MPPR on the chopping block?

Last month, legislators finally slayed the SGR after years of settling for temporary patches in the face of political gridlock. Could the Multiple Procedure Payment Reduction (MPPR) be the next controversial policy to go down?

It might just be, if recently introduced legislation passes through Congress. The Diagnostic Imaging Services Access Protection Act (HR 2043) was introduced in the U.S. House by Reps Pete Olson (R-TX), Peter Roskam (R-IL) and Betty McCollum (D-MN). It mirrors the newly introduced U.S. Senate bill S.1020 and would prospectively repeal the 25 percent MPPR applied to Medicare reimbursement of imaging interpretations for scans performed on the same patient, in the same session, on the same day.

The MPPR hasn’t been around as long as the SGR, nor does it have the headline-grabbing allure of the now defunct payment formula. Nevertheless, it has been fiercely opposed by many in the imaging community. MPPRs were first applied to the technical component of advanced diagnostic imaging services in 2006, with cuts spreading to the professional component in 2012.

However, studies have questioned the benefits of an MPPR-based approach to imaging utilization management. A study published two years ago in the Journal of the American College of Radiology pointed out the limited efficiencies stemming from separate radiologists in a single practice interpreting different imaging scans performed in the same session on the same patient. Total duplicated services averaged only 1.23 percent of total professional component fees, a small gain in the face of a 25 percent cut.

In a statement supporting HR 2043, the ACR also pointed out that the MPPR as implemented by the Centers for Medicare & Medicaid Services could affect funding for care of patients—particularly victims of trauma, stroke or widespread cancer—who need interpretations from multiple physicians.

“Imaging cuts are unnecessary and may cause more harm than good,” read the ACR statement. “Medicare imaging use and costs are down significantly since 2007. Medicare spending on scans today is the same as in 2003.”

The MPPR is a blunt instrument attempting to fix a problem that requires more precision. Clinical decision support systems, paired with robust appropriate use criteria, are more elegant tools to address unnecessary imaging and reduce costs, while ensuring the scans that are performed are valuable.

Perhaps the wave of bipartisanship that upended the SGR will also wash away the MPPR.

-Evan Godt
Editor – Health Imaging