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Assault On Imaging Cuts Both Use, Payments

September 11, 2012
Written by: , Filed in: Cardiac Imaging, Diagnostic Imaging, Practice Management
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Several informed observers now confirm that both the volume of and reimbursements for Medicare advanced imaging have declined.

David C. Levin, MD, chairman emeritus of the radiology department at Thomas Jefferson University Hospitals in Philadelphia, described the pressure that physicians have faced in recent years:

There has been a lot of attention focused on overutilization of imaging. Doctors all around the country are being bombarded with material and literature saying, ‘We’ve got to cut down on the use of imaging. We’ve got to try to reduce the cost of care.’

Dr. Levin was quoted in a Kaiser Health News story by the excellent health writer Jay Hancock. The story went online Monday.

Papers forthcoming from Dr. Levin and colleagues will show, for the first time, declines in outpatient MRI, CT, and cardiac nuclear scans per Medicare beneficiary in 2010, he said. The latest data from the Medicare Payment Advisory Commission (MedPAC), released in June, show similar results.

Meanwhile, Dr. Levin pointed out, private insurers have hired radiology benefits management companies to hammer away with the same “is this scan really necessary?” message. So, he said, advanced imaging likely has declined among the privately insured as well.

As for reimbursement, Dr. Levin co-authored a study in the current issue of the Journal of the American College of Radiology that found that Medicare Part B spending on diagnostic imaging declined by more than one-fifth from its peak of $11.91 billion in 2006 to $9.46 billion in 2010. That’s a decrease of nearly 21 percent.

That study noted, perhaps plaintively, “It is unclear whether this large payment reduction will satisfy federal policymakers.”

The reductions resulted from the cumulative effect of several Medicare initiatives, Dr. Levin said, including reductions in payments for MRI, demands for discounts when several scans occur during the same session, and changes in physician expense formulas.

Will those cuts be enough to take the cost-reduction heat off imaging and focus it somewhere else? In the short term, unfortunately, probably not. Perception always takes a while to catch up with reality. In this case, not much suggests that, among those trying to lasso health care costs, the lean reality has superseded the bloated perception.

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