The Access to Medical Imaging Coalition (AMIC) of Washington, DC, has issued a new analysis that criticizes proposals to change the utilization factor that determines Medicare reimbursement for advanced imaging procedures.
The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed changing the utilization factor to 90% from the current rate of 50%, while a healthcare reform bill in the U.S. House of Representatives would set the rate at 75%. The utilization factor is an estimate of the amount of time during a normal workweek that equipment is in use, and CMS uses the rate to determine technical component reimbursement. CMS proposed the change after receiving a recommendation from the Medicare Payment Advisory Commission (MedPAC).
But setting the utilization rate based on the MedPAC recommendation could result in unintended consequences, according to a new analysis conducted by David Butz, Ph.D., of healthcare Web site MDContent of Ann Arbor, MI, and David W. Lee, Ph.D., senior director of health economics and outcomes research at GE Healthcare of Chalfont St. Giles, U.K.
Increasing the utilization factor might initially lower the cost of imaging services, but a 90% utilization factor surpasses the tipping point at which increased utilization becomes counterproductive, and it could increase costs and overwhelm the healthcare system, they said. They also said that MedPAC's proposal "isn't supported by any credible data," and such a large increase in the rate "would likely lead to potentially dangerous disruptions in patient diagnosis and care."
The analysis concludes by recommending that changes to the utilization factor be postponed until better information on current utilization levels, along with a process to monitor access to care, are available.
Related Reading
AMIC: Voters oppose imaging cuts, September 9, 2009
Obama developing new healthcare strategy: official, September 3, 2009
Flawed MedPAC survey drives debate on imaging payment cuts, August 11, 2009
Medicare's equipment utilization rate: What it means for radiologists, July 14, 2009
CMS pitches 90% use rate in proposed 2010 MPFS rule, July 1, 2009
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