MR reimbursement changes lead to shake-up in Japan

Cuts in the reimbursement level for scans performed at field strengths of less than 1.5T look set to result in far fewer low-field MR examinations in Japan.

During spring 2006, officials at the Ministry of Health, Labour, and Welfare (MHLW) introduced new regulations in an attempt to reduce the total number of MR procedures and raise the quality of imaging services. They were concerned that too many MRI machines are used without a radiologist.

Under the old rules, levels of reimbursement varied according to the body part involved, not the field strength. For instance, the rate was 1140 points for a head scan, 1220 for the trunk, and 1160 for the extremities, where one point equaled 10 Yen.

Under the new system, the level is fixed at 1230 points for an examination of any part of the body when a scanner of 1.5T or more is used and at 1080 points below 1.5T. A 13.9% premium now exists for MRI above 1.5T, compared with MRI below 1.5T.

"It is too early to propose any final answers, as everything has just started," said Prof. Hiroshi Fukatsu, a radiologist at Nagoya University Hospital. "The most apparent change so far is that the low-field market is disappearing. But because the threshold of the reimbursement difference is 1.5T, there is no active motivation to purchase 3T instead of 1.5T."

There is a steady demand for 3T among university hospitals, and up to 100 machines may be installed within the next two or three years, but nobody can predict what will happen in the future, he said.

According to Shin Iryo, the monthly Japanese magazine, there were 27 3T MR systems installed in April 2006, compared with only 10 a year earlier.

The comparable figures for 1.5T were 2211 and 1946. In April 2006, there were 819 1T scanners, 758 machines of between 0.7T and 0.5T, and 1780 devices at field strengths under 0.5T, totaling 5595.

"It is too early to get a consensus among radiologists about whether 3T should be the standard technique. The majority of hospital managers are selecting 1.5T because of its cost-effectiveness," Fukatsu said. "I guess that for a hospital manager who has a US$3 million budget for an MRI purchase, he or she should buy two 1.5T systems instead of one 3T machine."

He thinks the new rules will encourage hospital managers to shorten the replacement cycle or buy an additional scanner. This means radiologists can deal with better quality images, and they can have more confidence in their interpretations.

Several uncertain factors could have an impact on clinical practice, including the diagnosis procedure combination (DPC) system, which is currently used to reimburse all hospitals with more than 400 beds.

The DPC system is complex but tends to reward examinations performed on an outpatient basis. The system also encourages hospitals to have a large capacity and throughput.

"3T MRI will increase gradually but not so rapidly because the reimbursement rate is the same as that for 1.5T," said Prof. Hironobu Nakamura, a radiologist from Osaka University Medical School. "Additional points for advanced imaging techniques such as acute brain stroke MRI/CT and coronary artery CT were also requested but not accepted by MHLW this year. We are planning to continue our work in these areas."

Reimbursement for CT has also changed. When multislice CT with more than two slices is used, about 20% more income per study is available. Many hospitals have ordered four-slice CT, which is particularly cost-effective due to the changes, he said.