Code bundling plus the recent Centers for Medicare and Medicaid (CMS) decision to hold firm in the denial of reimbursements for sodium fluoride (NaF) PET scans for bone metastases detection is leading to lower reimbursements for outpatient imaging practices. This burdens private imaging practices to the point that there will likely be closures resulting in reduced access for patients. In an article posted on the Radiological Society of North America’s (RSNA) website, Richard S. Dargan writes, “Outpatient advanced imaging is shifting from private imaging centers to higher-cost hospital facilities, according to a new study, raising concerns about reduced access for patients and increased costs to payers.”

Code Bundling and Payment Cuts

Dargan is referring to a study presented two years in a row at the annual RSNA conference, first in 2014 and again in 2015. Dr. Bhavik Patel of Thomas Jefferson University and his colleagues presented research results of payment cuts to outpatient imaging. In 2014’s presentation the group used 12 years of Medicare data (2001 to 2012) and 13 years of data in 2015 (2001 to 2013). They calculated procedure use rates per 1,000 Medicare beneficiaries on MRI, echocardiography, nuclear medicine, ultrasound and CT conducted by location. Conclusions drawn showed reimbursement rates were affected by code bundling.

A recent article, How Have Payment Cuts Affected Medical Imaging, quotes Patel and his concerns for radiology:
In particular, reimbursement rates for these modalities have been affected by CMS’ code bundling efforts:

  • Echocardiography: In 2009, add-on codes for spectral Doppler and color flow Doppler echocardiography were bundled into the code for primary transthoracic echocardiography.
  • Nuclear medicine: In 2010, codes for primary myocardial perfusion imaging and its two add-on codes for left ventricle wall motion and ejection fraction were combined.
  • CT: In 2011, codes for CT of the abdomen and pelvis were bundled.

The result? The relative value units for the new single codes were substantially lower than the previous sum for the codes, producing large apparent drops in utilization.

CMS rejects NaF-PET coverage

Making matters worse, CMS announced in December 2015 that NaF-PET scans to test for bone metastases would not be eligible for reimbursement. This decision disappointed several groups including NaF-PET advocates and members of the National Oncologic PET Registry (NOPR) who collected data from imaging facilities for years to determine how NaF-PET influenced patients.

How to survive payment cuts

There are two basic approaches to survival when payments are decreased: lower operating costs and look for ways to expand business. Doing both provides the most balanced course of action.

One way to increase business is to participate in the $100 million PET IDEAS study. There is still time to register your facility, but the time to act is now, and you must be accredited. For more information on this study, check out our recent blog. To begin a RadSite accreditation for your PET imaging center and learn how you can become a participant in the PET IDEAS study, contact us today!

How Payment Cuts Have Affected Outpatient Imaging

When lowering operating expenses, it’s important to cut the right things. Some things not to cut? Regular testing and maintenance on your equipment. Ensuring your equipment is properly calibrated is essential to keeping your accreditation, so don’t err on the side of making cuts in those areas. Not sure? RadSite can help. We provide a friendly, easy-to-use educational approach to getting and maintaining accreditation. We offer the lowest pricing in the industry. Contact us today to keep your practice fully accredited.

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