Regents Health Resources was formed in 1996 to assist hospitals and physicians in the development and management of their medical-imaging and oncology services. The consultancy has served more than 500 clients nationwide with a diverse range of services, from strategic planning and operational assessments to joint-venture planning, valuations, and imaging-center sales and acquisitions.
Introduction: CMS released the proposed rule¹ for the 2013 Medicare Physician Fee Schedule (MPFS) in July. This issue of the Imaging Market File estimates the impact on revenue and margins/losses for 18 imaging-center sites clustered in Washington, Missouri, and Florida (which performed 112,000 procedures) of the 2013 conversion rate and a presumed 27% sustainable growth rate (SGR) reduction. CMS proposes expanding the Multiple Procedure Payment Reduction (MPPR) to the technical component from 119 codes to an additional 530 codes, as well as to the professional component of same-day subsequent studies of one patient read by any member of the practice. The potential loss of revenue due to the expansion of the MPPR has not been factored into the scenarios depicted in Tables 1–3. SGR adjustment: The SGR is a statutory adjustment that has been overridden by Congress in each of the past five years. According to CMS, those reductions now are estimated at 27% and are scheduled to go into effect in the 2013 MPFS, unless Congress acts again to delay them. The reduction would be applied to the 2013 conversion factor, which affects both the technical and professional components of the MPFS. As demonstrated in Table 1, the reductions in the sample areas would be 29.62% to 30.12% if the CMS changes are adopted by all payors—a possibility for which there is ample precedent. Conversion-factor changes: Several other proposed changes would affect reimbursement rates for 2013, resulting in a reduction of the 2012 conversion factor from $34.0376 to $24.7124. In order to fund reimbursement increases for family practice (7%), geriatrics (4%), internal medicine (5%), and pediatrics (5%), reimbursement is being reduced for radiology, diagnostic-testing facilities, radiation oncology, and radiation-therapy centers, to create a budget-neutral impact. CMS has released an estimate¹ (Table 4) of the impact of the proposed changes. While CMS estimates a 4% cumulative impact of the conversion-rate reduction, our analysis of the sample data from 18 sites shows an impact of 4.47% to 5.25%, if all payors adopt the new conversion rate (Table 1). http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/html/2012-16814.htm. Published July 30, 2012. Accessed August 24, 2012. 2. MedPAC. Moving forward from the sustainable growth rate (SGR) system. http://www.medpac.gov/documents/10142011_medpac_sgr_letter.pdf. Published October 14, 2011. Accessed August 24, 2012.
Read or download the other Imaging Market Files. Accomodating Imaging Volume Under Health-care Reform read or download pdf Forecasting Imaging Use Under Health-care Reform read or download pdf CT and MRI: Regional Variations in Utilization and Reimbursement read or download pdf Hospital-based Versus Freestanding Outpatient Imaging Services read or download pdf Cost Comparison: Hospital-based Versus Freestanding Outpatient Imaging Services
read or download pdf Radiology-group Financial Performance read or download pdf Outpatient Imaging Utilization Trends read or download pdf