Diagnostic imaging pay has slid steadily since 2007, with MRI, bone densitometry bearing the brunt

Medicare reimbursement across several imaging modalities has dropped since 2007, according to a new analysis published Wednesday.

Adjusting for inflation, the downturn persisted across nine different modalities, with MRI hit the hardest in terms of dollars (down $52) and bone densitometry in terms of total percentage (-70.5%). Nuclear medicine, meanwhile, suffered the smallest mean decreases at $0.32 and 4.28%, researchers led by Brown University reported in JACR.

Policy changes meant to curb Medicare spending likely influenced these changes, but further investigation is needed to understand such trends, lead author Soryan Kumar and colleagues wrote July 22.

“The majority of imaging procedures examined in this investigation from 2007 to 2019 depicted reimbursement decreases, which are exacerbated by increasing demand and supply for diagnostic imaging to aid in the treatment plans of patients,” the team wrote. “With current inflation rates, increased demand of diagnostic imaging, and changes to healthcare policy, properly modeling these decreases is crucial to the continued maintenance of radiology practices around the country.”

Kumar and colleagues from the Warren Alpert Medical School reached their conclusions by querying the Physician Fee Schedule Look-Up Tool from CMS. They included bone densitometry, computed tomography, CT angiography, mammography, MRI, magnetic resonance angiography, nuclear medicine, radiography and ultrasound. PET/CT was excluded because reimbursement data was not available.

On average, all modalities demonstrated decreases in total percentage change and annual change in reimbursement over the 12-year study period. Beyond bone densitometry, others displaying large drops included MRI (-64%), MRA (-54%), CTA (-52.5%), and CT (-45%). Inflation-adjusted reimbursement rates dropped on average for about 92% of studies included in the analysis.

Nuclear medicine was one bright spot, with hepatobiliary iminodiacetic acid scans with cholecystokinin showing the largest increases at 67% or $17.15.

Kumar and colleagues noted that certain policy changes likely factored into these dips. In particular, the Medicare sustainable growth rate enacted under the Balanced Budget Act of 1997 was aimed at cutting doc and hospital pay by some $116.4 billion, the team noted.

“Many of the decreases in the current reimbursement trends observed in this study from 2000 to 2015 stemmed from the SGR,” they wrote, adding that the rate was eventually repealed in 2015.

On the brighter side, the team of researchers said these changes have likely had a positive impact on consumers.  

“Although studies in diagnostic radiology are experiencing decreased reimbursement rates, this is translating into lower cost-sharing responsibilities for patients, making these studies more affordable and accessible for individual patients,” they wrote

Read more of the analysis in the Journal of the American College of Radiology here.