Interpretation of imaging scans of the same patient by different physicians during the intra-service period provides little or no work efficiencies.
Interpretation of imaging scans of the same patient by different physicians during the intra-service period provides little or no work efficiencies, say researchers in a study published in the Journal of the American College of Radiology.
CMS introduced a new policy in 2012 that instituted a reduction of 25 percent in payment for physicians who provided multiple imaging services to the same patient in the same session. The reduction applies to all physicians in a group or practice, although it affects only the interpretations, not the number of scans ordered. According to the American College of Radiology (ACR), this type of reduction has recently been expanded to physical therapy, cardiovascular, and ophthalmology technical services as well.
Researchers from ACR’s Harvey L. Neiman Health Policy Institute in Reston, Va., quantified potential physician work efficiencies and appropriate multiple procedure payment reductions for different same-session diagnostic imaging studies interpreted by different physicians in the same group practice.
The researchers analyzed Medicare Resource-based data to determine the relative contributions of various pre-service, intra-service, and post-service physician diagnostic imaging work activities. An expert panel quantified potential duplications in professional work activities when separate examinations were performed during the same session by different physicians within the same group practice. Any maximum potential work duplications for various imaging modalities were calculated and compared with those used as the basis of CMS payment policy.
The researchers did not identify any potential intra-service work duplication when different examination interpretations were rendered by different physicians in the same group practice. There were some duplications in the pre- and post-service activities, however. The activities ranged from 5 percent (radiography, fluoroscopy, and nuclear medicine) to 13.6 percent (CT). Maximum mean potential duplicated work relative value units ranged from 0.0049 (radiography and fluoroscopy) to 0.0413 (CT). This equates to overall potential total work reductions ranging from 1.39 percent (nuclear medicine) to 2.73 percent (CT).
The calculations showed that across all modalities, the findings correspond to maximum Medicare professional component physician fee reductions of approximately 1.23 percent for services within the same modality. This is “much less than an order of magnitude smaller than those implemented by CMS. For services from different modalities, potential duplications were too small to quantify,” the authors wrote.
“These findings are important because the exams affected are primarily used to care for the most sick or injured patients - those with massive head and body trauma, stroke, or widespread cancer,” Geraldine McGinty, MD, chair of the ACR Commission on Economics, said in a statement. “These people often require interpretations by different doctors to survive. This study shows that the data Medicare used to justify funding cuts was inflated by 1,200 percent and not reflective of clinical practice.”