Imaging Fees for Physicians Get Pushed Over Fiscal Cliff

January 11, 2013

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The law passed on New Year's Day to avert the dreaded fiscal cliff of automatic spending cuts and expiring tax cuts miffed a lot of people, including physicians who own CT and MRI scanners.

To be sure, these particular physicians benefit from the measure's 1-year postponement of a 26.5% cut in overall Medicare reimbursement that had been set for January 1. The new law, called the American Taxpayer Relief Act (ATRA) of 2012, instead freezes payment rates at current levels through the end of the year.

However, lawmakers were under the gun to offset the cost of this "doc fix" — $25 billion over 10 years — along with the extension of other healthcare policies, which added several billion dollars more to the tab. After all, today's Congress is loath to put any expense on the USA credit card. So lawmakers reduced Medicare spending elsewhere by roughly that same amount. Hospitals took most of the hit. However, $800 million over 10 years was whacked from what Medicare pays physicians for "advanced imaging services," meaning CTs and MRIs.

Radiologists and other physicians who operate these expensive machines in medical offices and free-standing imaging centers are crying foul. They say that lawmakers acted on the erroneous assumption that Medicare spending on imaging services is growing out of hand and needs curbing. All the pay cut will do, the argument goes, is make it harder for physicians to offer MRI and CT imaging. Ultimately, they will surrender the field to hospitals, raising costs and limiting access to these services, especially if patients in small towns are forced to drive long distances to big-city hospitals.

"There are a lot of negatives downstream," said Bibb Allen, Jr, MD, vice chair of the American College of Radiology (ACR) Board of Chancellors.

These negatives, as well as actual trends in diagnostic imaging, were lost on lawmakers during the round-the-clock legislating that occurred at the juncture of 2012 and 2013, Dr. Allen told Medscape Medical News.

"In this whole shenanigans of (doing) the fiscal-cliff deal on New Year's Eve and New Year's Day, there was no way to present this information to them," said Dr. Allen, who practices at Trinity Medical Center in Birmingham, Alabama.

The impact of the ATRA pay cut, which takes effect January 1, 2014, goes beyond radiology. Cardiologists, orthopedic surgeons, oncologists, and other specialists also field CT and MRI scanners.

Medical societies such as the American College of Cardiology, the American Society of Clinical Oncology, and the ACR are not taking the reduction lying down. They intend to lobby Congress to undo the $800 million cut through an umbrella group called the Access to Medical Imaging Coalition (AMIC), which also includes diagnostic equipment manufacturers.