Drastic Medicare reimbursement cuts for out-of-hospital medical imaging procedures in the Deficit Reduction Act of 2006 may force many physicians to stop offering imaging services and limit the number of Medicare patients they receive. The Act, which was signed into law on 8th February by President George W Bush, makes numerous changes to the Medicare and Medicaid payment provisions and is expected to reduce spending by nearly $11 billion over five years.
The House of Representatives first passed the Act by a close vote of 212 to 206 on 19th December 2005. The Senate then passed the Act, but the Democrats used a parliamentary measure to send the legislation back to the House for a second vote. The House did not consider the Act until it returned from the December recess, and passed the Act on 1st February, again by an extremely close vote of 216 to 214.
Under current law, the Medicare physician fee schedule assigns a higher relative value for imaging services offered in a physician's office than in a hospital setting. This higher payment is to compensate for the physician's ownership of the equipment and the involvement of the staff in the service. However, from 1st January 2007 Medicare will pay for the technical component of such services at the lesser of the hospital outpatient prospective payment system (HOPPS) or the Medicare schedule. This new payment method applies to X-ray, ultrasound (including echocardiography), nuclear medicine (including positron emission tomography), magnetic resonance imaging, computed tomography and fluoroscopy, but excludes diagnostic and screening mammography.
The American College of Radiology (ACR) has stated that this move is "totally contrary to the good-faith effort of radiologists and other physicians regarding the increased utilisation of imaging services... These cuts disproportionately affect radiologists, radiation oncologists and other qualified physicians who have made a considerable investment in imaging equipment. Furthermore, this policy does not differentiate between diagnostic services and treatment planning services that are needed for cancer patients."
ACR chair Dr James P Borgstede commented: "The ACR will educate lawmakers as to the drastic consequences of the imaging reimbursement cuts in this bill and work to mitigate the severe, if unintended, effects that this bill will have on patient care and our healthcare system as a whole... The ACR urges lawmakers to take steps in the coming months to correct this disservice to patients and qualified medical imaging professionals that this bill has performed."
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