ACR to CMS: 2010 Physician Fee Schedule badly flawed

Dec 16, 2009

The American College of Radiology (ACR) has released a critique of the proposed physician payment changes for 2010 issued in October by the U.S. Centers for Medicare and Medicaid Services (CMS). The Reston, VA, society found the agency's proposals to be "badly flawed" and "based on incomplete data."

CMS released its proposed Medicare Physician Fee Schedule (MPFS) on October 30, calling for a range of cuts to healthcare services. On December 15, the ACR wrote a letter to CMS acting administrator Charlene Frizzera that outlined why the agency should not proceed with its final recommendations.

"We urge CMS not to implement the new payment rates for radiology services in 2010 and freeze reimbursement for these services at 2009 levels until appropriate utilization assumptions and survey data can be incorporated into the agency's rate-setting methodology," wrote ACR executive director Dr. Harvey Neiman.

Equipment use rate

CMS has said it plans to change the equipment utilization rate from the current 50% to 90% for all equipment priced higher than $1 million -- which would cover CT and MRI services. The new rate is based on the March 2009 Medicare Payment Advisory Commission (MedPAC) report to Congress and the American Medical Association's (AMA) Physician Practice Information Survey (PPIS). Neiman emphasized that these data were incomplete.

"The ACR urges CMS to examine additional data that we will present in cooperation with the Radiology Business Management Association (RBMA) and other organizations and adopt a more appropriate level of equipment utilization for radiology equipment in 2010," he wrote.

Equipment cost calculation

In this final rule, CMS assumes that CT and MRI equipment are used 52 weeks per year, rather than 50 weeks per year, an assumption that has been in place since 1999. The result of this change will be additional, inappropriate cuts to the direct costs of MRI and CT procedures, leading to incorrect practice expenses relative value units (PE RVUs).

"The ACR requests an immediate correction of this error," Neiman wrote.

Neiman also took CMS to task for the data it uses to calculate practice expense per hour, pointing out that under the final 2010 rule, the agency is using data that skew these calculations. ACR's comments to that effect have been disregarded, according to Neiman.

"The current practice expense per hour for radiology based on [data accepted by CMS in 2006] is $204.86. According to the [AMA's] PPIS, the practice expense per hour for radiology dropped 34% to $134.84. ... Any significant change in practice expense per hour, such as this change of more than 30%, must be based on accurate and reliable data that has been evaluated to determine if it reflects reality. Unfortunately, it appears that CMS did not critically evaluate the data," he wrote.

Neiman also criticized revisions CMS has made to bundled codes for 2010 for diagnostic CT colonography and myocardial perfusion, as well as missing practice expense inputs for select 2010 codes.

"In the final rule, the practice expense values for several 'new' codes did not reflect the four-year transition period described in the final rule," Neiman wrote. "In the interest of fairness, we ask that CMS apply [this transition] to any 'new' codes that describe services that were reported in 2009."

Grave consequences

If it goes forward as is, this final rule will have grave consequences on imaging access, according to Neiman.

"We are gravely concerned about patient access to imaging services in 2010 and beyond and urge you to continue current radiology reimbursement levels until appropriate equipment utilization assumptions and survey data can be incorporated," he concluded.

By Kate Madden Yee
AuntMinnie.com staff writer
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