JACR: Radiologists hit disproportionately hard by Deficit Reduction Act
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The DRA significantly impacted imaging payments, said David Levin, MD, from the department of radiology at Thomas Jefferson University Hospital in Philadelphia. Levin cited a Government Accountability Office (GAO) report, which determined that in 2007--the first year the DRA took effect--Medicare Part B payments for imaging dropped to $12.1 billion, 12.7 percent less than the $13.8 billion in payments reported in 2006.
According to the study authors, the American College of Radiology (ACR) and other organizations opposed the DRA for a number of reasons, particularly a concern over whether “nonradiologist physicians and groups who owned MRI and CT scanners would make up for any revenue shortfalls by increasing their self-referral of patients.”
The authors studied nationwide Medicare Part B databases for the years 2002 to 2007. Using Medicare physician specialty and place-of-service codes, the authors were able to study trends in procedure volume and payments in radiologists’ private offices compared with nonradiologist physicians (NRP).
Levin and colleagues found that for MRI exams, radiologists’ private office volume increased by 8.4 percent annually from 2002 to 2006, but dropped by 2 percent in 2007. During the same period, office MRI payments to radiologists increased by 11.2 percent annually from 2002 to 2006, but dropped by 30.1 percent in 2007.
NRP office volume for MRI exams increased 24.8 percent annually from 2002 to 2006, and then increased by another 7.6 percent in 2007. Office MRI payments to NRPs increased by 25.7 percent annually between 2002 and 2006, then dropped by 23.5 percent in 2007.
For CT, radiologists saw their private office volume increase by 11.2 percent annually from 2002 to 2006, then increase by just 2.9 percent in 2007. NRP CT office volume increased by 31.8 percent annually between 2002 and 2006, then increased by another 18.1 percent in 2007.
Office CT payments to radiologists increased by 13.4 percent a year from 2002 to 2006, then dropped by 5.2 percent in 2007. NRP CT payments increased by 34.9 percent annually from 2002 to 2006, and continued to increase by another 8.3 percent in 2007.
"It thus seems apparent that nonradiologist physicians fared considerably better than radiologists during the first year of the DRA,” the authors noted. “The data suggest that nonradiologist physicians may be able to offset the decline in reimbursement rates for in-office MRI and CT by increasing self-referral of their patients for scans.”
The authors also pointed to another possible explanation—that referral rates among nonradiologists remained stable but that more of them got into the imaging business.
The authors concluded that the “trends are of concern and should be scrutinized in future years.”