Is MedPAC finally acknowledging decline in imaging use?

2017 05 04 10 02 04 942 Capitol Hill2 400

The Medicare Payment Advisory Commission (MedPAC) may finally be acknowledging that use rates of advanced imaging have declined, according to data published in its latest report to the U.S. Congress, delivered on March 13.

The report's findings show that the efforts of the Centers for Medicare and Medicaid Services (CMS) to curb the use of advanced imaging -- in part based on MedPAC's recommendations -- have been successful, said commission Executive Director Jim Mathews, PhD, in a teleconference.

"In the past, MedPAC has been extremely concerned about growth in rate of use high-cost imaging and has made recommendations that CMS should pay close attention to those rates," Mathews said. "We've advised CMS to set payment rates based on valid assumptions about utilization rates, and CMS has acted on those recommendations, resulting in the moderation of growth use of CT, MRI, and PET over time."

In fact, the report found that the rate of imaging encounters in 2017 to 2018 grew the slowest, at 0.7%, compared with higher growth categories such as "other procedures," which grew 2.8%, and anesthesia, which grew 2.7%.

MedPAC also found that imaging hit the middle of the pack when it came to Medicare fee-for-service payments for clinician services per beneficiary between 2017 and 2018, at 2.4% -- compared with 1.9% for evaluation and management services, 2.7% for major procedures, 3.5% for other procedures, 2.4% for tests, and 1.3% for anesthesia services.

Changes in units of imaging service, allowed charges per beneficiary, 2013-2018
Measure Percent change
Changes in allowed imaging charges per beneficiary, 2017-2018 2.4%
Average annual change in allowed imaging charges per beneficiary, 2013-2017 0.3
Change in imaging units of service per beneficiary, 2017-2018 1.3%
Average annual change in imaging units of service per beneficiary, 2013-2017 -0.3%
Share of 2018 allowed charges 11%
MedPAC analysis of claims data for 100% of Medicare beneficiaries.

Increases in imaging volume in 2018 varied across imaging types. In 2018, x-ray grew by 1.5%, compared with average annual volume growth of -1.3% from 2013 to 2017; CT volume grew by 4.7% compared with 3.7% in that time period; MRI volume grew by 2% compared with -3.6%; and nuclear medicine grew by 2.6%, compared with -0.2%, the commission said.

All the same, MedPAC isn't quite willing to let its concerns about imaging use rates fade completely. Medicare is required to pay providers' claims, regardless of clinical appropriateness, it noted, and MedPAC recommended that CMS continue to closely examine claims and put prior authorization programs in place.

CMS should "establish a prior authorization program for practitioners who order a substantially greater number of advanced imaging services than their peers," the commission concluded.

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