A draft of a healthcare reform bill under consideration in the U.S. House of Representatives would increase to 75% the equipment utilization factor used to calculate technical component payments under the Medicare system.
The as-yet-unnamed bill includes a variety of changes to the Medicare program to provide "affordable, quality healthcare for all Americans and reduce the growth in healthcare spending." Several provisions in Section 1147 of the legislation deal with imaging payments, including changes to the equipment utilization factor and the discount for scans of contiguous body parts.
The utilization factor currently standards at 50%, meaning that the U.S. Centers for Medicare and Medicaid Services (CMS) assumes that imaging equipment is in use half of the time during a normal work week. The House bill would change that to 75% "to reflect higher presumed utilization." Proponents of raising the utilization rate say the 50% rate does not reflect actual use of imaging equipment under real-world conditions.
President Barack Obama recently called for increasing the utilization rate to 95% as part of a package of reforms to save money in the Medicare system. However, a recent study by the Radiology Business Management Association (RBMA) indicated that equipment in rural regions of the country operates only 48% of the time an office is open, while equipment in nonrural areas operates 56% of the time a center is open.
The House bill also includes provisions calling for an adjustment in the technical component "discount" on single-session imaging of contiguous body parts. The provision calls for increasing the reduction from the current 25% to 50%. Proponents believe that this change reflects the fact that imaging facilities are more efficient when conducting multiple imaging procedures of the same body part in the same patient session.
CMS implemented the 25% reduction in January 2006, and it proposed increasing the discount to 50% later in the year, but withdrew the latter increase.
Related Reading
RBMA: Equipment use rates far lower than President estimates, June 19, 2009
Imaging groups lobby against MedPAC call for more payment cuts, March 26, 2009
AMIC criticizes MedPAC report, February 26, 2009
Medical imaging hopes to cut losses in Medicare reform debate, January 27, 2009
Beware, AMIC says: The DRA could be the least of it, June 10, 2008
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