Stalling on imaging reimbursement legislation must stop

Last week Sen. Ben Cardin (D-Md.) again introduced legislation (S. 623) that would prevent the Centers for Medicare & Medicaid Services from applying a 25 percent Multiple Procedure Payment Reduction (MPPR) to Medicare reimbursement for interpretation of advanced diagnostic imaging scans performed on the same patient, in the same session.

The House version of the legislation (H.R. 846) was introduced earlier this year by Reps. Pete Olson (R-Texas), Peter Roskam (R-Ill.), John Barrow (D-Ga.), Betty McCollum (D-Minn.).

The MPPR of 25 percent on the professional component for CT, MR and ultrasound services is a particularly disconcerting development for the specialty. It's taking money out of the pockets of radiologists whose compensation levels have dropped recently, all because of a reimbursement cut most believe is unnecessary and arbitrary.

The American College of Radiology and other professional associations have long claimed the rationale behind the CMS policy is illogical. Radiologists perform scans ordered by other providers, and are, the ACR has pointed out out, ethically required to spend as much effort on reviewing images as necessary, regardless of whether the service is provided on one day or another. Consequently, the CMS policy will have no impact on the number of scans ordered by radiologists.

But what really seems to burn radiologists is that the CMS decision to apply the MPPR for the professional component of these imaging services was made with inadequate input from the imaging community, and that the rationale behind the policy is unsubstantiated. H.R. 846 reflects those concerns with a requirement that CMS can't apply the MPPR payment policy until it provides some analysis of the information used in its decision making, as well as "clinical aspects that went into those decisions."

Attempts to deal with this issue in 112th Congress stalled, despite the fact that the House bill had 269 co-sponsors--well above the majority needed to pass the legislation. Whether things change in the 113th Congress remains to be seen, but the evidence exists that there is broad, bi-partisan support to repeal the MPPR until the issue has been adequately studied and analyzed.

Let's hope the issue doesn't continue to get put on the back burner. - Mike  @FierceHealthIT


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