Reimbursement cuts to radiologists

[deleted263296]

http://www.ama-assn.org/amednews/2011/06/27/gvl10627.htm

Some of the ideas are pretty reasonable I think.

"MedPAC recommended that Congress reduce the professional component for multiple imaging tests performed on the same patient during the same session. Under such a policy change, physicians would be paid a reduced rate for interpreting the second scan and subsequent scans."

I'm not sure about this one, actually, since I am not in residency yet and I am unsure what serial scans refers to (like serial CXRs or reduce reimbursement for reading a MRI on a patient who initially received a CT?). My impression is this cut is to reduce reimbursement because it assumes that radiologists would need to spend less time reading the medical chart since they will be interpreting a film on the same patient.


"MedPAC also recommended that Congress reduce the physician work component for diagnostic imaging that is ordered and interpreted by the same physician, another change that would lead to lower payment rates."

I think that applies more to non-radiologists who interpret their own scans but also have a radiologist interpret it.

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[cowme]

I don't really see the first change really doing Much to curb imaging. The ordering physician won't stop ordering repeat scans just because the radiologist isn't making the same money for reads. If they are worried their patient is hemorrhaging into his brain because of heparin, I think they are sill gonna order that second head ct.

 

[DrBowtie]

"The suggestions are part of a continuing conversation by MedPAC commissioners about rebalancing Medicare payment toward cognitive services and primary care and away from procedural services, said MedPAC Executive Director Mark Miller, PhD. Commissioners continue to believe that fees for some services are overvalued."

A) I'm glad we have a PhD running this show.
B) I guess they don't think radiology is cognitive.

 

[colbgw02]

http://www.ama-assn.org/amednews/2011/06/27/gvl10627.htm

Some of the ideas are pretty reasonable I think.

"MedPAC recommended that Congress reduce the professional component for multiple imaging tests performed on the same patient during the same session. Under such a policy change, physicians would be paid a reduced rate for interpreting the second scan and subsequent scans."

I'm not sure about this one, actually, since I am not in residency yet and I am unsure what serial scans refers to (like serial CXRs or reduce reimbursement for reading a MRI on a patient who initially received a CT?). My impression is this cut is to reduce reimbursement because it assumes that radiologists would need to spend less time reading the medical chart since they will be interpreting a film on the same patient.


"MedPAC also recommended that Congress reduce the physician work component for diagnostic imaging that is ordered and interpreted by the same physician, another change that would lead to lower payment rates."

I think that applies more to non-radiologists who interpret their own scans but also have a radiologist interpret it.

I'm pretty sure only one can only bill for the professional fee once per study, which is what I assume they're referring to when they say "physician work component". That particular provision is squarely aimed at self-referral (hello cardiology).

I can see both sides of the first proposal. If an ICH patient is getting BID head CTs, assuming an absence of new pathology, it takes relatively less effort to interpret the subsequent studies.

What I worry about are patients whose initial imaging study has little to nothing to do with their eventual diagnosis. For example, let's say the ED physician orders a CT to rule out pulmonary embolism, because - you know - the patient's d-dimer is elevated. Eventually the surgeon gets consulted, who figures out that it's the gallbladder. A RUQ US is ordered, confirming the diagnosis. The guy is 95 years old, and the surgeon doesn't want to operate unless he has to, so a hepatobiliary scan is done, which is again positive. The surgeon operates, only to find persisent post-op fevers. A rule-out abscess CT is ordered. How many of these studies are considered "subsequent" to the inital examination?