MedPAC proposes payment cuts to radiology, other specialties

The Medicare Payment Advisory Commission (MedPAC) has proposed making payment cuts to numerous specialties, including radiology, to “rebalance” the Medicare Physician Fee Schedule toward ambulatory evaluation and management (E&M) services.

The proposal, one of many made in a new report to Congress, involves increasing payment rates for ambulatory E&M services—defined by MedPAC as “office visits, hospital outpatient department visits, visits to patients in certain other settings such as nursing facilities, and home visits”—and reducing payment rates for services such as medical imaging, procedures and tests.

“E&M services are critical for both primary care and specialty care,” MedPAC said in a Fact Sheet published along with the report. “The Commission has long been concerned that, over time, E&M services have become undervalued … relative to other services, such as procedures. This could limit beneficiary access to E&M services.”

The payment rate for several specialties, including diagnostic radiology and pathology, would be reduced by approximately 3.8 percent. Total fee schedule payments for a list of other specialties—including endocrinology, rheumatology and family practice—would see significant increases.

“If successful, these efforts would improve the accuracy of prices for ambulatory E&M and other services going forward and could reduce the need for future significant adjustments to the prices of E&M services,” the report’s authors wrote. “Together, these actions will help reduce the risk of beneficiaries experiencing problems accessing these services and will send a more positive signal to medical students and residents contemplating careers in specialties that provide large shares of these services.”

This full 407-page report, Report to the Congress: Medicare and the Health Care Delivery System, can be read on the MedPAC website. MedPAC publishes such a report, focused on issues affecting Medicare and healthcare delivery in the United States, each June.