AMA working with radiology groups to fix flawed approach that’s driving Medicare payment decisions

The American Medical Association is working with several radiology societies on a study to help fix the flawed approach that is driving federal payment decisions.

The Medicare Physician Fee Schedule—also used by other commercial payers—utilizes 2006 cost information to develop practice expense relative values and resulting reimbursements. But this outdated information is leading to payment calculations that do not reflect today’s financial realities, the American College of Radiology reported.

AMA is now working with 173 healthcare organizations on a new Physician Practice Information Survey aimed at updating this information and creating an accurate representation of medical groups’ cost of doing business.

“Practice expense payments no longer accurately reflect the relative resources that are typically required to provide physician services, as the U.S. economy and healthcare system have undergone substantial changes since that time, including inflation and the widespread adoption of electronic health records and other information technology systems,” ACR said in a July 12 news update.

AMA has contracted with research and data analytics consultancy Mathematica, which planned to begin pretesting the survey across 10 practices in May and June. It is slated to formally begin the survey this month, with data gathering occurring through April 2024, according to an information sheet from the association.

Mathematica is shooting for a sample size of 10,800 practices representing over 90,000 physicians, along with other qualified health professionals. It’s using several data sets to help pinpoint a representative mix of practices at the specialty level, along with varying sizes, ownership arrangements and sites of service.

AMA said it plans to share the data with CMS for use in calculating the Medicare Economic Index and the Resource Based Relative Value Scale. Survey data will be reported at the aggregate and specialty level, with no individual practice-level data shared with the public, those involved noted.

“One of the recurring comments that we hear from physicians is that decision-makers and payers are not fully informed about the broad clinical, operational and financial challenges that their practices face,” the AMA said in a letter signed by numerous state and medical societies. “This study represents your opportunity to communicate accurate financial and operational information to policymakers, including members of Congress and the Centers for Medicare & Medicaid Services.”

Along with ACR, those signing the letter include the American Society of Neuroimaging, the American Society of Neuroradiology, the Association of University Radiologists, RSNA, the Radiology Business Management Association, the Society of Interventional Radiology, and the Society of Nuclear Medicine and Molecular Imaging. The college urged those contacted by Mathematica to take, highlighting direct patient care hours as a crucial component of Medicare payment methodology.

“The input from physician practices and individual physicians that are randomly selected to participate in this study is critical for its success. Participation will ensure that practice expenses and patient care hours are accurately reflected,” ACR said in its news update.