Déjà Vu All Over Againdeja vu all over again

When you work at Montefiore Medical Center in the Bronx you pretty much have to be a Yankee fan.

Although my days of riding the 4 train past the House that Ruth Built (as in Babe Ruth, of course) are behind me now and, indeed, the old stadium has been replaced by a gleaming new one, the words of one of the Yankees' finest, Yogi Berra, never gets old. It's déjà vu all over again.

My last column was already off to the printer by the time the proposed rule on Medicare Physician Fee Schedule for 2013 was published. The ACR's success that I touted in that piece in persuading CMS to reserve the extension of the professional component multiple procedure payment reduction (MPPR) to members of the same group practice has been overturned. Once again, the CMS proposes to reduce reimbursement by 25 percent for the interpretation of a second procedure performed by a physician in the same group in the same session.

By the time you read this column, the ACR's economics and government relations teams will have crafted a strongly worded comment letter as well as communicated with members of Congress and other stakeholders about this flawed policy. I hope, too, that you will have responded vigorously to our calls for you to contact both your representatives and CMS. We cannot achieve change without your help. We have commented widely and published in the peer-reviewed literature on the specious reasoning that suggests there are efficiencies when two examinations are interpreted by one physician. How much more irrational is it to assume efficiencies when two different physicians are interpreting examinations? This does not even begin to consider the operational burdens for practices in understanding how to bill under the proposed new rules. We see significant risks of groups finding themselves not in compliance with vague guidelines about what constitutes a separate session and confusing instructions on how to use the 59 modifier. We are also fending off attempts by private payers to institute similar policies.

CMS has made it very clear in this proposed rule that its goal is to divert funds from specialists to primary care. This zero-sum approach is disappointing and, in radiology's case, is based on the erroneous assumption that imaging growth is out of control and bankrupting the system. In reality, gross imaging volume has decreased in recent years and is currently at 2003 levels. With the successive cuts that have been imposed, starting with the Deficit Reduction Act in 2006, imaging spending lags far behind that in other areas.

Imaging has made untold contributions in terms of lives saved, admissions avoided, and quality of lives improved. No professional society has been as aggressive as the ACR in advocating for appropriate imaging, and this leadership is something of which we can all be proud. Despite the cuts proposed for our specialty, the ACR will not engage in a battle with our fellow physicians in primary care for survival. We all recognize the value that our collaborative efforts bring to the continuum of care. That said, we will vigorously advocate for the role of radiologists in delivering this value. To use another Yogiism, "It ain't over til it's over."

Something that looked as if it might well be over earlier this summer was the Affordable Care Act. As we all waited with bated breath for the Supreme Court's decision, rumors and theories abounded. In a Dewey-defeats-Truman moment, both Fox News and CNN called it wrong. Moving forward from the decision to uphold the individual mandate, so many parallel efforts are ongoing to develop new payment models for both federally and privately insured consumers that the concepts of accountable care and value, rather than reimbursement based on volume, now seem to be truly baking into our health-care system. Your economics team is participating in a number of these efforts.

Our goal as your advocates is not only to ensure that the value of the contribution that radiologists make to the delivery of high quality and high-value care is fully recognized but also to make sure that you have the tools to navigate your way through these new payment models. The key to the ACR strategy is the concept that radiologists are the imaging experts, and through the use of decision support fuelled by the ACR's evidence-based Appropriateness Criteria®, we can deliver the highest quality and best value when it comes to imaging. Radiologists are integral to the care-delivery team. The one major change that the Supreme Court made to the president's Affordable Care Act has left states with the ability to decide whether or not to expand their Medicaid programs. Keeping up with the developments in the various Medicaid programs at the individual state level is challenging but vital to understand how our members are being affected. Our Medicaid Network, newly chaired by Ray Tu, MD, will be a valuable conduit for information that we will use to support your local efforts.

I'll close this month with one last gem from Yogi: "The future ain't what it used to be." These can seem like dark days for our specialty, and we are certainly challenged on a daily basis. However, the ACR Commission on Economics is committed to supporting you and making sure that your voice is heard.

As always, I would love to hear your feedback and invite you to email me at This email address is being protected from spambots. You need JavaScript enabled to view it..

Geraldine McGintyBy Geraldine B. McGinty, MD, MBA, Chair

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