Imaging Use in Medicare Is Down, Will the Feds Take Heed?

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ID 10096300September 4, 2012 -- Medicare payments for noninvasive diagnostic imaging exams are down 21% compared with their peak in 2006, reports a new study in the September issue of the Journal of the American College of Radiology. But are federal policymakers paying attention?

Because of the rapid growth of imaging use before 2006, Medicare payments for imaging procedures have been under intense scrutiny, according to lead author Dr. David C. Levin, of Thomas Jefferson University, and colleagues. Techniques to reduce this growth have worked, and it's time to stop the push to reduce payments for imaging, Levin told

"Whatever goal policymakers had in 2006 [to reduce imaging overuse], it's been accomplished," he said. "We don't need any further cuts in reimbursement."

Levin's group used Medicare Part B databases for 2000 to 2010 for the study, including all codes for noninvasive diagnostic imaging procedures and using physician specialty codes to identify radiologists, cardiologists, all other nonradiologist physicians as a group, and independent diagnostic testing facilities (IDTFs). The team also tracked Part B noninvasive diagnostic imaging payment trends (JACR, September 2012, Vol. 9:9, pp. 643-647).

Noninvasive diagnostic imaging spending skyrocketed between 2000 and 2006, rising from $5.9 billion to $11.9 billion. But after the Deficit Reduction Act (DRA) of 2005 went into effect in 2007 there was a sharp drop, followed by a slight rise in 2008 and then successive smaller drops the next two years, reaching $9.4 billion in 2010 (21% decrease compared to 2006), according to the authors.

Payments to radiologists totaled $2.9 billion in 2000, rose to a peak of $5.3 billion in 2006, and then dropped to $4.7 billion in 2010. Payments to cardiologists for noninvasive diagnostic imaging services were $1.3 billion in 2000, peaked at $2.9 billion in 2006, and dropped to $1.9 billion in 2010. Payments to other physicians were $1.1 billion in 2000, peaked at $2.3 billion in 2006, and dropped to $1.9 billion in 2010. Similar trends occurred in independent diagnostic testing facilities, according to Levin and colleagues.

"The most important finding of this study is that after a number of years of rapid growth in [noninvasive diagnostic imaging] costs to Medicare, which reached a peak in 2006, there was a 21% decrease from that year through 2010," the team wrote.

In addition, four other developments at the federal level have negatively affected imaging reimbursement to physicians in recent years, according to the authors:

  1. The multiple procedure payment reduction (MPPR), which applies a 25% reduction to the technical component of the second and any additional CT, MRI, and ultrasound examinations of contiguous body parts during the same session

  2. The decision by the U.S. Centers for Medicare and Medicaid Services (CMS) to revalue the practice expense component of imaging relative value units (RVUs), which reduced the imaging practice expense per hour from $204 to $135; this is being phased in over a four-year period that began in 2010 and will end in 2013

  3. An increase in the assumed equipment utilization rate; the Patient Protection and Affordable Care Act called for this rate to increase to 75% for all diagnostic imaging equipment costing less than $1 million (and the current administration's 2013 budget calls for the assumed utilization rate to be increased again to 95%)

  4. The bundling of certain high-volume CPT codes 

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