The impact of Medicare payment cuts on radiology and patient care access
Radiology faces unprecedented challenges due to imminent Medicare payment cuts in the 2024 Physician Fee Schedule. Cuts to reimbursements have already impacted radiologists with burnout, deciding to retire or leave clinical practice, which has increased the pace of staffing shortages. The radiologist shortage was one of the top concerns expressed across sessions, vendor booth visits and interviews during the Radiological Society of North American 2023 meeting.
Radiology Business Management Association President Kit Crancer, who is also executive director of the Rayus Quality Institute, spoke with Radiology Business on these issues at RSNA. He explained the gravity of these impending cuts and their potential ramifications for patient access.
"The Medicare Physician Fee Schedule has significant cuts to diagnostic and interventional radiology," Crancer said. "We've had this chronic cycle that we've been in where we've looked at these reimbursement cuts for the better part of the decade. We're looking at, at least, a 4% cut to the majority of providers, some more depending upon modality mix. The RBMA is advocating for congressional intervention to try and blunt some of these cuts in order that we don't have significant access to care issues down the line for Medicare patients."
The Centers for Medicare and Medicaid Services' budget is limited by a rule made by Congress that requires CMS to maintain a balanced budget, despite rising patient volumes and increasing costs. This clause necessitates reimbursement cuts to physicians to ensure the budget remains neutral in expenses. Crancer said, when more patients access care or CMS grants higher payments for another speciality or technology, budget neutrality necessitates cuts to other physicians.
Medical societies have warned for years that at some point reimbursement cuts will reach a tipping point where it is no longer economical to provide services to Medicare patients. Radiology Business asked Crancer how close we are to that point.
"I think we're there. We need some accountability when it comes to cutting Medicare. And the fact is a reimbursement cut to a radiologist, a reimbursement cut to a physician, is a cut to a Medicare beneficiary," he said.
Years of lobbying by more than 100 medical societies have failed to motivate Congress to do anything about the annual CMS cuts. So the RBMA, along with Rayus and several other provider groups, started the Radiology Patient Action Network in an attempt to give patients a voice in the conversation with Congress.
"Policymakers do react when it becomes a patient access issue or when it becomes a patient quality issue," Crancer said. "So, we started the Radiology Patient Action Network to try and really bring some of those patient issues to light. We started running polls. We just asked Americans how they feel when it comes to significant cuts to their services. They agree: A cut to their physicians, a cut to their benefits is a cut to Medicare. So, getting that issue across to policymakers has been a top priority from the RBMA, but we have a long ways to go."
He emphasized the detrimental effects already witnessed with patients having to travel farther for care, longer wait times, and the potential abandonment of prescribed treatments due to access hurdles.
"There is a real possibility of clinics and hospitals refusing Medicare patients service due to these cuts. This predicament could trigger further consolidation within hospital systems, reducing patient options and potentially exacerbating healthcare disparities," Crancer said.
Care may be delayed with growing shortage of radiologists and technologists
Beyond reimbursement concerns, the looming shortage of radiologists exacerbates the crisis, he explained. There are not enough graduating radiologists or residency positions to meet increasing demands for care. That also creates concerns about access, especially in rural areas. Crancer underlined the need for stability in reimbursement rates and calls for improvements in Medicare physician fee schedules to sustain an independent provider base and preserve access.
The shortage has led to higher salaries being offered to fill open radiology positions. If compensation is much higher than what a radiologists is already earning, especially if being offered the perk of working from home, many will make the transition. This is creating a bigger radiologist shortage in rural areas, Crancer said.
"We have seen Congress, this administration and previous administrations really focused on health equity. Well, the fact is, if you're looking at cutting these safety net programs like Medicare and Medicaid, which has its rates tied to the Medicare Physician Fee Schedule, you have a trickle down effect that really exacerbates some of those health disparities that Congress and other policymakers have ostensibly stated that they've looked to close over the past decade," he said.
The shortage of staff also extends to technologists, necessitating concerted efforts to attract and retain individuals in this field.
"That is why we have seen scope-of-practice expansion," Crancer said. "I think that's one of the reasons why when we turn around there is artificial intelligence everywhere. Everyone is looking for what can they do with the current radiologist that they may have within their practice in order that they're able to continue seeing patients and not have a significant backlog of cases. So, I think everyone is grappling with that."
In response to these challenges, the RBMA is exploring several strategies. These include advocating for legislative changes, expanding residency slots and addressing technologist shortages. Crancer said leveraging technological advancements like AI to optimize existing resources appears to have a really good business case in the current staffing shortage climate if it can improve efficiency and workflows.
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