2014 MPFS Includes Additional Imaging Cuts and Makes SGR Threat Real

The final 2014 Medicare Physician Fee Schedule (MPFS) released by the Centers for Medicare & Medicaid Services (CMS) includes particularly harsh news for providers of image-guided breast biopsies. In setting relative value unit (RVU) assignments for several new Current Procedural Terminology (CPT) codes for breast biopsy procedures, CMS elected to reduce physician work values for the new breast biopsy codes by 29 to 54 percent. According to an ACR statement posted online the day the 2014 MPFS was released, such a deep cut coupled with the many other cuts to medical imaging over the years could lead to patient access problems in the future as fewer providers opt to make the investments necessary to offer this service to women. "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,” stated Barbara S. Monsees, M.D., FACR, chair of the ACR Commission on Breast Imaging in the statement. In addition, the ACR predicted that not counting the application of the sustainable growth rate (SGR) formula to reimbursement under the MPFS, radiologists would see an overall reduction of 2 percent. Assuming the SGR is applied, as mandated by law, on January 1, the cut would be around 24 percent. “The clock is ticking," warmed the American Medical Association (AMA) in its statement about the 2014 MPFS final rule. Although Congress has passed temporary fixes to the SGR nearly annually since the flawed physician payment formula became law in 1997, the AMA is pushing for getting rid of the formula once and for all. Because Medicare utilization actually declined for the first time in decades last year, the Congressional Budget Office revised its estimate of what a permanent SGR repeal would cost downward, and the AMA is urging legislators to grab this discount price while it lasts. "The timing is right: repealing the SGR formula this year and paving the way for a more stable and innovative Medicare program would cost half as much as last year’s projection," it reminded legislators and the public in its statement.However, with less than a month to go for Congress to pass an SGR temporary fix or a permanent repeal, the SGR bills under consideration in the House and Senate still do not include details on where the money to implement them will come from. A small silver lining for radiology is that at least the 2014 MPFS does not include further multiple procedure payment reductions (MPPR), which CMS administrators had hinted it might. Also, interventional radiologists and radiation oncologists may be relieved to find that the final MPFS rule did not include an earlier proposal to cap payments by changing the practice expense methodology to use the current year Hospital Outpatient Prospective Payment System (HOPPS) or ambulatory surgical center (ASC) rates as a point of comparison in establishing practice expense relative value units (RVUs) for medicare physicians, the ACR noted. This would have meant significant payment reductions for these specialists. Because the 2014 MPFS final rule was delayed due to the government shutdown, CMS is accepting comments on the rule until January 27, 2014.