Adjusting for inflation, diagnostic radiology absorbed a more than 44% Medicare reimbursement reduction across the 50 most common imaging exams, according to new research published Friday.
Only three services on the list saw pay increases between 2011-2021, including radiographs with varying views of the abdomen (up 2.5%), hip (3.3%) and femur (6%). Meanwhile, many others have sustained sizable drops, with ultrasound guidance for biopsy (down 75%), DEXA bone axial (66.2%) and MRI of the brain without contrast (64.1%) sustaining the biggest blows.
The numbers appear “troublesome” and offer strong evidence of the need for payment reform, researchers argued in Current Problems in Diagnostic Radiology.
“Diagnostic radiology has experienced significant reimbursement cuts over the past decade, most severely among cross-sectional modalities,” Derrek Schartz, MD, with the Department of Imaging Sciences at the University of Rochester Medical Center, and co-authors concluded. “This data further characterizes reimbursement trends for the field and suggests the need for sustainable future reimbursement schedules.”
Study authors gathered their global reimbursement data from the Centers for Medicare & Medicaid Services. They noted that the one increase in reimbursement for diagnostic radiology was recorded between 2016-2017 (0.2%). On the other side, 2013-2014 saw the steepest decline at 16%, while the overall annual percent change averaged about -5.5%. MRI experienced the biggest drop during the study period at 60.6% followed by reductions in CT (44.4%), ultrasound (31.3%) and radiographs (6.2%).
Average work relative value units also dropped 1.3% during the study period, falling from 0.79 to 0.78. About 68% of imaging exams experienced no change in wRVUS, nine had a reduction, and seven sustained increases. Maxillofacial CT without contrast dropped the most at -25% (1.14 to 0.85) and limited breast ultrasound increased the most at 26% (0.54 to 0.68).
“The relative stability of both wRVUs and [the conversion factor] has likely contributed to reimbursement not keeping up with inflation but may not fully explain the 44% overall reduction in adjusted reimbursement,” Schartz and co-authors wrote. “Other possible factors contributing to this decline include the technical component and geographic component, both of which could be investigated in future studies on reimbursement in radiology.”