Imaging reimbursement cuts: Enough is enough

Tools

New research published this week reconfirms that advanced imaging utilization is on a steady decline, after having peaked in the periods immediately before and after the turn of the century.

The study, reported about in this week's issue of FierceMedicalImaging, suggests that the slowdown has been attributable to pre-authorization requirements, increasing concerns about radiation exposure from advanced imaging modalities like CT and PET, and Medicare reimbursement cuts.

Critics of government healthcare policy, particularly among radiologists, have argued that a series of reimbursement cuts that have hit the industry over the last eight years are unnecessary--especially considering the way utilization rates are falling--as well as counterproductive when it comes to providing patient care.

Coincidentally, this study comes out at a time when the Centers for Medicare & Medicaid Services released the Medicare Physician Fee Schedule Final Rule. One area of concern relates to another reimbursement cut--this one for image-guided breast biopsies. Which again begs the question--at what point are these reimbursement cuts just too much?

Organizations such as the American College of Radiology and the Society of Breast Imaging argue that the cuts will result in insufficient reimbursement for these procedures and force radiologists to reduce services; the evidence seems to support that.

For example, according to the U.S. Food and Drug Administration, there are almost 150 fewer mammography facilities and 600 fewer mammography units in existence today than there were in 2007, when that string of reimbursement cuts was just beginning.

What's more, there's evidence that imaging reimbursement cuts are having an effect on patient care. While research has demonstrated that imaging utilization has steadily declined since the 2006, according to a recent report from the Neiman Health Policy Institute, the average length of hospital stays has increased from 4.9 to 5.2 days.

Is there a connection? Well, this study published in the Journal of the American College of Radiology in 2010 demonstrated that patients who were imaged early when hospitalized had shorter stays than those who were imaged later in their stays.  And this study, published in the New England Journal of Medicine in 2012 showed a connection between providing patients arriving at the emergency department with coronary CT angiography and fewer hospital admissions and shorter stays.

Then there's this study, published in Health Affairs in 2011, in which researchers determined that decreased reimbursement for imaging to test for osteoporosis led to fewer tests performed (about 800,000 fewer tests); those tests, the researchers estimated, could have prevented approximately 12,000 fractures.

The researchers of the study we report on today suggest that their findings "can inform policy makers and payers as they develop future imaging-related policies." I certainly hope that's the case, given how the evidence stacks up. - Mike (@FierceHealthIT)