AMIC questions CMS utilization rate increase

The Access to Medical Imaging Coalition (AMIC) has released a statement of "concern" over the Center for Medicare & Medicaid Services' (CMS) recent recommendations to President Barack Obama and Congress to reduce Medicare reimbursement rates for medical imaging and radiation therapies through an increase of 90 percent in assumed utilization rates for outpatient imaging and radiation facilities. 

According to the American College of Radiology (ACR), the rate change proposed on July 1 could ultimately reduce reimbursements to lifesaving procedures such as CT, MRI, PET and radiation therapies by as much as 40 percent, threatening patient access to quality care.

"There are countless other ways--such as appropriateness criteria, accreditation and physician feedback systems--to reduce costs and ensure proper utilization of imaging and radiation therapy, without compromising patient access in the way that the CMS proposed changes will," said Tim Trysla, executive director at AMIC. "The CMS recommendation to arbitrarily raise utilization assumptions is entirely unfounded, and have tremendous potential to threaten patient access to care, particularly in areas such as rural America, which is already being hit hardest by similar Medicare imaging cuts enacted by Congress in 2006."

Although the cutbacks would be felt nationwide, AMIC said that rural communities--where the actual imaging utilization rate is only 48 percent (approximately half the rate that Congress is proposing)--would be hit the hardest due to their already limited access to independent medical imaging and treatment centers.

The coalition said that an increase in the utilization rate assumption could very well result in facility closures in these areas, forcing patients to travel farther to receive their scan, wait longer in emergency rooms and doctor offices and experience delays in their results, all of which could lead to complications in patient care and setbacks in fighting disease.

"We hope that members of Congress and the Administration will make the right decision and choose to protect their constituents by rejecting this proposal, and instead work with organizations such as AMIC which support the adoption of physician-developed appropriateness criteria," Trysla said. 

CMS will accept comments on the proposed rule until Aug. 31, and will issue a final rule by Nov. 1.

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