Attention Physician Practices, Imaging Centers: Tell Congress to Stop Additional Imaging Cuts
September 30, 2009
The Medical Imaging and Technology Alliance (MITA) is urging primary providers of imaging services to let Congress know that additional cuts in medical imaging reimbursement are unacceptable and could provide serious access issues for Medicare patients. MITA represents makers of imaging equipment and technologies. Here is the MITA customer alert.
Medical Imaging Technology Alliance
Customer Alert
Your help is needed to stop further imaging cuts!
Additional cuts to your payments for imaging services beyond the DRA caps will happen as a result of new legislation or regulation unless stopped. As primary providers of imaging services, it is VERY important that you let Congress know that these cuts are unacceptable and could provide serious access issues for Medicare patients.
CMS Proposed 2010 Medicare Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) is proposing the following:
- CMS is proposing to change the equipment utilization assumption from the current 50% to 90% for equipment priced over $1 million. (Note: The $1million threshold is not directly related to how much you paid for the equipment. The equipment costs are rolled into the codes, so essentially CT, MR, PET and Nuclear Codes are all impacted)
- CMS is proposing to include new practice expense per hour data from the Physician Practice Information Survey (PPIS), conducted by the AMA. This will replace of the AMA’s Socioeconomic Monitoring System (SMS) data and supplemental data from certain specialty societies (such as the ACR) to calculate the fee schedule’s Practice Expense (PE) RVUs. This produces significant reductions to the PE RVUs for imaging and radiation therapy services.
The combined effects of the 90% utilization assumption and the new practice expense data result in proposed rates significantly lower than the DRA caps.
- MRI Lumbar Spine w/o Dye (72148) would go from $348 to $231
- MRI joint of lower extremities w/o dye (73721) would go from $348 to $261
- MRI Lumbar Spine w/ and w/o Dye (72158) would go from $539 to $332
- CT Pelvis w/ Dye (72193) would go from $265 to $145
- CT Thorax w/ Dye would go from $265 to $154
*Rates reflect national average allowances and DRA caps
Imaging Cuts Also Are Under Consideration by Congress as Part of the Health Reform Package
- Legislation passed by three Committees in the House of Representatives increases the utilization assumption used by Medicare from 50% to 75% for advanced imaging equipment and increases the reduction of payments for images done on contiguous body parts from 25% to 50%.
- Proposals under consideration by the Senate increase the utilization assumption used by Medicare from 50% to 90% for advanced imaging equipment.
These cuts are on top of cuts to payments for imaging services under the Deficit Reduction Act (DRA) of 2005 and the contiguous body part reduction policy of 25%!
Congress Should Reject Additional Massive Cuts to Imaging
Further reductions in payment threaten the viability of free standing imaging centers and patient access to care
Link to rightscanrighttime.org and Write Congress
AND
Tell your Congressional Representatives and Senators:
- About your practice and how these huge cuts on top of the DRA reductions will affect your center(s) and your community
- What the impact on patients will be (increased wait times, inability to get services in a timely and safe manner, etc.)
- Whether you will be able to continue to provide services in your community
- Why a 90% utilization assumption is not appropriate given that these proposals are based on a limited and outdated survey of imaging centers in only six urban areas. Explain how different patients, different modalities vary in length of scan time and how this impacts “utilization.” Share data you have that provides more accurate picture of your facilities’ utilization percentages over the course of a year.
- Urge them to ask CMS to delay the implementation of the AMA PPIS data used to determine rates in the 2010 proposed Physician Fee Schedule rule. It is not reflective or representative of the industry or of actual practice expenses. Data that reflects such a small number of respondents is not accurate and should not be used.
- Encourage them to ask CMS not to implement the proposed 90% utilization assumption until more accurate data is available.
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