Legislation proposes moratorium, while study alleges flaws in imaging payment reductions

February 28, 2007

Outpatient medical imaging advocates fired two salvos Feb. 28 to encourage Congress to adopt a two-year moratorium against recent Medicare payment rate reductions they say cut reimbursement by half for some CT and MRI procedures.

Outpatient medical imaging advocates fired two salvos Feb. 28 to encourage Congress to adopt a two-year moratorium against recent Medicare payment rate reductions they say cut reimbursement by half for some CT and MRI procedures.

Rep. Carolyn McCarthy (D-NY) introduced legislation mandating a two-year moratorium for imaging rate reductions included in the 2006 Deficit Reduction Act. The DRA law, enacted by Congress in February 2006 and implemented in January 2007, capped the technical component of payments for physician office imaging to the lesser of the Medicare Part B hospital outpatient payment system or the Medicare fee schedule.

McCarthy's bill also calls for a Government Accountability Office study to analyze the effect of the DRA cuts on patient access to diagnostic imaging, especially in rural and medically underserved communities. The bipartisan bill was cosponsored by 25 representatives.

American College of Radiology support for the bill was reflected in a cautionary statement issued by ACR board of chancellors chair Dr. Arl Van Moore Jr.

"Congress needs to act now to stop these ill-advised medical imaging cuts before they significantly harm our seniors' ability to readily receive life-saving and life-enhancing medical imaging care," he said in a release.

To punctuate that position, the Access to Medical Imaging Coalition announced the results of a study showing that office-based imaging providers are losing money on 87% of the 126 imaging procedures affected by the DRA payment limits. The study, commissioned by the AMIC and conducted by the Moran Company, a Washington, DC-based research and consulting firm, found that Medicare began paying office-based providers 16% to 18% less than hospital outpatient departments for the same procedures, after the new formula was enacted Jan. 1. The findings were based on an analysis of 145 codes for which complete data were available, according to the AMIC.

"The Moran report shatters the pre-DRA myth that total imaging payment for physician offices and imaging center were wildly out of line with imaging payments in the hospital outpatient departments," said Tim Trysla, AMIC executive director, in a release. "Everyone knows that Medicare has always paid below the true costs of providing many medical procedures, but this report reinforces the fact that the DRA is only making that worse."

The AMIC counts 40 imaging-related associations and private companies among its membership, including the Academy of Molecular Imaging, ACR, Society of Diagnostic Medical Sonography, Society of Interventional Radiology, and Society of Nuclear Medicine.

For more information from the Diagnostic Imaging archives:

2007 reimbursement guide: What you need to know

Congress finds money for physicians at imaging's expense

Reimbursement cuts could make exams money losers