Medicare pay for most interventional radiology procedures has declined in recent years
Medicare reimbursement for most interventional radiology procedures decreased between 2007 to 2020, after adjusting for inflation, according to an analysis published Monday in the medical journal Cureus [1].
Vascular and emergency procedures were the two exceptions, recording adjusted payment increases during that time span. Biliary procedures, in particular, saw the largest average decrease in reimbursement rates at -$21.25, while vascular emergency treatments notched the biggest gain ($3.23).
Researchers involved in the analysis believe this information underlines the “critical need” for advocacy at a national level among IR professionals.
“Decreasing Medicare reimbursements across most procedural classes indicates a necessity for engagement in current and future congressional policy,” Soryan Kumar, an MD candidate with the Warren Alpert Medical School of Brown University, and co-authors wrote Aug. 21. “While physician and policymaker acknowledgment and understanding of these results are vital, their involvement in creating a sustainable reimbursement model to guarantee continued patient access to IR services must be an even higher priority,” they added later.
For the analysis, researchers selected common IR procedures across multiple classes, including gastrointestinal, urinary, fallopian dilatation, other injection/change/removal and iliac vascular, among others. They queried the Physician Fee Schedule Look-up Tool from CMS for current procedural terminology codes and adjusted figures for inflation using the consumer price index.
Out of the 69 procedures pinpointed in the analysis, 33 (or nearly 48%) experienced a CPT code change between 2007 to 2020. All procedures with reimbursement rate increases had a CPT code change during the study period, while nearly 37% of those with decreases did. Endovascular repair of infrarenal aorta had the largest increasing annual reimbursement rate ($58.06) during the study period, and placement of bile duct stent for existing access had the largest decreasing rate (-$43.78).
Both had branching CPT codes with large shifts in annual reimbursements. Biliary procedures encompassed many of the individual procedures with large annual drops, and those of the urinary variety contained eight of all increasing procedures, the analysis found.
“As CPT code replacements may not be perfect due to code branching, procedures with code changes were typically noted to have sudden changes in annual reimbursements at the year of the code change,” the authors wrote.
Kumar et al. noted that congressional policies likely played a part in declining reimbursements to interventional radiologists. In particular, the enactment of the Sustainable Growth Rate as part of the Balanced Budget Act of 1997 resulted in “significant reductions” in Medicare pay to physicians and hospitals prior to its repeal in 2015. Declining doc pay became “even more pronounced” by 2007, via reductions from the Deficit Reduction Omnibus Reconciliation Act.
“Further investigation is warranted to provide the foundation necessary to combat declining rates and sustain IR practices nationally as reimbursement decreases in specific procedural groups may impact the procedures that practices choose to conduct,” the authors noted in their conclusions.
The findings mirror another study published in 2022, which found that diagnostic radiology absorbed a more than 44% Medicare reimbursement reduction across the 50 most common exams, after adjusting for inflation.
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.