ACR responds to OIG report on imaging reimbursements
Source: El Paso Independent School District
Dec. 10 – A recent Office of Inspector General (OIG) report documented the nature, the extent of utilization and spending for advanced imaging services (CT, MRI and PET) paid under the Medicare Physician Fee Schedule (MPFS) provided in physicians’ offices and independent diagnostic testing facilities (IDTFs) between 1995 and 2005.

The ACR reported that the OIG found that both the utilization and allowed charges for advanced imaging grew significantly between 1995 and 2005 and the utilization across states varied substantially throughout the period. The report covered spending by provider specialty and discussed the rapid growth of advanced imaging in IDTFs by 22.77 percent over the 10-year period.

The OIG report recommended that the Centers for Medicare & Medicaid Services (CMS) monitor the growth of advanced imaging performed in ambulatory settings and reissue technical direction to Medicare carriers regarding oversight of the new IDTF performance standards as part of such monitoring.

The ACR said that while the data from the OIG indicates that diagnostic radiology accounts for the majority of advanced imaging billings, its share of total billings shrank dramatically between 1995 and 2005. Moreover, diagnostic radiology’s growth rate over the 10-year period was less than average and much lower than that for other prominent specialties, according to the ACR.

CMS agrees with the OIG’s recommendation that it should reissue technical direction of Medicare carriers regarding oversight of new IDTF standards, but also noted that it does not have funding to support unannounced site visits to IDTFs.

The association said that data presented in the OIG report, but not discussed in text, revealed that 2001 yielded the greatest year-over-year growth rates in services and allowed charges for advanced imaging services overall since 1995.

Since 2001, the ACR said there has been a general downward trend in growth rates:
  • Allowed services growth in 2005 was 17 percent for CT, compared with 23 percent at its peak in 2002;
  • MR grew 10 percent in 2005, down from 27 percent in 2001; and
  • PET growth displayed a similar pattern but on a different scale — growth in PET allowed services peaked at 345 percent in 2001, but moderated to 36 percent in 2005.
The ACR highlighted CMS’ response that the OIG report stated that “preliminary analysis of 2006 claims data shows that the overall rate of growth in imaging services is declining.”

The association added “that further imaging growth rate reductions will likely show up for 2007 and beyond due to the Deficit Reduction Act of 2005 (MPFS-HOPPS lesser-of payments and multiple procedure payment reductions), while imaging continues to be a prime target when Congress is looking for ways to cut Medicare expenditures.”