GAO report targets MRI payments for refiguring

Payments for MRI scans are too high in some regions of the country,despite cuts engineered through the resource-based relative valuescale (RBRVS), according to a July report by the General AccountingOffice.

The number of MRI scanners in the U.S. grew from 200 to 2000between 1985 and 1991, the GAO reports. Medicare payments forMRI studies skyrocketed in a similar way, from $37 million in1986 to $237 million in 1990.

Medicare payments under the RBRVS are a combination of professionaland technical components. Professional component payments arederived from relative values, while technical components are basedon practice costs.

Even after the advent of the RBRVS, the GAO found paymentsfor the technical component of the MRI exam ranging from a lowof $276 in some regions to $485 in others. The disparity is tiedto the way in which the Health Care Financing Administration initiallycalculated MRI practice costs.

Rates for scans were developed in part by calculating a projecteddaily volume of 10 to 12 scans. But as MRI technology has advanced,the ability to scan increasing numbers of cases per day has reapedprofits for centers scanning higher volumes.

The GAO, Congress and the Physician Payment Review Commissionare reviewing the MRI payment issue, said Dr. James M. Moorefield,chancellor of the American College of Radiology.

The GAO report suggests that all MRI payments be recalculatedto account for higher utilization. It also recommends that Medicareconduct annual payment adjustments to "capture any savingsrealized as a result of technological advances." Other high-techradiology services may be refigured in the same way.

"The government wants people to take the risk and sharethe rewards with them," Moorefield said. "But if thevolume is set too high--at 20 cases per day, for example--peoplewho are doing 15 cases per day are going to fall short."

So far, HCFA has not endorsed the report except to say thatMRI payments should be refigured. The actual volume of scans thatwill be used to calculate payments is under negotiation, Moorefieldsaid.

"The number they come up with is critical, because youcan make these calculations turn out any way you want, dependingupon the volume," he said.