Research questions rationale for multiple procedure payment reduction

Any new efficiencies in physician interpretation and diagnosis gained when different providers interpret different medical scans performed on the same patient are minimal and vary by procedure, according to an article published online in the Journal of the American College of Radiology.

This is a touchy issue within the imaging world because the Centers for Medicare & Medicaid Services recently enacted a 25 percent multiple procedure payment reduction to Medicare reimbursement for interpretation of advanced diagnostic imaging scans performed on the same patient in the same session.

The authors, led by led by Richard Duszak, M.D., of ACR's Harvey L. Neiman Health Policy Institute, found no potential intra-service work duplication when different scans were interpreted by different physicians within the same group practice. They did find that some small efficiencies were achieved in pre- and post-service activities, but across all modalities would only correspond to a maximum physician fee reduction of only 0.95 percent to 1.87 percent.

"While potential efficiencies exist in physician pre- and post-service work when same-session, same-modality imaging services are rendered by different physicians in the same group practice, these are relatively minuscule, and have been grossly overestimated," Geraldine McGinty, M.D., chair of the American College of Radiology Commission on Economics, said in an ACR announcement. "These findings support the need for greater transparency and methodological rigor when healthcare regulatory actions are taken."

Last week ACR staff, along with representatives of the Radiology Business Management Association, met with CMS staff to discuss their ongoing concerns with the multiple procedure payment reduction and to present the results from the JACR paper.

To learn more:
- see the article abstract in the JACR
- read the announcement from the ACR
- read about the ACR/RBMA meeting with CMS

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