Imaging Fees for Physicians Get Pushed Over Fiscal Cliff

A Dystopian Vision for Free-Standing Imaging Centers

For physicians who operate MRI and CT scanners, ATRA is just one more injury to their bottom line.

"This (law) doesn't come in isolation," said MITA's Connell. "It comes after a series of billion-dollar cuts."

Connell and others were disappointed that lawmakers failed to save physicians from one particular cut in their New Year's Day frenzy. A bill before Congress called the Diagnostic Imaging Services Access Protection Act (DISAPA) would have rolled back a 25% reduction in the professional-component fee for multiple imaging procedures — the vast majority of them MRI and CT scans — furnished by the same physician to the same patient in the same session on the same day. The physician would receive his full PC fee for the first procedure, but only 75% for subsequent procedures. The reduction took effect January 1, 2012.

CMS reasoned that it had been overpaying physicians by giving them the full fee for every procedure in this scenario, because same-day multiple procedures made their job easier. The ACR has countered that this pay cut overestimates efficiency gains for physicians who read and report on a bundle of scans.

DISAPA would have granted ACR's wish to eliminate the cut, but lawmakers did not include the bill in the legislative package that they passed on January 1. Dr. Allen called Congressional inaction on this measure "shortsighted."

Yet another financial pressure on physicians who own MRIs and CT scanners is the 2.3% excise tax that the ACA imposes on medical devices this year. The tax will raise the price of diagnostic equipment at a time when reimbursement is declining, according to Dr. Allen.

"We're getting closer and closer to the threshold for free-standing imaging centers to not make a profit and buy new equipment," he said.

Brian Connell at MITA noted that the financial crisis in imaging services makes it harder for physicians to invest in new CT scanners that expose patients to less radiation. Instead, physicians hang on to old equipment, and patient safety suffers.

If these trends continue, Connell and Dr. Allen envision an end-game in which free-standing, physician-owned imaging centers shut down in small-town America.

"Medicare patients will have fewer choices in access as all this stuff is pushed to hospitals," said Dr. Allen. And because hospitals receive higher fees than free-standing imaging centers, Medicare will shell out more money in the long run.

Dr. Allen said he can't understand why Congress is letting this happen.

"Our legislative processes," he said, "are failing us right now."