ACR seeks to correct RBRVS flaws

Angered officials of the American College of Radiology will seekhelp from Capitol Hill to alleviate the deep cuts in radiologistincome contained in the new Medicare physician payment reforms.

The society will present its legislative plan to Congress inJanuary, said Dr. James M. Moorefield, chairman of the ACR boardof chancellors, in a letter to members last month.

ACR analysts found Medicare payments for radiological serviceswill be reduced by about 20%, if the final relative value scalepublished last month is implemented. From the ACR's standpoint,the overall cuts are an improvement over the 32% cuts writteninto the proposed reforms. However, they fall short of addressingissues that drew more than 27,000 protests in a letter-writingcampaign orchestrated by the society.

"Based on the HCFA response to our comments, it will benecessary to go back to Congress to get relief," Moorefieldsaid.

The ACR found no evidence in its preliminary review of the1500-page regulation that the Health Care Financing Administrationhad revised the resource-based relative value scale to recognizethe 18% Medicare rate cut that was applied to radiology two yearsago, Moorefield noted.

"HCFA did add to the data used for rescaling the radiologyrelative values...but the increase does not appear to significantlychange the inappropriately low relative values for radiology,"he said.

The federal agency specifically rejected the ACR's plea forrelief from RBRVS behavioral offset. The 6.5% across-the-boardrate reduction was built into the formula because regulators expectphysicians to increase Medicare patient volumes to compensatefor lower payment rates.

An ACR-sponsored study found no evidence of behavioral increaseswhen relative values were first applied to Medicare's paymentof radiology in 1989, according to Moorefield. The findings suggestthat the ACR will garner Congressional support to exempt radiologistsfrom the adjustments, he said.

As expected, the final RBRVS rules will provide separate paymentfor low-osmolar contrast media under specific conditions. Butthe payment rate will be based on the lower of two cost estimatesgained from surveys of the actual invoice prices paid by physiciansand published wholesale drug prices, Moorefield said.

BRIEFLY NOTED:

• An FDA proposal to limit iodine content in x-ray contrastmedia was the subject of hours of testimony before a medical imagingdrugs advisory committee meeting last month. The proposal nearlyovershadowed NDA review of MRI agents manufactured by Squibb andSterling Drug (see story above).

The session on x-ray contrast was primarily for the purposeof fact-finding. The proposal to limit iodine content is onlyin a preliminary stage. But after hearing testimony from companiesand their consultants, the committee concluded that it may beeasier to establish ranges of ionicity rather than limit concentration,said Leander B. Madoo, executive secretary for the committee.

"Obviously, the manufacturers are totally against thenotion of quantifying (an overall range) for iodine concentration,"he said. "The impression is that it may be easier to havehigh, medium and low ranges."