CHICAGO – After a meteoric rise that peaked in 2006, Medicare reimbursements for noninvasive diagnostic imaging fell by 21% in 2010, a new analysis shows.
But Medicare's total payments in 2010 were still 60% greater than what it paid a decade earlier.
Dr. David C. Levin
"I think we in radiology can hope that this big cut in payments will convince the feds and payers that enough has been taken out of imaging and hopefully no more cuts will occur in the future year," Dr. David C. Levin said at the annual meeting of the Radiological Society of North America. "Unfortunately, I don’t think we can hang our hats on that hope."
Even without the so-called "fiscal cliff" around the corner, federal policy makers began cutting reimbursement for imaging services starting with the Deficit Reduction Act in 2006. Imaging has been identified in recent years as the most rapidly growing of all physician services, and it is well known that radiologists are highly compensated, he said.
As a result, efforts have been made by the Centers for Medicare and Medicaid Services to rein in reimbursements for imaging. This trend continues in the recently released final rules for the Hospital Outpatient Prospective Payment System (HOPPS).
To track these trends, the investigators used the Medicare Part B Physician/Supplier Procedure Summary Master Files for 2000-2010. These files provide data on volume and allowed reimbursements for every procedure code. All noninvasive diagnostic imaging codes, covering all specialties and all places of service, were selected and aggregated.
From 2000 to 2006, Medicare Part B payments to physicians for noninvasive diagnostic imaging rose from $5.9 billion to $11.9 billion – a 101% increase over those years.
There was a sharp reversal in 2007 when the Deficit Reduction Act first took effect, followed by a slight rise in 2008 and progressive declines to $9.45 billion in 2010, representing a 21% decrease from 2006, said Dr. David Levin, founder of the Center for Research on Utilization of Imaging Services (CRUISE) at Thomas Jefferson University Hospital in Philadelphia.
"That’s obviously a huge hit," he said.
When looked at by specialty, radiologists’ payments from Medicare rose 81% from $2.93 billion in 2000 to $5.3 billion in 2006, before dropping 11% to $4.7 billion in 2010.
Cardiologists, the second-largest group of imaging providers, suffered more than radiologists, Dr. Levin said. Their payments fell 33% to $1.9 billion in 2010, after rising 126% from $1.3 billion in 2000 to $2.9 billion in 2006.
Medicare spent $2.3 billion on imaging services to all other physicians in 2006, a 115% increase from $1.1 billion in 2000, before throttling back 17% to $1.9 billion in 2010.
Medicare payments to independent testing facilities increased 124% from 2000 to 2006, before declining 37% from 2006 to 2010.
The Deficit Reduction Act was the biggest reason for the drop in Part B payments for noninvasive diagnostic imaging – but other factors played a role, particularly in the progressive declines seen after 2007, Dr. Levin said.
Those factors include the Multiple Payment Procedure Reduction, the Centers for Medicare and Medicaid Services’ practice expense revaluation that cut the hourly rate for noninvasive diagnostic imaging from $204 to $135, an increase in the assumed equipment utilization rate from 50% to 75%, and a decrease in the volume of advanced imaging.
Finally, there was the bundling of codes for transthoracic echocardiogram, radionuclide myocardial infusion imaging, abdominal and pelvic computed tomography, and coronary CT angiography. "These had tremendous impacts," he added.
Dr. Levin reported serving as a consultant for HealthHelp and as a director for Outpatient Imaging Affiliates. CRUISE is funded in part by the American College of Radiology.