Beating Back the MPPR
A recent decision from Congress rolls back one of radiology’s most maligned reimbursement cuts.
We’ve faced arbitrary cuts to the reimbursement for imaging services in recent years, but none rankled quite as much as the multiple procedure payment reduction (MPPR) for the professional component (reimbursement for the interpretation of images).
As I write in December 2015, I am delighted to be able to share that the impact of this policy has been significantly mitigated starting in 2017. We’ve all learned valuable lessons during this process, which will help us in future legislative efforts. But first, a little history.
In the summer of 2011, CMS initially proposed a 50 percent reduction on the payment to a radiologist interpreting a second procedure on a single patient in the same session. The ACR immediately rallied to dispute this flawed policy. We started with a data-driven approach, combing the databases Medicare uses to develop payment policy to determine whether there were any grounds for such a policy.
In a paper published that summer, we demonstrated that the efficiencies CMS used to justify the policy, if they existed at all, were negligible. Many of you submitted comments to CMS and to your elected representatives, and the impact of the policy was mitigated somewhat when the reduction was set at 25 percent for the 2012 Medicare Physician Fee Schedule — not that we were happy to let that pass.
We commented robustly, and you all brought the story to your representatives on Hill Day in 2012 at the ACR annual meeting. We were not alone in opposing the policy: in June 2012 the AMA House of Delegates passed a unanimous resolution opposing it.
It goes without saying that, as physicians, we give each study we interpret for our patients 100 percent. For patients who present with complex trauma or extensive malignancy, the fact that there are multiple studies to interpret can actually multiply the intensity of the work. This reduction in reimbursement threatened our ability to deliver the high-quality, high-value care on which our patients depend.
To add insult to injury, CMS extended the policy across different radiologists in the same group for 2013. Again, an extensive review of the inputs used to develop Medicare payments did not support this. This issue remained at the top of the ACR’s economics agenda, so we were delighted when the Protecting Access to Medicare Act of 2014 mandated that if CMS would not consent to undo the MPPR, the agency at least had to justify its methodology for calculating the reduction.
But fast forward two rule-making cycles later, to 2015, and CMS had not done its homework and no justification of the reasons for imposing the MPPR had been published. Undaunted, our terrific ACR government relations team pursued every avenue to do away with this unjustified reduction. And as you saw on Dec. 18, both houses of Congress passed the Consolidated Appropriations Act of 2016, which the president signed into law, that included a rollback of the MPPR to 5 percent starting in January 2017.
What a great result for the efforts of our team, our members, our fellow physicians, and even our patients, many of whom spoke out on our behalf. It’s a testament to the effectiveness of organized medicine and specifically the unique voice of the ACR in representing radiologists and the patients we care for to policy-makers and Congress. We owe so much to ACR leaders like John A. Patti, MD, FACR, and Bibb Allen Jr., MD, FACR, who hustled us to generate the data needed to oppose the policy with peer-reviewed literature and who challenged us never to give up on this fight. It speaks to the relationship building that many of you have worked on with your elected representatives, amplified by the tireless ACR government relations team. It also highlights the fact that, as my colleague and our Economics Commission Vice Chair Ezequiel Silva III, MD, FACR, says, “Data prevails.” We didn’t just whine because our payments had been cut. We did our due diligence, demonstrated the lack of data behind CMS’ decision, asked and allowed time for CMS to respond, but eventually we had to pursue a rational, data-driven policy with Congress.
If you’re reading this, you’re probably a dedicated ACR member. But we know that not all radiologists understand the value of ACR membership. This story is a powerful reminder of why we are stronger together. Why not print this and pop it on the desk of any of your colleagues who need to get on board!
Learn more about the economics of radiology at ACR 2016. Dr. McGinty will be moderating the Economics Forum and presenting at multiple sessions around payment policy.