March 20, 2020

MedPAC Report Policy Proposals Would Impact Radiology Payments

In its March 2020 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) discussed previous recommendations that would have an effect on radiology fee-for-service (FFS) reimbursement rates, if adopted by Congress.

They included:

  • Improving the accuracy of payments and increasing payments to primary care providers by reducing the payment rates in the Medicare Physician Fee Schedule for overpriced services
  • Establishing a prospective payment per beneficiary for primary care practitioners, funded by reducing fees for nonprimary care services in the fee schedule
  • Making payments site-neutral by reducing or eliminating differences in payment rates for evaluation and management (E&M) office visits and other selected services performed in hospital outpatient departments versus the same services performed in physician offices
  • Eliminating differences in payment rates between inpatient rehabilitation facilities and skilled nursing facilities for selected conditions
  • Establishing a prior authorization program for practitioners who order substantially more advanced imaging services than their peers

Looking at overall spending trends, the commission reported that per beneficiary FFS Medicare spending grew in most settings from 2013 to 2018 following a slowdown from 2009 to 2013. Much of this growth related to increased drug prices and a shift in site of service from physician offices to hospital outpatient settings. The rate of growth for Medicare physician reimbursement rates slowed between 2013 and 2018. MedPAC’s exploration of physician payment equity found relatively low reimbursements for primary care services compared to specialty care.