New CMS fee schedule hits radiology, radiation oncology

By Kate Madden Yee, staff writer

July 9, 2012 -- The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed a new Medicare Physician Fee Schedule (MPFS) for 2013 that will slash payments to radiologists by 4% and radiation oncologists by 15%. The proposal would also expand to other medical specialties a controversial policy on imaging contiguous body parts.

CMS is making the cuts to pay for a 7% payment increase to family physicians and increases of 3% to 5% to other primary care practitioners. For example, geriatrics and internal medicine would see payment increases, at 4% and 5%, respectively.

"Because of the budget-neutral nature of this system, proposed decreases in payments in one service result in proposed increases in payments in others," CMS wrote.

Under the proposed rule, radiation therapy centers would take the biggest hit of all medical specialties, with payment cuts of 19%. Other imaging-related specialties would also feel the pain, but at lower percentages.

CMS MPFS payment changes by medical service
Specialty Total (cumulative impact)
Diagnostic testing facility -8%
Interventional radiology -3%
Nuclear medicine -4%
Portable x-ray +2%
Radiation oncology -15%
Radiation therapy centers -19%
Radiology -4%

The proposed MPFS cuts do not take into account the effects of whether Congress is able to fix the flawed sustainable growth rate (SGR) formula, according to CMS. The agency is now projecting a 27% reduction in 2013.

"While the Congress has provided temporary relief from negative updates for every year since 2003, a long-term solution is critical," CMS said. "We are committed to working with Congress to permanently reform the SGR methodology for Medicare PFS updates."

The proposed rule indicates a broadening of CMS' cost-cutting efforts, according to Cynthia Moran, assistant executive director for government relations at the American College of Radiology (ACR).

"In the past few years, CMS has been taking money from radiology and giving it to primary care," she told "In this rule, they've taken the gloves off. They're redistributing income from many other specialties to primary care. They're great at pitting physicians against physicians, specialty against specialty."

Contiguous imaging

The 2013 MPFS proposed rule also expands the reach of the current 25% multiple procedure payment reduction (MPPR) on the professional component for CT, MR, and ultrasound services, according to Moran. The MPPR went into effect on January 1 for imaging services performed by the same physician on the same patient in the same session.

Under the new proposal, the MPPR would still be applied if other physicians stepped in and performed subsequent procedures on the same patient in the same session. CMS is also taking the MPPR model to other specialties, such as cardiology and ophthalmology, Moran said.

"This new rule proposes that if any other physician in a group practice or hospital looks at a patient and provides another study, the professional component for that study will be reduced as well," Moran said. "[The proposal] shows outrageous ignorance on the part of CMS policymakers on how radiology is practiced."

Copyright © 2012
Member Sign In:
MemberID or Email Address:  
Do you have a password?
No, I want a free membership.
Yes, I have a password:  
Forgot your password?
Sign in using your social networking account:
Sign in using your social networking