CMS targets imaging services for fee cuts

Radiologists warn that a proposal to reduce Medicare payments for multiple services could be a precursor to more cuts.

By David Glendinning, AMNews staff. Aug. 22/29, 2005.

Washington -- The Centers for Medicare & Medicaid Services may have fired the opening salvo in the struggle to rein in the rise in spending on physician services.

Tucked away in the nearly 800 pages of a recently released CMS proposed rule on the 2006 physician fee schedule is a new plan to reduce reimbursements for certain imaging services when performed on one patient during a single session. For instance, the government currently pays full price for magnetic resonance imaging of the abdomen and the pelvis when a physician administers both scans during the same visit. The federal proposal, though, would reduce payment for the second procedure by half.

The Medicare Payment Advisory Commission provided the inspiration for the move last March when it recommended new, lower-paying reimbursement codes for multiple imaging services. The commission said it believes that is fair, because much of the physician's work in setting up the patient for the first scan does not need to be repeated for subsequent scans.

CMS agreed with MedPAC's assessment and concluded that doctors' ability to achieve such operational efficiencies warrant lower reimbursements. But Medicare officials might have been shortsighted when they came to this conclusion, said James Borgstede, MD, chair of the American College of Radiology's board of chancellors.

"We're not convinced that the way they're doing this is appropriate, particularly on nuclear magnetic resonance and ultrasounds," said Dr. Borgstede, a radiologist in Colorado Springs, Colo. "In nuclear magnetic resonance, for example, when you do contiguous scans, oftentimes you have to take the patient out of the scanner between parts, you have to change some of the technical equipment that you're using on that scanner and you also have to do repeat localizing images before you can do the second part."