ACR Issues Its Formal Response to the Proposed 2013 Medicare Physician Fee Schedule

Reiterating its arguments from last year when the Centers for Medicare and Medicaid Services (CMS) first proposed a multiple procedure payment reduction (MPPR) on the professional component of imaging studies performed by physicians in the same group practice, the ACR pushed back hard against this idea in its formal written response to CMS this week. According to the ACR, there is little if any efficiency in two radiologists in the same practice reading images from a single patient taken in a single session because they are reading separate images, often of completely different portions of the patient’s anatomy. The ACR also argued that even if there were efficiencies, these would vary by procedure and setting and should be studied before an MPPR is set. Establishing an across-the-board MPPR percentage on the professional component of imaging studies would be arbitrary and not based on facts. The ACR also took issue with CMS’s contention that the “operational difficulties” in implementing the MPPR policy that led CMS to rescind the policy for 2012 have been resolved. With input from the Radiology Business Management Association (RBMA), it presented a list of five “not benign” operational problems that still existed. In addition to strongly opposing the MPPR, the ACR also commented on issues and concerns it had with several other proposed policy changes in the fee schedule. These included:

• Concerns that CMS’ proposed three levels of “sliding” interest rates from the Small Business Administration are overly complicated and do not concur with the stated intention to reflect the cost of capital set forth in the 1997 practice expense methodology.
• Problems with how CMS had identified potentially misvalued codes using information from online patient resources instead of its own well-established methodology for validating relative value units (RVUs).
• Concerns that CMS did not address narrowing the payment gap for radiology services provided in Puerto Rico.
• Concerns about potential fraud with expanding the types of providers who can order of portable X-rays.

In a separate letter, the ACR also commented on the proposed cuts to radiation oncology services reimbursement. These cuts are some of the steepest proposed in the fee schedule and, according to the ACR, would “represent a 15 percent reduction in overall payment and nearly a $300 million loss for cancer care services.” Read the 33-page ACR letter to CMS.