Update: Penalties just months away for outdated CT technology

Providers are just eight months away from facing 5% penalties from Medicare for exams acquired with outdated CT technology. Over a year after the policy was first announced, manufacturers and providers are running out of time to get everything in order.

Beginning in January 2016, any exam acquired with a CT system that does not meet the XR-29-2013 standard, also known as MITA Smart Dose, will be hit with a 5% penalty. In 2017, that penalty jumps to 15%. XR-29-2013 was published by the National Electrical Manufacturers Association’s Medical Imaging & Technology Alliance (MITA) in 2013, and is considered the industry standard for CT technology.

The penalties became official when President Obama signed H.R. 4302, the Protecting Access to Medicare Act of 2014 into law in April of last year. That law may be more famously remembered as the final “Doc Fix” bill before Medicare’s Sustainable Growth Rate was repealed, but this policy has also proven to be impactful.

There have been no updates from CMS since the policy was announced over a year ago, something that may be giving some providers a false sense of confidence that the penalties will be forgotten or removed, according to Jakub Mochon, Siemens Healthcare’s director of marketing and operations for CT.

“A lot of customers actually translate silence into, ‘Oh, it’s going to go away, they’re going to repeal it’ or, ‘That’s not going to be implemented’,” Mochon told RadiologyBusiness.com in a phone interview. “The legislation...is in place, and...right now, they’re probably working hard on figuring out how to [implement].”

A CMS official and Thad Flood, MITA industry director, both told RadiologyBusiness.com that there are presently no new updates to the policy. “CMS is currently drafting the payment rule and intends to accurately implement Congressional intent,” Flood said.

Getting up to speed

Mochon said Siemens is investing a lot of time and energy to get its CT systems updated, even though many of their newest scanners already met XR-29 when they were released.

“This year, we’re upgrading up to 300 scanners a month to meet XR-29 requirements,” he said. “And that’s a huge impact on the servers in our organization.”

Mochon projected that Siemens will update approximately 2,000 CT systems by the end of the year, and the upgrade—which is software-based in most cases—can take 5-8 hours. Siemens is providing the upgrade to customers at no cost, and if a service contract through Siemens is still in place, it will also be installed at no cost.

Mochon estimates that about 90% of the Siemens CT systems currently in the marketplace can be upgraded in this way. The others, he said, may require a minor hardware upgrade or need to be completely replaced.

Of course, Mochon said, this policy creates work for more people than just the manufacturers.

“Ultimately, there’s going to be a lot of administrative work on providers,” he said. “Especially when you have a mix of scanners that meet the requirement and some that don’t meet the requirement. You have to be able to have noticeable procedures in place that appropriately bill Medicare."

Mochon praised legislators for setting a high bar by choosing XR-29 as the standard for CT technology. But manufacturers had as little notice as did providers that this would soon become public policy in the U.S.

“To some extent, we learned about the inclusion of this XR-29 element in the legislation almost at the same time that the general public learned about it,” Mochon said. “The only reason why this was sufficient time for us to react is that we were aware of the XR-29 standard, and this was something we were implementing anyway in our scanners. That’s why I appreciate that the legislators used the industry standard as part of this legislation, because they could have used something else that would have been much harder for everyone to implement.”

Flood said it made sense for legislators to go with MITA’s recommendation of XR-29, because it’s a reasonable update instead of a radical shift that caused manufacturers and providers to panic or start from scratch.

“XR-29 represents essential technologies for radiation dose reduction and management, upon which future advancements will be built,” Flood said. “These attributes are established modern technologies which represent the current state-of-the-art. The intent was to define a level of technological capability to which all patients should have access, not to advance or adopt a ‘new’ technology.”

The deadline before the deadline

The 5% penalties begin in January, but manufacturers have another deadline to focus on: July 2015, when MITA expects vendors to provide certificates for each scanner, indicating full compliance.

“The manufacturers will provide a certificate with every new piece of equipment they sell,” Flood said. “They will also provide certificates for equipment in the install base which meet XR-29 or has been upgraded to comply. The certificates identify a specific CT machine based on a unique identifier.”

Flood also said many manufacturers have set up web portals, allowing customers to see if their CT system is fully up to date. For example, Mochon said Siemens has set up such a website.  

Users should contact their manufacturer directly if they are unsure how their vendor is making certificates available, Flood said.

Though the new policy isn’t live yet, it’s never too early to wonder when the next round of government-required updates might come into play.

Mochon said he anticipates that updated CT technology requirements may get more common as the healthcare sector moves from focusing on quantity to focusing on quality of care.

“As we make the dramatic shift toward quality, I think there are going to be more standards like this,” Mochon said. “We [at Siemens] just assume there will be more changes like this one.”

Flood said MITA has no current plans to upgrade XR-29, but that MITA standards have a five-year stability date from the time they are published. So in 2018, XR-29 will be up for review, and it will be either reaffirmed, updated or replaced. If XR-29 does get replaced in 2018, and the timeline stays roughly the same next time around, Medicare penalties for out-of-date CT technology could reappear around 2020 or 2021.