Medicare fee schedule proposal could force nonrads to close office-based imaging services

July 3, 2008

Proposed rules announced June 30 for the 2009 Medicare Physician Fee Schedule feature provisions that could both hinder and help radiologists who perform outpatient imaging practices. The proposal, issued by the Centers for Medicare and Medicaid Services, asks for a 5.4% cut in physician payments, but it also raises the possibility of harsh regulations to make it harder for nonradiologists to provide office-based imaging services.

Proposed rules announced June 30 for the 2009 Medicare Physician Fee Schedule feature provisions that could both hinder and help radiologists who perform outpatient imaging practices. The proposal, issued by the Centers for Medicare and Medicaid Services, asks for a 5.4% cut in physician payments, but it also raises the possibility of harsh regulations to make it harder for nonradiologists to provide office-based imaging services.

"It could strike a blow to self-referral," said Thomas W. Greeson, J.D., a partner in the law firm of Reed Smith LLP in Falls Church, VA.

The proposed 2009 MPFS rule would require all physicians and nonphysician providers who perform diagnostic imaging in their offices to enroll and meet many standards that currently apply to independent diagnostic testing facilities (IDTFs). CMS will also impose proficiency requirements to all supervising physicians and proposes restricting supervising physicians from overseeing more than three IDTFs.

Currently, CMS administrative contractors allow only board-certified radiologists to be the supervising physicians for radiology studies performed in IDTFs. The proposed measures, designed to improve cost efficiencies in the system, would also make it extremely hard for many physician practices to qualify to provide in-office imaging services.

"(The proposed rule) may drive many nonradiologists out of the office-based imaging practice," Greeson told Diagnostic Imaging.

The 2009 MPFS also proposes modifying antimarkup rules. On one hand, it will narrow the definition of an office practice in relation to the technical component of imaging services (where services are rendered and by whom). On the other, CMS proposes to stop reassignment of payment rights by allowing the physician responsible for the professional component (interpretation service) to bill CMS directly.

In an unexpected move, CMS did not revisit possible reforms to federal Stark self-referral regulations that it invited interested parties to discuss last year before setting its 2008 Physician Fee Schedule. Many had expected to see such reforms in this year's proposal.

CMS proposed additional changes to the Physician Quality Reporting Initiative. It allows eligible physicians to earn incentive payments in exchange for reporting quality measures related to their clinical practice. The 2009 MPFS also promotes the use of electronic health records to improve efficiency and coordination among providers and to reduce malpractice.

The proposal could potentially improve the quality of imaging in physicians' offices. It is likely to face significant opposition from representatives of physicians who have imaging in their own offices, Greeson said. It could prove a boon for radiologists, however.

"Radiologists are going to be very happy with the proposed rule, particularly the requirements that are designed to try to curtail self-referral," Greeson said.

The document is pending publication in the Federal Register. CMS will accept comments on the proposed rule until Aug. 29 and will issue its final rule by Nov. 1. The revised policies and payment rates will become effective Jan. 1, 2009. For more information, visit the online CMS Physician Center

For more information from the Diagnostic Imaging archives:

CMS decision didn't come out of the blue

Medicare takes aim at self-referred imaging

New CMS rules will prohibit certain equipment leasing arrangements

Analysis encourages comments on CMS fee schedule proposal