MRI and CT imaging services could still be targets for reimbursement cuts.
Let?s pull together and shoot for something better.
It is important for each of us to participate in the health care debate, as individuals and as members of the medical imaging community. We all have a vested interest in making sure that whatever plan is put forward ?gets it right? for the areas of health care that we are most familiar with.
As we all know, there has been a concerted effort over the last several years to focus on controlling the rate of growth for Medicare?s imaging expense. These changes are significant because they tend to cascade into policies of private insurers over time. The emphasis in most papers on this subject has been on the economic impact and the need to slow the growth rate for imaging. The Deficit Reduction Act of 2005, implemented in 2007, has definitely accomplished this goal as reported by the GAO in mid 2008. At that time, they reported the rate for Medicare imaging services declined by 12.8% for 2007 when compared with 2006, providing a savings of approximately $1.8 billion for that year.
As the health care debate gained speed in June of this year, MRI and CT imaging services were still targets for further reimbursement reductions, even though the impact of the DRA had been studied for only 1 year. CMS proposed modifying the 2010 Medicare Physician Fee Schedule to change the MRI and CT technical component funding formula to increase the efficiency assumption from 50% to 90%. This change would reduce the technical component reimbursement for these services by an additional 44%. The July Whitehouse Healthcare Factsheet called for an increase in the technical component efficiency calculation factor from 50% to 95%, and the Senate bill under consideration called for increasing this factor to 75%.
As our leaders and health care policy makers work to ?fix? the many issues that need to be addressed in our health care system, we need to remind them of a few important medical imaging facts that should be considered as health care change moves through the legislative process:
1. The rationale for the 90% recommendation adopted by the White House, Congress, and CMS is largely based on a flawed study done by MedPAC on the accuracy of payment for MRI and CT. The study recommended an increase in the efficiency calculation, without asking any questions of their survey respondents about testing volumes or testing slot availability. This is a critical error in study design. Without this information, it is impossible to accurately estimate the efficiency of outpatient imaging center operations.
2. There are almost no studies that evaluate the benefits of imaging services in regard to diagnosing or staging treatment and their effect on patient outcomes. There are also almost no studies that evaluate the impact on cost of using these services instead of the alternatives that they replaced. Does imaging add to the cost of care or reduce the cost of care? Does imaging improve outcomes? Difficult questions that have not been studied in an effective way.
3. The implication of the cost analyses that have been done is that there is a great deal of waste and unnecessary utilization in imaging during the period from 1999 to 2006. We should remind our leaders and policy makers that more than 20 major improvements to advanced imaging modalities were introduced during this period that enhanced quality and improved utility. The impact of these improvements on volume growth is rarely if ever considered in the analyses that have been presented in studies that evaluate the economic impact of imaging utilization.
4. Lastly, providing state-of-the-art, high-quality imaging services requires significant capital investment. Our leading imaging centers are extremely high fixed cost businesses. Their existence is based on stable pricing for the services that they provide. Reducing payment for advanced diagnostic imaging services without sound data to support the proposed reductions will cause tremendous financial difficulty for imaging centers that are bound by fixed price contracts for their equipment, facilities, maintenance, and health care IT expenses. Drastic reductions in reimbursement will result in imaging center failures for the highest quality centers in our country since their cost basis is higher than centers with older equipment.
It is important for each of us to remain vigilant and involved as the health care debate continues over the next several months. Being a part of the solution is more important than ever because sitting on the sidelines and not engaging in this debate could result in unreasonable changes for medical imaging in the future.
Ed Eichhorn is president of the Medilink Consulting Group that specializes in strategic planning, marketing, and advocacy issues. He can be reached at: .