Drastic reimbursement cuts for image-guided breast biopsies, and other medical imaging techniques in the 2014 Medicare Fee Schedule Final Rule, may further reduce women's access to mammography and other breast cancer services. The Centers for Medicare and Medicaid Services (CMS) directly cut imaging reimbursement every year since 2007. This, along with 12 Medicare imaging cuts in the last six years due to legislation, increasingly threatens patient care.
Repeated imaging cuts have reduced funding for many common exams up to 50 percent. This is forcing many facilities to close or cut services. According to the U.S. Food and Drug Administration, there are now roughly 150 fewer mammography facilities and nearly 600 fewer mammography units available than in 2007.*
"Targeting breast cancer procedures, along with other massive cuts, may result in reduced services or even facility closures, limiting access. Women may have to wait longer for mammograms or diagnostic evaluation. This may increase patient anxiety by resulting in a delay for those who need a biopsy to determine if they have breast cancer. Worse yet, it may delay subsequent treatment for those who do," said Barbara S. Monsees, M.D., FACR, chair of the American College of Radiology (ACR) Commission on Breast Imaging.
CMS used hospital-based computed tomography (CT) and magnetic resonance imaging (MRI) cost center data to calculate reimbursement for many exams included in the Hospital Outpatient Prospective Payment System (HOPPS). Although CMS excluded the use of half of the hospital data for four years where the "square footage" method of cost allocation was used, hospitals will still see cuts of up to 18 percent depending on the type of study. However, CMS' exclusion of the "square footage" data will avoid more drastic cuts to office-based imaging due to a combination of that data policy and imaging provisions in the Deficit Reduction Act of 2005.
"The ACR asked CMS to abandon the idea of using the CT and MR cost center data and instead to use its standard diagnostic cost center data in its calculations. CMS' attempt to instruct hospitals on how to correct this data is positive. The ACR will work with hospitals and CMS in the future to ensure costs are accurately allocated for CT and MRI. However, this policy must be corrected in the next four years or we will be facing significant access issues related to artificially inflated imaging cuts that providers simply can't absorb," said Geraldine B. McGinty, M.D., MBA, FACR, chair of the American College of Radiology Commission on Economics.
Imaging cuts are unnecessary and potentially dangerous. A Neiman Health Policy Institute report, study in the Journal of the American College of Radiology and Moran Company report show Medicare imaging use and costs are down significantly. Medicare imaging spending is the same as in 2003. Yet, cuts continue. This is not without consequences. A Neiman Institute report shows that length of hospital stay in the U.S. has increased, in nearly inverse proportion, to declining imaging use. Publicly available figures for the national average cost of a day in the hospital, and the number of Americans hospitalized each year, indicate the added cost to the system from this trend may be up to $21 billion per year. A 2011 Health Affairs study found that as many as 12,000 American seniors may have suffered broken bones due to Medicare cuts in reimbursement for imaging to gauge bone density (dual energy X-ray absorptiometry -- "DEXA").
"Sustained cuts to medical imaging and radiation oncology may halt or reverse gains against cancer and other serious illnesses. Congress must act to protect care that their constituents receive now, and protect and encourage future advancements that may otherwise be negatively impacted by these repeated cuts," said Paul H. Ellenbogen, M.D., FACR, chair of the American College of Radiology Board of Chancellors.
- David C. Levin, Vijay M. Rao, Laurence Parker, Andrea J. Frangos. The Sharp Reductions in Medicare Payments for Noninvasive Diagnostic Imaging in Recent Years: Will They Satisfy the Federal Policymakers? Journal of the American College of Radiology, 2012; 9 (9): 643 DOI: 10.1016/j.jacr.2012.05.004
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