The American College of Radiology on Monday expressed its displeasure with proposed payment policy changes some experts estimate would cost the field $10 billion over the next decade.
The Centers for Medicare and Medicaid Services recently unveiled its proposed Medicare Physician Fee Schedule (MPFS), which is set to take effect on Jan 1, 2021. Specifically, the ACR took exception with changes to office/outpatient Evaluation and Management (E/M) coding.
In its preliminary summary, the ACR said it’s “extremely disappointed” that CMS chose to move forward with the alterations.
“These changes will result in significant payment reductions to all services including radiology services in 2021 unless Congress acts to suspend the budget neutrality requirement,” the College said in a preliminary summary published Monday. “The ACR will use every avenue available to work with Congress to modify the impact of these changes.”
Imaging groups have been urging Congress for relief from such coding modifications in an effort to prevent significant reimbursement reductions across the field. And in May, an ACR-commissioned analysis found that increasing E/M services by about $5 billion would cost the imaging field $770 million in the first year of implementation alone and $10 billion over the next 10 years.
CMS estimated the overall impact of the MPFS proposed changes on radiology would be an 11% decrease, with interventional radiology suffering an aggregate 9% decline. Similarly, nuclear medicine is expected to see an 8% decrease, while radiation oncology and radiation therapy centers will face a 6% drop.
The ACR said it will review the entire MPFS proposed rule in the “coming weeks” and offer up a more comprehensive summary.
Changes to Hospital Outpatient Prospective Payment System
On Tuesday, CMS also released its proposed HOPPS rule, with changes set to appear in the final rule that goes into effect on Jan. 1, 2020.
Among the changes are the implementation of CT and MR cost data regardless of the cost allocation method. The ACR has expressed repeated concerns in the past that some hospitals reporting under the “square foot” method would underestimate the “true costs” of such exams.
Additionally, CMS is proposing to place low-dose CT for lung cancer screening in the lowest Imaging without Contract APC, and “visit to determine lung LDCT eligibility” in APC 5822. The College has also “raised concerns” that flawed hospital data would lead to inadequate payments for such screening.
A detailed analysis of the rule changes will be released in the upcoming days, according to the ACR. You can read its preliminary breakdown here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.