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."

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Copyright © 2012

Last Updated bc 7/12/2012 10:07:35 AM

24 comments so far ...
7/10/2012 1:08:14 PM
So why do we pay thousands to get ACCREDITED... if all we see is payments going down??
what is it that ACR and others doing for the radiology community exactly? I don't see to many wins in our column

7/10/2012 1:41:44 PM
From the article: '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.'
How do they determine which specialties get a payment increase and which ones get a decrease?
My impression is that slowly what they're trying to do is equalize salaries across specialties. If they do that, what will be the incentive for a physician to train 6+ years to become subspecialized vs stopping at PGY3 and start working as an attending? On the other hand, it seems that the only specialties getting hit are radiology and radiation oncology, most medicine and surgical specialties aren't getting any payment decrease.
Here is another aspect of the new rule that I find really disconcerting. From another article:
'Now, under new proposals released Friday, a range of physician and non-physician providers, from nurse practitioners and midwives to social workers, can also get paid for ordering the scans, as long as they're in compliance with state law and their Medicare statutory benefit.'
'Covered by the proposed new rules are nurse practitioners, clinical nurse specialists, physician assistants, certified nurse-midwives, clinical psychologists and clinical social workers. Also included are doctors previously uncovered by the regulations, including doctors of optometry, dental surgery, dental medicine and podiatric medicine, CMS said. '
They're cutting payment to radiologists who read radiographs but on the other hand they now want to pay non-radiologists to read those same studies?

7/10/2012 2:47:17 PM
Just love the ABR. 
They push for subspecialization which make training all the way to PGY6-PGY7 to be a radiologist. 
They increase the number of radiology spots the last 5 years to over 1100 spots. 
Add it all up. 
If I was a third year medical student, I would think long and hard if was going to consider going into radiology. 
CMS looks at imaging as the main culprit for astronomical healthcare costs.  Therefore, more annual cuts are coming down the pipe.  Plus, CMS has cut reimbursement of emerging modalities such as PET CT and molecular imaging. 
Didn't Pathology get annual CMS cuts in the 1980's that permanently disabled that specialty? 
Radiology seems like it is on its way.
Wish Obamacare didn't pass. 

7/10/2012 3:22:13 PM
I do not have a sophisticated understanding of CMS and how they reach their conclusions but based on their actions of the past few years it really seems that they have a personal vendetta against radiology, I thought imaging costs already plateaued the past few years, what exactly is the endpoint?...I am not a greedy b*stard but as I come close to completing training (just started fellowship), I find it extremely disheartening to realize that I will likely obtain my peak earnings in the next few years (if I'm actually lucky enough to find a job) and should subsequently expect a continuous never ending drop in income thereafter

7/10/2012 7:15:32 PM
just a patient
The cuts could also be because urologists in New Jersey are sending patients to Rad Onc practices, which they own part of, for treatment of indolent prostate cancer. Now, I am only a patient, but I was told the cost of that kind of 6 weeks of external beam treatment is about $42,000. It seems that men I speak with in our PCa support group, that are newly diagnosed , all need radiation. This is an abuse of our system, and the CMS can figure it out.
Just a patient