Putting US radiology reimbursement cuts in context and what comes next
Radiology is seeing rising demand for its services, but there is a capacity limitation with the number of radiologists available coupled with a growing physician shortage. This is being exacerbated by downward pressure on reimbursements and occurring during a period of inflation and rising costs. Radiology is now looking at a 3.4% cut in Medicare payments in 2024. These issues were all seen as major concerns at the Radiological Society of North America's 2023 annual meeting.
"We are calling this a perfect storm because it is all coming together at the right time to hit us when we have all this volume and we are struggling with these capacity challenges, downward reimbursements and while inflation is going up," said Richard Heller, MD, RSNA Board member, associate chief medical officer for health policy and communications, and national director of pediatric radiology at Radiology Partners. He spoke in sessions at RSNA on the Centers for Medicare and Medicaid Services cuts.
"We looked at the Medicare 2024 Physician Fee Schedule and it is almost like the movie 'Groundhog Day,' where every year we are reliving the same thing, year after year, and waiting to see how much they are going to cut radiology. We went and looked at the impact table, which CMS puts out every year. Some years you should be in the plus column and some years you should be in the minus column. We went back and looked at diagnostic radiology for the past 15 years, and how many times were we in the plus column? Not once. So what we see are constant reductions for radiology. I think we would all agree that radiology is something that we should be investing in," Heller said.
The specialty that is getting cut the most in 2024 is interventional radiology, with a 4% pay reduction. Heller said this a paradox because IR is one of the areas of medicine that focuses on minimally invasive, cost effective treatments for patients.
"It has a 4% cut, and that is the most of any speciality in the whole House of Medicine. This is a speciality that offers minimally invasive procedures, that offers more cost-effective outcomes, and cutting that speciality seems like the wrong way to be focusing on value," Heller said.
Another slap in the face to radiology, he described, is the conversion factor used by CMS to calculate payments, which is lower in 2024 than it was 30 years ago.
"The actual number CMS plans to use to pay doctors, unless Congress intervenes, is lower that what they used in 1994," Heller said.
This is compounded by the fact that CMS does not have a provision for inflation-based rate increases in physician payments, either. Hospitals do receive an inflationary update, and next year this should help to offset rising costs. But this is not the case with physicians, underlining the inequities within the CMS system.
"They went to physicians and said, 'You are going to experience 3.8% inflation in 2023; however, we are going to reduce your reimbursements 4.5% to not offset the inflation, but to exaggerate it and make it worse,'" Heller said.
Radiology ended up not sustaining a 4.5% cut in 2023 because of advocacy efforts by the American College of Radiology and other imaging groups. Congress reduced this to just a 2% cut, but Heller noted that this was still a reimbursement reduction following years of the same for the specialty.
ACR calls members to action
ACR is asking members to take action by calling or sending a letter to their congressional lawmakers to explain the CMS reimbursement issue and concerns that physicians may be forced to stop accepting Medicare patients.
Heller said the ACR website has a page where members can log in, type up their information and it auto-populates a letter to their members of Congress. Read more on the ACR call to action.
When should radiologists stop accepting Medicare patients?
Heller, radiology groups and other medical societies all assert that future access to care for Medicare patients is at stake. He said the factors outlined above impact not only revenue for radiologists and radiology departments, but will at some point impact their ability to care for Medicare patients.
"We are already seeing it now with patients [who aren't] getting access to interventional radiology," He said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com