ACR: Medicare cuts may end non-hospital imaging

The American College of Radiology (ACR) released a statement yesterday charging that medical imaging cuts contained in the 2010 Medicare Physician Fee Schedule may restrict imaging services to large hospitals, produce longer commutes and wait times to receive care, and could cause delays in diagnosis and treatment of cancer and other serious illnesses.

“These short sighted, unfounded and misguided cuts will imperil community-based imaging, restrict access to cutting-edge imaging scans and delay diagnosis of cancers and other critical conditions which may ultimately cost lives,” said James H. Thrall, MD, chair of the ACR’s board of chancellors. “Many hospitals are not equipped to handle the substantial influx of patients that could result from the inevitable closure of rural and suburban imaging facilities caused by these cuts.”

Specifically, the Centers for Medicare & Medicaid Services (CMS) will raise the imaging equipment utilization rate assumption—the time during office hours that imaging equipment is assumed to be in operation—from the current 50 percent rate to 90 percent.

However, the ACR cited a recent Radiology Business Management Association report that found that rural providers use scanners only 48 percent of office hours and that the national average is only 54 percent. “This assumption is a major factor to determining reimbursement,” the ACR explained. “The wider the gap between the new mandated 90 percent rate and the actual time a provider uses scanners, the deeper the cut.”

CMS also will implement new practice expense data collected through the Physician Practice Information Survey (PPIS) further decreasing reimbursement to CT and MRI scans.

The college said that data from the PPI survey, based on a limited amount of survey responses, are not as robust as that from the ACR Socioeconomic Monitoring Survey and not representative of practicing radiologists. “The costs of the practice of radiology in the office setting are significantly underrepresented in the PPI survey,” the ACR said.

The CMS 90 percent utilization mandate and practice expense reimbursement adjustments produce an average across the board 16 percent cut to imaging providers, but specifically reduce reimbursement to such essential studies as lung CT or MRI of the spine by 40 percent or more.

According to ACR, these cuts, on top of an average 23 percent reduction from the Deficit Reduction Act of 2005, totaling $13.8 billion, will end the ability of many non-hospital providers to offer imaging services, particularly in rural areas where equipment is needed, but utilized less frequently.

“Not only will these cuts affect patients in need of high-tech scans, but wait times for common exams like bone density scans and even mammography will skyrocket,” said Thrall. “The number of centers offering mammography has already begun to go down because of poor balance between reimbursement versus risks and costs. Women could wait months or longer to receive mammograms if additional non-hospital providers who rely on offsetting payments for MRI and CT to allow them to offer mammograms, are forced to stop providing the service.”

Instead of the cuts, the ACR said that Medicare should pursue “sensible alternatives like wider use of ACR appropriateness criteria to guide physicians as to which scans are most appropriate for particular conditions and physician order entry systems based on appropriateness criteria such as that mandated for 2010 by the Medicare Improvements for Providers and Patients Act of 2008.

“Medical imaging exams have been directly linked to greater life expectancy, declines in cancer mortality rates, and are generally less expensive than the invasive procedures they replace,” the ACR said.