Imaging Fees for Physicians Get Pushed Over Fiscal Cliff

January 11, 2013

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"Thank Goodness Medical Imaging Is Higher"

Dr. Allen said it makes no sense to raise the utilization rate for MRI and CT scans in the TC fee formula when the volume of such scans — and diagnostic imaging in general — is on the decline.

MEDPAC figures support his claim. After rising from 2005 to 2009, the units of imaging services per Medicare beneficiary decreased by 1.5% from 2009 to 2010, according to the group's 2012 report to Congress. Other service categories fared better. The growth rate was -0.1% for evaluation and management (E/M) services, 1.1% for major procedures such as coronary angioplasty, 0.2% for other procedures such as colonoscopy, and -0.6% for tests such as electrocardiograms.

This downward trend for imaging services has continued since 2010, according to the Medical Imaging & Technology Alliance (MITA), which belongs to AMIC. A MITA report issued in September 2012 stated that Medicare spending per beneficiary on all imaging services, excluding hospital claims, fell 16.7% from 2006 to 2011. For advanced imaging services such as MRI and CT, the drop was even steeper at 27.6%. In contrast, spending on nonimaging services rose 21.3% during this period.

All this goes to show that diagnostic imaging is not the bad boy of Medicare costs, according to Brian Connell, MITA's director of state and federal government relations.

There are other places to look for savings. Imaging shouldn't be at the top of anyone's list.

"There are other places to look for savings," Connell told Medscape Medical News. "Imaging shouldn't be at the top of anyone's list."

The 2012 MEDPAC report doesn't let imaging services entirely off the hook. Before the slippage in 2010, the volume of these services had grown 85% from 2000 through 2009, more than double the rates for E/M services and major procedures, according to MEDPAC. Only tests were a faster-growing service category, and barely so. And units of service per 1000 beneficiaries for non-head CTs more than doubled during this time, going from 258 to 551.

This upward trend may catch the eye of budget cutters, but MITA's Brian Connell said the growth is justified. Advances in diagnostic imaging since 2000 have revolutionized medical care, allowing physicians to see things in the human body that they couldn't see before. "It reduced the amount of exploratory surgery dramatically," Connell said.

Dr. Allen concurs.

"Thank goodness medical imaging is higher," he said. "A decade ago, we were doing exploratory laparotomies. Do you want an arthroscope or an MRI scan of your knee? I used to stick needles into people's abdomens to see if there was blood after a car crash. We don't have to do that anymore."

Both men agree that some physicians order diagnostic imaging when it's not necessary. Connell said it was a "small sliver" of the profession. The answer to that problem, he said, is developing "appropriateness criteria" to reform promiscuous users, not penalizing the good and the bad alike with across-the-board pay cuts.