ACR Bulletin

Covering topics relevant to the practice of radiology

AMA Still Needs Help with Survey on Indirect Expenses

Radiology practitioners have been mostly unresponsive, not realizing the information is being gathered to present to CMS in the hopes it will be used to calculate reimbursement. 
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Gregory N. Nicola, MD, FACR

Gregory N. Nicola, MD
Chair of the ACR Commission on Economics

We encourage our members to look through their inboxes for this survey.

—Gregory N. Nicola, MD, FACR
February 01, 2024

From the Chair of the Commission on Economics
Gregory N. Nicola, MD, FACR

Indirect practice expense is a key component of reimbursement for radiological services. Michael Booker, MD, a radiologist volunteer serving on the ACR Economics Commission as our practice expense expert, discussed the nuances of practice expense and established a burning platform for radiologist involvement in an ongoing survey of these expenses in a previous ACR Bulletin column in October 2021 titled “What’s Next for Indirect Expense Reimbursement?” 

Indirect expenses are currently calculated by CMS using data obtained from a Physician Practice Information Survey from 2007-2008. CMS has announced plans to update the information used in calculating indirect expense but has not announced how it plans to collect the data necessary for the calculation. 

Meanwhile, the American Medical Association (AMA) has commissioned an outside company, Mathematica, to help conduct a new survey with the hopes CMS will use the results for indirect expense calculation. 

Recently, the ACR economics team and staff sat down with the AMA to gain insight on how the survey process is going. The following is a summary of the information learned during this meeting.

Survey Update

The process of creating, administering and collating the AMA/Mathematica survey has been slow, but the AMA sees it as a “no fail” project that will proceed until they receive statistically valid data. 

Thus far, 10,000 physician practices from all specialties have been sent surveys with the plan to wrap up the process by April. This completion date is subject to change as needed to collect adequate data.

Radiology was not an outlier in the low response or engagement with the survey. Low engagement was seen across all specialties.

—Gregory N. Nicola, MD, FACR

As of December 2023, the AMA had sent out surveys to 160 diagnostic radiology practices representing roughly 3,000 radiologists. Additionally, surveys have been sent to 76 interventional radiology (IR) practices representing approximately 117 IR physicians, 58 radiation oncology (RO) practices representing approximately 250 radiation oncologists and three nuclear medicine practices.  

Radiologists within multispecialty organizations will be captured separately as part of surveys sent to multispecialty groups. Data for how many radiologists are represented by these multispecialty groups was not available at the time of the meeting with the AMA. 

So far, the AMA has not received many completed surveys. Only seven diagnostic radiology practices have returned completed surveys representing 70 radiologists. One IR practice submitted a completed survey. No surveys have been returned by independent nuclear medicine or radiation oncology practices. 

AMA can also track which surveys have been opened but not completed. Only 10% of all surveys have even been opened. Surveys were sent to independent diagnostic testing facilities in January, and no further data is available regarding these entities.

Further Efforts

During this discussion with the AMA, radiology was not an outlier in the low response or engagement rate with the survey. Low engagement was seen across all specialties. 

One of the biggest concerns was that practices are not clicking on the survey delivered by email sent from Mathematica out of cybersecurity concerns. Perhaps many of the emails went to spam folders. The AMA also has some outdated contact information for groups, which it is reconciling via other data sources. 

Initially, the AMA targeted business managers and financial experts within groups but is now also sending surveys to the physician members, hoping the doctors will bring the survey to the correct person in their group. 

The AMA is deploying multiple strategies to mitigate the potential negative effects of cybersecurity precaution by the receiving organization, including calling group leaders who were sent a survey, as well as meeting with medical specialty societies to help get the message out.

How to Help

Certainly, this is sobering news from the AMA on the difficulties of conducting large-scale surveys in the modern era of cybercrime. This is also concerning for the practice of radiology because the original survey in 2007–2008 shifted significant amounts of money away from the specialty mainly because of poor survey response rate leading to narrow and unrepresentative data sets. 

We encourage our members to look through their inboxes for this survey. Two separate surveys are sent to each practice. 

One is sent to the business manager or financial expert with the subject line reading “American Medical Association requests input on physician practice expense and patient care hours” from

The second email is sent to the group’s physician members and is tilted “Please help to update accurate physician payments” from

If received, working through the questions with the group’s financial expert is vital. The AMA needs information from us to provide to the CMS. The outlook for our reimbursements might depend on it.

Author Gregory N. Nicola  MD, FACR, chair of the ACR Commission on Economics