Final Medicare Fee Schedule Includes MPPR Cut

Despite vigorous lobbying efforts, the 2013 Medicare Fee Schedule Final Rule includes the 25% multiple procedure payment reduction (MPPR). The MPPR applies to interpretations of multiple body parts on the same patient, on the same day. “CMS continues to show that they have no real understanding of how subspecialized radiology care is delivered in the United States,” laments Cynthia Moran, assistant executive director, American College of Radiology (ACR). “We talked to them until we were blue in the face.” While disappointing, MPPR’s inclusion was not a surprise. Instead, Moran saw yesterday’s rule as part of a continuing policy by CMS to redistribute income from specialties to primary care. “They have whetted their appetite on diagnostic imaging services,” she says. “This is not the beginning of the trend, and it is far from the end. It is very frustrating for most specialties. This is part of a significant policy change that came with the passage of the Affordable Care Act in 2010.” Moran sees “zero hope” in changing CMS’ mind via the rule’s 60-day comment period. Instead, she says it’s time to capitalize on the broad-based support of HR 3269. The familiar bill to stop CMS from implementing MPPR policy has 270 members of the House signed on as cosponsors. Along with additional support for the bill in the Senate, the ACR received welcome backing from the American Medical Association (AMA) earlier this year when the influential group passed a resolution denouncing MPPR. For ACR officials, it all adds up to what they hope will be a victory during the brief lame-duck session following the election. “There are many unresolved issues that they must deal with before Jan 1,” says Moran. “We would hope that on that long list of to-dos, they can somehow add our MPPR legislation to a legislative vehicle that passes both Houses of Congress—and gets signed into law by the President.” ACR officials called imaging cuts in the final rule potentially dangerous, unfounded, and unnecessary. “These cuts primarily affect care for people with immediately life threatening illnesses or injuries—those suffering from multiple trauma or heart attacks, stroke patients and people fighting cancer—all of whom often need multiple imaging exams to survive,” said Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors, via press release. “Interpretation of these scans many times requires expertise of different physicians. These cuts discourage doctors from working as a team, which is the direction that health care is supposed to be going, and pull the rug out from under physicians working to save these people's lives.”