par Brendon Nafziger
, DOTmed News Associate Editor | July 09, 2012
The Centers for Medicare and Medicaid Services plans to expand controversial reimbursement cuts to doctors who perform multiple advanced imaging scans on the same patient during the same diagnostic session, and radiologists aren't happy.
In the proposed 2013 Medicare Physician Fee Schedule, published Friday, CMS said it would dock 25 percent from the professional component from any doctor in a practice performing second and subsequent CT, MRI or ultrasound scans on the same patient on the same day. Earlier cuts, introduced last year, only applied to a single radiologist, not all professionals in the same practice.
The agency said the cuts are in line with similar policies for other medical procedures, and take into account efficiencies doctors enjoy for multiple scans. But the American College of Radiology said the cuts were "unnecessary" and "unfounded," as patients getting multiple scans are often the sickest -- cancer, trauma, or stroke victims -- and the supposed efficiencies are often illusory.
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"These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people's lives," Dr. Paul Ellenbogen, chair of ACR's board of chancellors, said in a statement, issued Monday.
CMS also will reduce payments for the technical component of two kinds of radiation therapy. "We propose to adjust the payment rates for two common radiation oncology treatment delivery methods, intensity-modulated radiation treatment (IMRT), and stereotactic body radiation therapy (SBRT) to reflect more realistic time projections based upon publicly available data," the agency said. ACR said this would be technical component cuts of up to 28 percent for IMRT and 40 percent for SBRT.
The 25 percent cut to multiple advanced imaging services was first instituted last year, after ACR and others talked CMS down from a 50 percent professional component reimbursement reduction. However, because of "operational problems," CMS only applied the cuts to a single radiologist interpreting multiple scans on the same patient on the same day, not to all doctors in the same practice, as originally intended, ACR said. But in its proposed rule notice for the 2013 Medicare Physician Fee Schedule, CMS said it has fixed the processing problems. Starting January 1, the multiple procedure payment reduction, or MPPR, now applies to all providers at the same institution. CMS is also applying an MPPR to some cardiovascular and ophthalmologic procedures.
"This policy is consistent with other PFS (physician fee schedule) MPPR policies for surgical and therapy procedures," CMS said. "We continue to believe that the typical efficiencies achieved when the same physician is furnishing multiple procedures also accrue when different physicians in the same group furnish multiple procedures involving the same patient in the same session."
However, ACR said the efficiencies were largely unrealized, and cited a 2011 study published in the Journal of American College of Radiology, which purported to show that duplications in work for multiple scans were low, and would only amount to a projected cut of, at most, around 5.5 percent.
CMS is accepting comments on the rule until Sept. 4.