Everyone loves good news. Especially when it comes to money.
While the U.S. economic climate hasn’t provided much good news of late, the radiology reimbursement front is bringing improving, and even good news in some areas.
You’ll find the good news and bad news in this month’s cover story, “Trends in Reimbursement: The Downs and Ups.” The good news comes in reimbursement for PET, IMRT (intensity modulated radiation therapy), 2D and 3D ultrasound, CT and MRI. The Center for Medicare and Medicaid Services (the new name of HCFA as of June) and private insurers have ruled favorably on these technologies.
Since HCFA started reimbursing for PET procedures in 1998, PET reimbursement has surged to include scans for diagnosis, staging and restaging of lung cancer, colorectal cancer, melanoma, lymphoma, esophageal cancer and head and neck cancer. There is an exception, however, in some areas of the country where an over abundance of PET scanners is bringing lower reimbursement from all payers. CMS also recently declined to reimburse for most PET studies done on gamma cameras, but will revisit it in 2003.
More good news for PET came in June when a Medicare advisory panel ruled in favor of providing Medicare reimbursement for recurrent breast cancer. An implementation date has yet to be set. Industry watchers are optimistic that CMS will broaden reimbursement for other breast cancer indications in the near future. Alzheimer’s as an indication for the use of PET also is expected to gain eyeballs at CMS this fall.
Interestingly for PET, private insurers have leap-frogged HCFA/CMS over the last few years in reimbursing for PET scans in breast, cervical and ovarian cancer cases because it has proven that it can eliminate unnecessary surgery. Money talks.
More good news comes in radiation therapy with Medicare reimbursement of IMRT at four times the rate of traditional radiation therapy. Decisions like this enable facilities to invest well in new technology and personnel that can truly make a difference in patient treatment.
3D ultrasound is yet another bright spot. Reimbursement adds a further boost to 3D ultrasound’s promising and proven applications in gyn, neonatal brain, tumor evaluation and breast imaging.
For CT, MRI and 2D ultrasound, experts call current reimbursement rates “reasonable.” While they may not be generous, they are adequate to cover good technology and people.
So where’s the bad news? Mammography is radiology’s problem child.
But I’ll give you the good news first. Medicare has recognized the added cost of acquiring and operating digital mammography systems and set the payment rate for a digital mammogram at 150 percent that of an analog exam.
But the financial truth about mammography, according to a recent study, is that facilities providing it are losing money. The seven leading university healthcare centers surveyed said they lost $408,585 per institution in 1997.
Hope may come in the Harkin-Snowe bill. The Assure Access to Mammography Act of 2000, introduced in the Senate in March and since co-sponsored by many, looks to increase Medicare reimbursement for a screening mammogram to $90 from the current $69. Plus, CMS has said it will re-visit screening mammography sometime this year.
We’ll keep you posted on this and other areas of reimbursement. We’re always looking for good news.
Mary C. Tierney, Editor
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