The reimbursement perfect storm
A slew of reimbursement changes have gathered together to create a sort of "perfect storm" for radiology practices in the past few years, said Maurina Spillman Dennis, MPH, senior director, economics and health policy, American College of Radiology (ACR), in a presentation at the Radiology Business Management Association 2007 annual meeting in St. Louis, Mo., this week.

As usual, the Deficit Reduction Act of 2005 (DRA) which went into effect in January, topped the list of concerns for reduced reimbursements. In brief, the DRA limits certain payments for imaging services performed at physician offices or imaging centers, and specifically targets certain Medicare physician payment rates of the Ambulatory Payment Category under the hospital outpatient prospective payment system.

Dennis provided a "hit list" of economic impacts as a result of the DRA, with lost revenue annually industry-wide as follows: MRI brain — $162 million; MRI spine — $90 million; myocardial perfusion SPECT — $132 million; carotid artery duplex — $87 million; echocardiography color Doppler — $83 million; and considerable losses for PET and PET/CT that have not been calculated yet.

ACR still remains hopeful that it can have some influence on halting or modifying the DRA, which was "done in the dark of night" and was implemented without any industry feedback, said Dennis.

Hope has emerged despite previous failed attempts to halt the DRA because of the new Democrat-led congressional leadership in Washington. ACR hopes it "can have a better influence." The organization soon plans a Hill Day to meet with leaders to discuss the negative impact of DRA.

ACR will introduce a "2008 moratorium of DRA" to counter the cuts and will continue to revise its proposals throughout the year.

Other ACR policy priorities for 2007 include:
  • Support for Medicare’s efforts to develop accreditation requirements/appropriateness criteria based on private sector/doctor specialty society programs; and
  • Support of participation in accreditation programs by any specialty willing to commit to quality and appropriate use of imaging studies.
As for 2008, ACR expects to focus on issues such as the national provider identifier; leasing arrangements; additional self-referral regulations; and adjustments to the practice expense formula relating to equipment utilization and the interest rate.

ACR also has developed a Carotid Artery Stent (CAS) Registry designed to bolster quality of care in CAS procedures. The registry will gather data elements needed for CMS quality reporting, Dennis said.

The registry also will provide evidence-based outcomes data to aid physician decision-support processes, and to overall define the elements of ideal performance, she said.

ACR will be involved in further registry-type activities, and is currently working with the American College of Cardiology on additional cardiac-related projects.