Radiologists gain ground in final RVS regulations

The final rules for Medicare's new resource-based relative valuescale appear to address two of the three major issues posed bythe American College of Radiology regarding physician paymentreform.

The 1500-page regulation, announced last week, recognizes radiologistfee reductions made in 1989 when Medicare adopted a relative valuepayment approach designed by the ACR. The Health Care FinancingAdministration also restored $7 billion in proposed physicianfee cuts from controversial transitional offsets, but retainedbehavioral adjustments applying to radiologists' fees.

The sweeping Medicare payment reforms cover about 7000 medicalservices performed by nearly 500,000 physicians and 250,000 alliedmedical professionals. The payment plan takes effect Jan. 1.

Medicare spending covered by the fee schedule will increasefrom $27.3 billion in 1991 to $47.5 billion in 1996, accordingto HCFA. The plan features a major shift in reimbursement fromhands-on physician services, such as surgery, to so-called cognitiveservices, including family practice.

General practitioners are the big winners in the new plan.Family practitioners and GPs will see their Medicare income riseabout 28% by 1996, according to HCFA. There was no early indicationas to how the payment schedule will affect radiologists' income,but they will probably face substantial rate reductions.

Those cuts may not be as deep as the ACR feared, however. Thoughdetails were not available at press time, the final regulationsappear to integrate the 18% rate reductions radiologists tookin 1989 when the ACR's approach to relative value payment wasadopted. The proposed RBRVS would have reduced radiologist feesanother 32%, ACR officials said.

"The physician fee schedule law acknowledges that specialrules are already in effect with respect to payment for radiologyservices," the summary said.

While the ACR appears to have gained a victory on this score,it lost the battle over behavioral offsets. HCFA adjusted ratesfor all physician classifications downward by 6.5% to anticipatethat physicians will increase patient volume to recover lost Medicareincome.

From a physician's standpoint, this is an improvement overthe 10.5% offset in the proposed regulations. But the change isnot likely to please the ACR, however, which lobbied HCFA to exemptradiologists from the adjustments.

The ACR argued that radiologists cannot manipulate their volumesbecause referring physicians control those rates. The argumentfound favor among radiologists and sympathy with RBRVS authorDr. William Hsiao, but it apparently did not sway Medicare regulators.