Imaging reimbursement cuts: When is enough, enough?

It's a question radiologists ask every year, particularly with the release of proposed Medicare Physician Fee Schedules, which contain a new round of imaging cuts.

And each time the reaction from organizations such as the American College of Radiology borders on the apoplectic.  This past July, for example, the ACR, in response to the imaging cuts in the proposed 2013 Medicare Fee Schedule Rule, called them "potentially dangerous, unfounded and unnecessary."

"These cuts affect primarily those suffering from multiple trauma or heart attacks, stroke patients and those with widespread cancer--all of whom often require multiple imaging scans to survive," Paul Ellenbogen, M.D., chair of the ACR's board of chancellors, said in a statement.

Now, a study in the September issue of the Journal of the American College of Radiology gives groups like the ACR some ammunition in making the argument that imaging has taken enough punishment.

In the study, David C. Levin, M.D., and his colleagues from Thomas Jefferson University Hospital point out that although it's undeniable that imaging was a huge health cost driver through 2007, all of that abruptly changed with the passage of the Deficit Reduction Act. That, and the implementation of a number of policies (such as multiple procedure payment reductions and code bundling) has ended up cutting Medicare imaging costs by 21 percent from 2007 to the end of 2010.

While Levin is not alone in arguing that imaging is no longer the driver of health costs that it once was, he believes he and his colleagues are the first to back up the point with strong, convincing data (they used Medicare Part B databases from 2000 to 2010 for the study).

"The data is concise and accurate," he told FierceMedicalImaging. "And if you want to make your point in Washington, you just can't whine about things, you have to show the data."

And the point he wants to make? "I hope that policymakers and payers--particularly Medicare--see that imaging has been hit hard and that there's no need to make any further cuts in imaging reimbursement," he said.

It seems self-evident that one of the goals of healthcare policy should be to encourage the delivery of appropriate, productive services such as advanced imaging. If Medicare reimbursement policy is being made under the faulty assumption that imaging remains a key cost driver and, in turn, that potentially discourages the use of valuable clinical tools in appropriate circumstances, then perhaps it is time, as Levin suggests, for federal policymakers to reconsider things.

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