The U.S. Centers for Medicare and Medicaid Services (CMS) didn't back down from its previously announced plan to increase the utilization rate for imaging equipment from 50% to 90%. It's now going to take an act of Congress -- literally -- for medical imaging to avoid what could be severe cuts in Medicare reimbursement starting January 1, 2010.
The news came October 30, when CMS announced final changes to its Medicare Physician Fee Schedule (MPFS) for 2010, which it will publish in the Federal Register November 20. The new utilization rate was one of a host of other changes in the rules.
The equipment utilization rate represents CMS' estimate of the amount of time imaging equipment is in use in outpatient settings. CMS telegraphed its intention to raise the rate when it issued proposed MPFS rules on July 1.
Increasing the utilization rate to 90% would decrease global reimbursement by 15% to 20%, according to industry experts; the effect of the change on the daily practice of the average imaging facility would depend on a number of factors, including a center's patient mix, whether it's a single-modality facility, and whether the center is urban or rural.
In the end, however, Congress will most likely save the day: Bills being considered by the U.S. House of Representatives and the Senate propose much lower utilization rates, 75% and 65%, respectively, and CMS will be hard-pressed not to follow Congress' mandate.
In the final rule, CMS also has proposed an updated conversion factor of -21.2%, or $28.4061, and a sustainable growth rate of -8.8%.
As for accreditation, CMS confirmed its plan to require suppliers of advanced imaging -- mobile units, physicians' offices, and independent diagnostic testing facilities (IDTFs) -- to be accredited by 2012.
Finally, CMS backed down on a proposal to cut radiation therapy payments by 19% on January 1, instead opting for 5% cuts phased in over the next four years. That means that radiation oncology is scheduled for a far-less-severe 1% reimbursement cut in the new year.
CMS will take comments on provisions of the final rule until December 29.
ACR responds
The American College of Radiology (ACR) of Reston, VA, was quick to express its disappointment in CMS' actions, saying in a statement that "the 90% utilization mandate and practice expense reimbursement adjustments will produce an average across the board 16% cut to imaging providers, and specifically reduce reimbursement to studies such as lung CT or MRI of the spine by 40% or more. These cuts, on top of an average 23% reduction from the Deficit Reduction Act of 2005, totaling $13.8 billion, will end the ability of many nonhospital providers to offer imaging services, particularly in rural areas where equipment is needed, but utilized less frequently."
The final rule is disastrous for patient care, said Dr. James Thrall, chair of ACR's board of chancellors.
“Medical imaging exams have been directly linked to greater life expectancy, declines in cancer mortality rates, and are generally less expensive than the invasive procedures they replace," he said in the statement. "Utilization growth is in line with or below that of other physician services. Why CMS would want to restrict access to lifesaving procedures and stifle research and development of new technologies at a time when imaging can do so much good for so many people is mind boggling. There will be a human cost such short-sighted policy decisions.”
By Kate Madden Yee
AuntMinnie.com staff writer
November 3, 2009
Related Reading
Radiation oncology celebrates as CMS backs down on 19% cut, November 2, 2009
Senate bill calls for 65% equipment utilization rate, September 16, 2009
AMIC report attacks utilization rate changes, September 11, 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
Copyright © 2009 AuntMinnie.com
