It could have (and has) been worse, but an overall 2% reduction in Medicare reimbursement paid under the MPFS will have repercussions for any radiology practice. That’s the overall impact of practice expense (PE) RVU changes (and a slightly lower conversion factor) contained in the proposed 2015 Medicare Physician Fee Schedule.
For a practice billing $20 million (in Medicare charges), that is $400,000; for a larger practice billing $50 million, that is a $1 million hit. Those are big numbers and necessarily must result in job losses for employees, another year of deferred technology upgrades or one more partner pay cut. We know that no one outside of radiology—especially MedPAC—will shed a tear over the latter.
Nonetheless, an adjustment in PE RVUs for x-ray—based on the conversion from analog to digital workflows—seems to be one of the more reasonable justifications for reducing radiology reimbursement proposed in the past 10 years. At least it was based on the Resource-Based Relative Value Scale rather than pulled out of someone’s hat. Of course, I haven’t seen the formula or cost inputs used, but based on productivity gains alone, an adjustment makes sense. The Relative Value Update Committee proposed the update, and the CMS intends to implement the change. This is the primary source of the 2% reimbursement reduction for radiology.
On the other hand, 20% of the codes on a list of high expenditure, potentially misvalued codes slated for review are radiology codes, and one of them is CT of the thorax without contrast. How did a CT thorax without contrast end up on the list of potentially misvalued codes? Even with the introduction of PACS and advances in visualization techniques, it would be hard to make the case that this exponentially larger study takes less time to read today than when the code was last valued.
This is pure supposition, but maybe CT thorax without contrast is on the list because CMS knows it must ignore MEDCAC’s recommendation to not cover low-dose CT lung-cancer screening for Medicare patients. That’s more like how Medicare rolls with radiology.
Vice President, Executive Editor, Radiology Business
Cheryl began her career in journalism when Wite-Out was a relatively new technology. During the past 16 years, she has covered radiology and followed developments in healthcare policy. She holds a BA in History from the University of Delaware and likes nothing better than a good story, well told.