CMS proposes more imaging cuts, expanded MPPR

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Reimbursement Cuts - 41.93 Kb

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on July 6 updating payment policies and rates under the Medicare Physician Fee Schedule (MPFS) for 2013. CMS projected significant reductions in MPFS payment rates under the sustainable growth rate methodology, and medical imaging faces severe cuts, particularly due to an expansion of the multiple procedure payment reduction (MPPR) policy.

The annual update to the physician fee schedule is calculated based on a formula which applies a sustainable growth rate for expenditures. If actual expenditures exceed expectations, the physician fee schedule is reduced, and CMS is required by law to apply these updates unless averted by Congress.

“While the Congress has provided temporary relief from negative updates for every year since 2003, a long-term solution is critical,” wrote the authors of the proposed rule.

CMS estimated the combined payment impact for specialties based on changes to relative value units, including:

  • 4 percent reduction in total allowed charges for radiology;
  • 3 percent reduction in total allowed charges for nuclear medicine;
  • 14 percent reduction in total allowed charges for radiation oncology; and
  • 19 percent reduction in total allowed charges for radiation therapy centers.

CMS also proposed an expansion of the MPPR policy which would apply the MPPR to both the professional component and the technical component of advanced imaging procedures performed by one or more physicians in the same group practice to the same patient, in the same session, on the same day.

“When multiple diagnostic tests are furnished to the same patient on the same day, most of the clinical labor activities and some supplies are not furnished twice,” read the proposed rule. Some of the activities that CMS states would not be duplicated in such scenarios are greeting the patient, equipment preparation, taking vitals and reviewing prior imaging.

A press release issued by the American College of Radiology (ACR) labeled the cuts “extreme,” and said they were “unnecessary, unfounded and undermine care for the most sick or injured seniors.” The ACR said there was no evidence to support a 25 percent reduction to physician interpretation payments and pointed to a 2011 study published in the Journal of the American College of Radiology, which demonstrated that efficiencies in the multiple procedure setting are highly variable and much less than what CMS contends.

Also included in the proposed rule was a proposal to allow Medicare to pay for portable x-ray services ordered not only by physicians, but also by non-physician practitioners acting within the scope of their Medicare benefit and state law.

The proposed rule will appear in the Federal Register July 30, with comments accepted until Sept. 4.

The full text of the proposed rule can be downloaded here.