Three of the biggest names in the specialty are urging the Centers for Medicare & Medicaid Services to address what they say are “systemic threats” to imaging services. They may have a powerful advocate in their corner, after MedPAC recommended a pay hike for physicians on Wednesday, a move that drew praise from the nation’s largest physician association.

Radiology Partners, RadNet and Rayus Radiology made their case in a March 13 letter to the head of CMS. They highlighted a more than 2% reimbursement reduction in the 2023 Medicare Physician Fee Schedule, after Congress took action to avert an even larger cut coming into this year.

The three radiology providers—along with six other co-signatories, including the Radiology Business Management Association—also highlighted an early 2022 economic analysis tied to the specialty. The study found that diagnostic radiology has absorbed a more than 44% Medicare reimbursement reduction across the 50 most common exams between 2011-2021, after adjusting for inflation.

“Temporary relief is welcome but fails to adequately address the serious financial pressures of sustained high inflation, escalating supply costs, a dwindling workforce and the ongoing economic effects of the COVID-19 pandemic,” the organizations wrote to CMS chief Chiquita Brooks-LaSure on Monday. “Without adequate reimbursement, imaging practices will not be able to invest in new technologies, maintain existing technologies or meet challenges such as new cybersecurity requirements,” they added later. “This will be especially true in underserved communities such as rural areas and inner cities.”

Meanwhile, the Medicare Payment Advisory Commission released its latest report to Congress on March 15, recommending a positive payment update for physicians paid under the fee schedule. It noted that 2021 per-beneficiary spending on imaging and other procedures was lower than 2019 levels, while evaluation and management services saw an increase. They’re recommending a pay increase tied to 50% of the Medicare Economic Index, citing some of the same pressures highlighted by the three radiology groups.

“Given the recent growth in inflation, cost increases could be difficult for clinicians to absorb,” the MedPAC report noted. “However, current payments to clinicians appear adequate on the basis of our indicators.”

This would be the first time MedPAC has called for a physician pay update tied to the index, the American Medical Association noted on Wednesday. The AMA said it has “long championed” such a change and called this a “critical first step” toward beginning to reform Medicare. However, AMA believes that a change tied to just 50% of the Medicare Economic Index will cause “physician payment to chronically fall even further behind increases in the cost of providing care.”

Echoing the concerns from the letter penned by Rad Partners et al., AMA and 134 other organizations—including the American College of Radiology and Society of Interventional Radiology—wrote to leaders of the House and Senate asking for reform on Wednesday. Docs are one of the only Medicare providers without an inflationary payment update, they noted, and when adjusting for such economic pressures, doc pay in the federal program fell 26% between 2001 and 2023.

“These increasingly thin or negative operating margins disproportionately affect small, independent, and rural physician practices, as well as those treating low-income or other historically minoritized or marginalized patient communities,” AMA President Jack Resneck Jr., MD, said in a statement announcing the letter to Congress. “Our workforce is at risk just when the health of the nation depends on preserving access to care.”

Back in August 2020, consultancy Merritt Hawkins estimated that 16,000 physician practices had closed due to the effects of COVID-19, with another 8,000 to follow during the next year. California-based Yuba City Advanced Imaging Center recently highlighted this data in announcing its own closure after more than 16 years in business, calling itself “one of the 16,000.” Radiologist, owner and CEO Nancy Chege, MD, cited rising costs, inflation, service disruptions and a “broken” insurance system as factors influencing the decision.

“When reimbursement doesn’t cover the cost to provide services, no practice can stay alive,” she said.