RSNA and several other medical societies are calling for serious, national discussions on Medicare cuts planned for 2023, which the groups say are not sustainable and will negatively impact care.

“Once again, radiology is looking at disproportionate cuts for diagnostic, interventional and radiation oncology,” Gaines explained. “There are several components, [including] the RVU changes where radiology was negatively impacted.”

The Centers for Medicare and Medicaid Services (CMS) has a fixed amount of money in its budget, so if CMS wants to offer incentives to one area of medicine, money must be taken away from another in a sort of robbing Peter to pay Paul strategy. Gaines said CMS is trying to put more money into primary care because of the growing shortage of physicians in that field. However, the shift impacts radiology and other specialties in the form of lower reimbursements from the changes in relative value units (RVUs).

“You also have the sequestration cuts, which have been around for years but were suspended during COVID,” Gaines said, adding this amounts to a 2% cut for radiology. 

Another big impact on CMS payments is the PayGo cut, a federally mandated plan to make cuts elsewhere to balance the budget. Gaines said this reduction in reimbursements is paying for the American Rescue Plan during COVID. This amounts to a 4% hit in the 2023 fee schedule. 

Overall, depending on the subspecialty, CMS cuts amount to a 10 to 12% reduction in payments ins 2023. Gaines said this might be offset possibly by 3 to 4% with legislation pending in Congress in December 2022, but the net results even with Congressional relief would still be overall reduction in reimbursements. This would come, he points out, at a time when inflation and increased supply chain costs are impacting the bottom line in healthcare.

“There is a cost vs. quality equation, and the argument we have to have in Washington now is that the physician fee schedule does not have some component that captures inflation,” Gaines explained. “The Physician Fee Schedule in real dollar terms is down over 60% since its creation in 1992. It has never been indexed to inflation. That is the next bar for us to really try and go for in terms of advocacy.”

Further cuts will come in 2024 when the CMS quality payment program MIPS will be eliminated, Gaines said. 

He said CMS has been trying to convert the U.S. healthcare system from a fee-for-service model to alternative payment models that reward efficiency and outcomes rather than volumes of procedures and tests. MACRA was supposed to help move healthcare economics in that direction.

Gaines feels U.S. healthcare is no further along that path than it was 10 years ago.