If you thought the Deficit Reduction Act (DRA) of 2005 was bad, wait until you see the impact of imaging reimbursement cuts proposed by the U.S. Centers for Medicare and Medicaid Services (CMS).
CMS has proposed changes to the reimbursement formula that would cut payments to freestanding imaging centers and private offices more than the DRA did, according to an analysis released last week by 3d Health, a Chicago-based firm that provides consulting services to healthcare providers.
The net impact of the adjustments in CMS' proposed 2010 Medicare Physician Fee Schedule, published on July 13, would mean a 26% reduction in reimbursement across all modalities, if the agency used its proposed 90% utilization rate, according to Jon Geise of 3d Health. The current utilization rate is 50%.
The cuts would affect each imaging modality differently, with dual-energy x-ray absorptiometry seeing a 43% reduction; CT, 38%; nuclear cardiology, 32%; MRI, 31%; general radiology, 14%; nuclear medicine, 8%; mammography, 7%; and ultrasound, 4%, Geise said.
"Ninety percent is worst case, and CMS will probably back down once legislation comes out," he told AuntMinnie.com. "But they won't go back to the status quo -- there will be changes."
Congress is working to develop healthcare reform legislation, with the House of Representatives proposing a 75% utilization rate and the Senate proposing 65%. If CMS ends up using a 75% rate instead, cuts for CT and MR reimbursements would be halved, with CT going down 21% instead of 38% and MRI going down 16% instead of 31%, according to Geise.
Those doctors who perform many CT and MRI studies will feel the pain, as well as cardiologists with nuclear medicine units in their offices, Geise said.
"Imaging cuts aren't going away," he said. "The industry will continue to consolidate, and those centers that could make a profit if they were running at 50% capacity probably won't be able to stay in business anymore."
Related Reading
Senate bill calls for 65% equipment utilization rate, September 16, 2009
AMIC report attacks utilization rate changes, September 11, 2009
AMIC: Voters oppose imaging cuts, September 9, 2009
Obama developing new healthcare strategy: official, September 3, 2009
U.S. Senate may drop public healthcare option, July 29, 2009
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