How to Deal with the Medicare Imaging Cuts

November 14, 2011

Whenever there is anticipated change to your bottom line, it is good for the practice leaders to ask the business office for a "damage report." In other words, find out what the real facts are regarding the impact might have been for the last fiscal year. At least this will give you a little financial perspective to share with everyone.

In the Medicare Physician Fee Schedule final rule published last week, CMS announced a Multiple Procedure Payment Reduction (MPPR) that applies a 25 percent reduction to the professional component of second and subsequent advanced imaging services furnished by the same physician (or same group practice) to the same patient, in the same session, on the same day.

This is scheduled to take effect on Jan. 1, 2012. For proponents, the argument goes that if you read one study on someone, you have to do less work to read the second one.

Whether you agree, it will have a considerable impact on reimbursement next year. So there has been a lot of gnashing of teeth among colleagues who are anguished over this change. Perhaps rightly so. This change is one of many that have happened, and I think many more that we will see soon see proposed.

There are at least two important considerations from our practice's perspective.

First, take a breath. This kind of change produces anxiety for many. And anxiety like that may engender dissatisfaction in the practice, produce attitude changes that are negative or prompt calls for changes to ameliorate the effects.

Clearly, we all want to try and avoid this kind of hair-trigger response and work from facts. Not all such changes have as dramatic an impact on your practice as are originally anticipated. In this particular instance, the changes are not aimed at angiography or other interventional services, plain films or nuclear medicine. So depending on your practice they may have more or less effect.

They also are for CMS reimbursement, so if that is not a large part of your practice the impact may be less. Lastly, the change would not affect any contracts where you are paid by the facility on a per case basis.

So, whenever there is anticipated change to your bottom line, it is good for the practice leaders to ask the business office for a "damage report." In other words, find out what the real facts are regarding the impact might have been for the last fiscal year. You don't have to do this by a comprehensive audit of all of your charges; You can estimate. Just choose a sampling. The larger your sample, the more accurate your estimate, but a week might be reasonable. Or you can do this prospectively, and keep track of how many such studies are done next week. At least this will give you a little financial perspective to share with everyone.

Share the results, good or bad in your opinion, with all of the practice. If better than anticipated, the information may calm some. If they are worse than expected, at least you can work from facts to try and ameliorate their impact. It may be a good idea to share them as part of your regular meetings, and with someone from your business office or your finance physician available to talk about the results. Sending out such results in a vacuum can create more problems, as they might be interpreted variably.

Second, remember this: The world is what we make it much of the time. Things don't happen to you, you can make them happen or not in many cases. Complaining about the changes, if you think they are wrong, will not affect them. You have to act, not just complain. The ACR, ASNR and other societies spoke up about the changes. The changes imposed were less than originally proposed, though they will still have a large impact. In the future, if we want to have the changes we want, we must all support those organizations or speak up and speak out to our representatives and lobbyist to tell them what we believe and need. If you like or don't like a change, make sure your voice is heard. You may not always get the changes you want. But you'll never get them if you don't speak up.