2021 Medicare policy changes dragged down radiologist pay, new study confirms

As members of the specialty feared, 2021 Medicare policy changes appear to have dragged down radiologist pay, according to a new study published Tuesday in JAMA [1].

The Centers for Medicare & Medicaid Services made the recent modifications in a bid to redistribute reimbursement from procedural specialists to primary care. Among nearly 181,000 physicians included in the study, repricing of 2020 Medicare services led to a 3.3% drop in reimbursement for the median radiologist (or about -$4,557), assuming year-over-year patient volumes stayed constant.

Meanwhile, family physicians saw the largest positive change at 11% (or $3,683). But the changes were not enough to meaningfully narrow the payment gap between PCPs and specialists, Hannah Neprash, PhD, with the University of Minnesota School of Public Health, and co-authors concluded.

“In part this is because many non-primary care specialties provided many E/M services and had opportunities to increase coding intensity,” the study noted. “Nevertheless, specialties that provided fewer E/M services, such as radiology and general surgery, did see payment declines.”

To reach their conclusions, Neprash et al. performed a retrospective, observational analysis of office-based physicians in specialties with 5,000 or more members billing Medicare. Those who met the study criteria also had 50 or more fee-for-service Medicare visits both before and after the E/M policy change. To ensure an apples-to-apples comparison, the team simulated payment amounts, assuming no changes in volume or service mix. Authors also analyzed the extent to which relaxing documentation rules possibly altered billing patterns across specialties.

Most physician specialists in the study absorbed an increase in total Medicare payments between the period before (July to December 2020) and following (July to December 2021) the E/M update. Family practitioners (12%) and otolaryngologists (9.9%) experienced the largest gains, while the median physicians in general surgery (-4.2%) or radiology (-2.1% or $1,927) recorded the largest drop. Almost every physician type in the analysis (including radiology) saw a concurrent increase in E/M coding intensity following the policy change, the authors noted. (However, the 25th percentile of radiologists billed 0% of their E/M visits at level 4 or 5, the highest intensity of services.)

“Nearly all specialties took advantage of the eased documentation requirements, billing more intense E/M services in 2021 compared with 2020,” Neprash et al. wrote. “While family practice specialists were in the top five specialties with large increases in coding intensity, coding intensity increased more for the median psychiatrist, orthopedic surgeon, urologist and otolaryngologist.”

The study occurred amid the COVID-19 pandemic and authors warned that the crisis may have impacted the data, and further research is needed to better understand the results.