Ways to Improve Coding
Richard L. Duszak, M.D., offered members a glimpse of the mechanism by which Medicare decides codes for different procedures. About 200 new codes are added each year. Last year, ACR sponsored or co-sponsored 85 new codes, 22 deletions, and four editorial revisions.
Duszak also offered suggestions for improving coding, including careful documentation. For example, a physician who neglects to indicate that a CT or MRI was done with intravenous contrast could lose out on part of his or her payment.
The federal government is serious about prosecuting physician practices for fraudulent billing. "It's not mistakes, but what you do when you find them," Duszak said.
Ullrich: Be at the Table
Christopher G. Ullrich, M.D., chair of the ACR's Managed Care Committee, suggested that radiologists who build relationships with managed care companies and intervene early will have the most success staving off problems and working out fair payments for new procedures. "If you're not at the table, then you're on the menu," he said.
At the local level, Ullrich advises radiologists to approach major payers and ask for input. He said most medical directors will welcome a collegial relationship built over time. "Ask to be on an interdisciplinary panel," he said. "Ask for a dedicated radiology panel."
Allen: Changing Value
Reimbursements may change drastically if a movement to redefine how services are valued in the Resource-Based Relative Value Scale (RBRVS) goes ahead, said Bibb Allen Jr., M.D., who was seen on a recorded presentation while he attended a high school graduation.
The RBRVS is one way that Medicare determines reimbursements, and it has generally been good to radiologists, Allen said. However, it's an easy target for cost-cutters because slight changes in the formula can have a big impact.
Changes to the RBRVS might range from tweaking the formula to an overhaul of the committee that oversees the system. Currently, physicians are heavily involved in the committee.
"Challenges always present opportunities," Allen said. "This is an opportunity to define ourselves."
Rawson: Medicare's Human Face
James V. Rawson, M.D., advised radiologists who want to influence reimbursements to add input to the charge data at the hospitals where they work. Such data is used to set the hospital outpatient prospective payment system, another system that Medicare uses to decide physician reimbursements.
Rawson also recounted a story that put a human face on Medicare, rare on a morning focused more on bureaucracy. He said that in a meeting, he and another doctor complained about a recent reimbursement decision on Medicare's part that they believed might hurt access to care.
"Then we went and had lunch," he said. "(Meanwhile) they sat through lunch and reanalyzed all the data … they were worried they had done something to harm Medicare beneficiaries."
"And we were wrong. The procedure in question had gone up in use."
Lexa: Where Are the Studies?
Frank J. Lexa, M.D., detailed the fast-rising movement toward pay for performance and shed some doubt that it will work to lower costs or raise quality.
As of 2007, 110 pay-for-performance programs are in place nationwide, he said. They've been pushed by such organizations as the Leapfrog Group, which represents major corporations. The Centers for Medicare and Medicaid Services began using pay for performance in major group practices in 2005.
"But how many peer-reviewed studies show improved patient outcomes for radiology?" he asked. His answer: "None."
However, doctors who participate in a pay-for-performance program by providing data on quality of care can receive a 1.5 percent rebate on their total Medicare reimbursement.