Reduced reimbursement for imaging may negatively impact patient outcomes

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) has directly cut imaging reimbursement every year since 2007. This, along with 12 Medicare cuts in imaging reimbursements in the last 6 years due to legislation, increasingly threatens patient care.

Repeated cuts in reimbursement for imaging techniques have reduced funding for many common examinations up to 50%. This is forcing many facilities to close or to cut services. According to the US FDA, there are now roughly 150 fewer mammography facilities and nearly 600 fewer mammography units available than there were 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, MD, 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 examinations included in the Hospital Outpatient Prospective Payment System (HOPPS). Although CMS excluded the use of half of the hospital data for 4 years where the square-footage method of cost allocation was used, hospitals will still see cuts of up to 18% depending on the type of study.

“The ACR asked CMS to abandon the idea of using the CT and MRI cost center data and instead to use its standard diagnostic cost center data in its calculations. This policy must be corrected in the next 4 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, MD, MBA, FACR, chair of the ACR Commission on Economics.

Imaging cuts are unnecessary and potentially dangerous. Several recent studies indicate that 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 United States 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.

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