New research explores the frequency in which CMS devalues radiology services
New research published Tuesday in JAMA Network Open explores the frequency in which the Centers for Medicare & Medicaid Services devalues care provided by radiologists.
To price imaging exams and interventional procedures under the physician fee schedule, CMS relies on recommendations from specialty societies such as the American College of Radiology. Such societies survey members, develop initial recommendations, and send them to the American Medical Association’s RVU Update Committee, which votes to accept or adjust before forwarding them to Medicare.
Researchers aimed to better understand how frequently CMS agrees with the influential, 32-member AMA committee. Their work spanned nearly 2,200 RUC recommendations for over 1,900 unique CPT codes. Based on 48 interventional radiology codes considered, CMS issued negative adjustments about 52% of the time, the study found. Meanwhile for 90 diagnostic radiology codes, CMS made negative adjustments about 28% of the time, compared to the radiology societies’ initial recommendations.
“Variation in valuation adjustment rates and amounts may reflect factors such as specialty society influence, valuation methods and negotiation strategies,” lead author Vinay K. Rathi, MD, MBA, an otolaryngologist and assistant professor at Ohio State University, and colleagues wrote Sept. 1. “When reducing valuations, CMS frequently cited site-of-service anomalies, clinical review findings, and identification of clinically similar procedures for crosswalk.”
The study examined all specialty society and RUC recommendations within the 2004 to 2025 editions of the Current Procedural Terminology code set. It excluded recommendations without all 3 valuations (specialty society, RUC and CMS), along with those unrelated to physician services or with code deletions. Society coalitions representing multiple specialties were classified into categories such as mixed procedural, mixed cognitive or mixed multispecialty.
According to their results, the RUC devalued services from the initial specialty society proposal about 29% of the time in interventional radiology and 12% in diagnostics. Meanwhile, CMS devalued RUC-proposed service valuations 33% of the time in IR and 24% for DR. For interventional rads, the median adjustment from the specialty society to the final CMS recommendation was about -5.6%, with a range of -0.7% to -14.7%. Diagnostic radiology saw a median per-service reduction from specialty society to CMS of -17%, with a range of -7.6% to -66.9%.
In a corresponding editorial, Mark D. Schwartz, MD, contended that the study’s principal contribution is to “replace assumptions with evidence.”
“Rathi et al. have provided an important empirical account of how physician work values are shaped before becoming Medicare policy,” Schwartz, with the Department of Population Health at NYU’s Grossman School of Medicine, wrote Sept. 1. “Their study reminds us that improving physician payment requires not only designing better payment models but also strengthening the evidence, institutions, and governance that determine what physician work is measured and, ultimately, what the healthcare system chooses to reward.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.