AMIC counters MedPAC imaging report

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The Access to Medical Imaging Coalition (AMIC) released new data analysis Monday countering recommendations from the Medicare Payment Advisory Commission (MedPAC), which has called for significant cuts in physician reimbursement rates for advanced medical imaging procedures.

The AMIC analysis was delivered the day before a U.S. House of Representatives Ways and Means Committee hearing on MedPAC's annual report to Congress on Medicare payment policy.

MedPAC is urging the Centers for Medicare & Medicaid Services (CMS) to significantly slash reimbursement rates for diagnostic imaging on the basis of its data that advanced diagnostic imaging equipment sees a much higher utilization rate than was previously assumed.

The AMIC report, prepared by healthcare research and consulting firm the Moran Company, analyzed Medicare claims data from 1998 - 2007 for advanced imaging services (CT, MR and nuclear medicine--including PET).

The researchers looked at volume and spending on physician imaging services billed to Part B Medicare contractors and paid under the Medicare Physician Fee Schedule to assess the effect of the Deficit Reduction Act (DRA) on spending; to evaluate utilization spending trends over a 10-year timeframe; to identify physician specialties providing advanced imaging services; and to understand trends in site of service.

The report found that in 2007, 182 million imaging procedures were performed at a cost to Medicare of approximately $11.8 billion, compared with 113 million procedures costing $5.5 billion in 1998, said Donald W. Moran, president of the Alexandria, Va.-based firm.

"By 2007 total spending dropped 13.3 percent and when the subset was applied to advanced imaging only, spending dropped by 19.2 percent from 2006 to 2007," he said during a conference call on Monday.

Additionally, they found that the majority of advanced Medicare imaging is ordered by non-radiologists and referred to radiologists suggests economically neutral incentives, according to the report.

AMIC said its data proves that MedPAC's survey of imaging utilization is flawed and should be discounted, since MedPAC only surveyed two imaging modalities in six urban areas.

"Changing the utilization rate assumption (the amount of time imaging equipment is used during a 50 hour week) from 50 to 90 percent, as MedPAC recommends, will further reduce access to imaging services," AMIC stated.

The MedPAC report was flawed specifically because it only looked at two modalities (CT and MR), measuring only one component of a formula for determining payments to physicians, instead of looking at other factors including maintenance costs, as well as for limiting its analysis to equipment costing more than $1 million, according to AMIC.

"It is certainly appropriate to look at how we assess utilization and how we compensate for procedures but to simply isolate one factor to support a decrease in reimbursement is inappropriate because it doesn't take into account how and where it is used and who is being imaged and for what reasons," said Mark Carol, MD, chief medical officer for radiology and oncology at Alliance Health Care Services.

Representatives of the American College of Radiology (ACR) and Cardiology Advocacy Alliance (CAA), also stated during the conference call that changing imaging equipment use assumptions will impact access to services.