Why the SGR fix helps radiologists

Last week, federal lawmakers finally reached a deal to permanently repeal the perennially unpopular sustainable growth rate (SGR) formula.

The central provision of bipartisan legislation avoids a 23.7 percent reimbursement cut scheduled for April 1 of this year, and instead increases physician reimbursement rates for 0.5 percent annually for five years.

This, of course, is welcome news. As the American College of Radiology has pointed out, repeated cuts in all probability had a negative impact on medical imaging facilities being able to keep their doors open, never mind continuing to offer a full range of services. The SGR fix, as contained in the legislation, "is a step toward sensible imaging reimbursement policies," Paul H. Ellenbogen, chair of the ACR's Board of Chancellors said.

The bill also contains provisions that will reward physicians for the quality of the care they provide in the future, rather than the quantity. This should be particularly welcome news to a specialty like radiology, which has committed itself to increasing quality and efficiency of patient care.

For example, a major component of the legislation requires providers to consult physician-developed appropriateness criteria when ordering advanced imaging studies for Medicare patients. According to the legislation, the U.S. Department of Health & Human Services will, by April 1, 2016, have to identify resources such as clinical decision support that ordering physicians can consult in order to make their ordering decisions.

And there will be teeth in this provision. Starting in 2017, Medicare will only pay for diagnostic imaging services that meet certain criteria, including appropriate-use criteria. In addition, HHS will be able to identify up to 5 percent of doctors who aren't complying with the appropriateness criteria and, starting in 2020, force them to obtain prior authorization before ordering the applicable imaging services.

These kinds of provisions should help reduce duplicate or unnecessary imaging, and the costs associated with such scans, and help ensure that patients receive the right exam at the right time.

Of course, before this legislation has any chance of being enacted, there's still the matter of the how much its going to cost to repeal the SGR. According to the latest estimate from the Congressional Budget Office, enacting this legislation will increase direct spending by $121 billion over a 10-year period.

That money will have to come from somewhere--most likely out of healthcare system. Medical imaging has been the target of many healthcare cuts over the last several years; hopefully it won't be further targeted to make the SGR fix work. - Mike (@FierceHealthIT)


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