As we await decisions on CMS policies, radiologists wonder what will be on the table this holiday season.
As I write this column in mid-September, I wish I had a crystal ball. Will we as radiologists have much for which to be thankful when the November Bulletin is printed?
CMS should, by that time, have issued its final rules for 2014. We'll see if we were successful in asking the agency to refrain from imposing separate cost center reporting for CT and MR for hospital billing. (Read more about this in our HOPPS comment letter at http://bit.ly/HOPPS.) If our pleas fall on deaf ears, we'll see huge decreases in CT and MRI reimbursement on the HOPPS side, with corresponding significant decreases on the Medicare Physician Fee schedule, as the two fee schedules are linked by the impact of the Deficit Reduction Act. If that flawed policy has been implemented, you will definitely be hearing from us asking you to participate in a grassroots response to CMS.
By that time, we will also know the results of the CMS requirement that the breast biopsy codes and imaging guidance codes be bundled. Typically, bundled codes have been associated with significant decreases in value (more than 20 percent when CT abdomen and pelvis were bundled together, for example). The availability of safe, minimally invasive breast biopsy has been one of the major improvements in care that we as radiologists have been able to offer our patients. Drastic payment reductions could potentially force practices already struggling with the cascade of cuts implemented in the past few years to no longer offer this valuable service. This would represent a real blow to quality breast care for women. Since all code values are considered interim for one year and CMS allows an appeal to what is known as a "refinement panel," we will certainly engage in a vigorous advocacy process with your help should we feel that the eventual values for these codes have the potential to reduce access to care for our patients.
As I write, the bill to repeal the SGR is still simmering along and still includes language that mandates CMS disclose its reasoning and data support for the imposition of the multiple procedure payment reduction. It also includes a requirement that the secretary of HHS provide a report to Congress on the benefits of decision support. While neither of these stipulations goes as far as we would have liked, their continued inclusion in a successful bill would be a very positive step toward helping radiologists embrace change and the principles of Imaging 3.0™. In the words of an old English proverb, however, "there's many a slop 'twixt the cup and the lip." Wrangling over the national debt ceiling looms, and who knows our eventual fate, including that of the SGR repeal process in general.
At the ACR, we continue to not only fight to overturn arbitrary reimbursement cuts but also to place radiologists at the center of the delivery of high-value care.
Nobody wants to feel as if they have no control over their destiny. At the ACR, we continue to not only fight to overturn arbitrary reimbursement cuts but also to place radiologists at the center of the delivery of high-value care, which is where we belong. Our Imaging 3.0 campaign continues and is allowing members all over the country to tell a compelling story about why imaging is part of the solution to high-value, low-cost care and why radiologists have a unique part to play in the delivery of that care. New case studies are added all the time to our Imaging 3.0 website. You can find them at www.acr.org/Advocacy/Economics-Health-Policy/Imaging-3.
We continue to look for new opportunities to demonstrate the value of radiologists, whether it is working collaboratively with CMS to develop the program for lung cancer screening or continuing to engage state Medicaid authorities on how decision support can safely and effectively manage imaging utilization in a way that is more palatable than radiology benefit managers. We are also continuously engaged with private payers to make sure that they are up to date with new technology and changes in our specialty, such as the new board examination timetables.
November for me means not only Thanksgiving but the run-up to RSNA. It's always a great chance to connect with colleagues not only from the United States but also from around the world. It's also an opportunity to remember that we are a community of innovators. Our service commitment to our patients demands that we make the very best diagnostic tools available to them and that we use those tools safely and cost effectively. Your ACR Commission on Economics is focused on making sure that payment policy supports your ability to do just that.
By Geraldine B. McGinty, MD, MBA, FACR, Chair