Key Medicare reimbursement and No Surprises Act updates from RSNA 2024
At the Radiological Society of North America 2024 annual meeting, Radiology Business spoke with Richard E. Heller III, MD, MBA—an RSNA board member, senior VP of policy, and national director of pediatric radiology at Rad Partners—who provided crucial updates on Medicare reimbursement changes and the ongoing impact of the No Surprises Act. These issues, central to the financial and operational dynamics of radiology practices, also were focal points in sessions at the conference.
Looming Medicare cuts and related legislative efforts
The Medicare Physician Fee Schedule remains a contentious issue, with a proposed 2.8% conversion factor cut set to take effect in 2025 if Congress does not intervene soon. This would result in radiologists being paid approximately $6 less per relative value unit (RVU) than in 2001, not accounting for inflation. Heller highlighted that radiology has not seen a positive update in Medicare impact tables for the past 15 years.
These continued cuts have been a big contributor to radiologist burnout, forcing some to retire early or leave clinical practice to work on the vendor side. Combined with a growing radiologist shortage, this has forced hiring managers to increase salary offers to attract existing radiologists away from their current jobs.
"Who's going to really be impacted by that ends up being communities that are rural and underserved that may not have the resources or the ability to keep pace with other communities. Radiologists are getting pulled away from these areas. So, I have concerns about access to care in rural and underserved communities," Heller explained.
Bipartisan House Bill 10073 offers a temporary solution, eliminating the 2.8% cut and providing a partial inflation adjustment for 2025. While this is a step forward, long-term reforms are necessary. The Senate Finance Committee also has acknowledged these challenges, suggesting interest in sustainable solutions, based on a white paper it released earlier this year.
NSA offers incentive for payers to push patients out of network
The No Surprises Act, which took effect in 2022, aims to shield patients from unexpected out-of-network medical bills. While the law has largely succeeded, its implementation has revealed flaws that disproportionately impact radiology.
Since insurance companies often pay lower amounts for out-of-network expenses and make the patient pick up the rest, insurance carriers have found pushing patients to out-of-network providers saves them money. Heller also noted that some insurance companies exploit loopholes in the NSA, such as “shared savings” programs, which incentivize forcing providers out-of-network to generate additional fees for the insurer to "manage" out-of-network care.
"If there's more care out-of-network, they can get extra fees from the so-called shared savings program, and that creates a financial incentive for them to divert specialties out of network so they can access these fees," Heller explained.
He was one of the authors of a recent article in Health Affairs that explained this issue. There also was a series of articles written by the New York Times that exposed more details around the issue of shared savings.
This dynamic has undermined fair negotiations between providers and insurers, and Heller believes there is a need for regulatory adjustments to address the problem.
Bill would force insurers to pay when they lose in arbitration
Another issue radiologists should watch is the bipartisan House Bill 9572, which seeks to address problems with insurance companies not paying physicians, even when required to do so after arbitration. The legislation would enforce penalties on insurers who fail to pay arbitration awards within the required 30-day timeframe, ensuring accountability and compliance with the existing law, Heller noted.
"All it says is: 'Insurance companies, if you go to arbitration and you lose, you actually have to pay,'" Heller explained. "If you don't, there's going to be financial penalties, which I think we would all agree is reasonable. All it's saying is just follow the law," he added later.
Access to care and workforce challenges
Heller emphasized the broader implications of these policies.
“Radiology is at the nexus of healthcare—nearly every hospital visit involves imaging,” he explained. If reimbursement continues to decline and workforce shortages worsen, access to essential imaging services could be jeopardized, especially in rural and underserved communities.
Capacity challenges were a recurring theme at RSNA 2024, with many attendees noting difficulties in recruiting radiologists. Over 60 healthcare systems, including rural providers, recruited at the conference, with some reporting vacancies unfilled for over 18 months.
"The biggest things that I hear talked about at this RSNA 2024, you would think AI is No. 1, but I'm going to put AI as No. 2. Capacity issues are the No. 1. When I talk to colleagues around the country, everyone's interested in AI, but they're also asking, 'Hey, do you know anybody who's looking for a job? Do you know anybody who's interested?' Everybody's trying to find somebody," Heller said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com