Paltry Medicare pay fueling imaging access gaps, radiology experts charge
Inadequate payment updates under the Medicare Physician Fee Schedule are fueling challenges for seniors seeking medical imaging, radiology experts contend in new research.
The conversion factor, used to calculate doc payments, has dipped almost 15% since 2005, down to $32.35 as of last year. However, when factoring for inflation, this figure has actually fallen more than 48%, according to a new analysis from the Neiman Health Policy Institute.
“In real terms, clinicians are being paid about half as much for providing the same services today as they were paid in 2005,” Eric Christensen, PhD, lead author of the study and research director for the American College of Radiology-backed policy institute, said in a statement shared Monday.
This, of course, isn’t news to the imaging industry. However, Christensen and colleagues contend Medicare’s failure to keep pace with inflation is harming patients, too, alongside radiologists. For their new study, researchers utilized a nationally representative, 5% sample of fee-for-service Medicare claims, spanning 2005 to 2023, extrapolating the results for the full picture across the U.S. They examined inflation-adjusted decreases to the conversion factor, calculating how this impacted healthcare utilization for various socioeconomic groups across 4.7 million unique Medicare beneficiaries. Researchers statistically modeled whether declining doc payments were tied to access-to-care gaps between underserved and more advantaged communities.
| Year | Metro | Small/rural | Gap (PP) |
| 2005 | 61.54% | 62.87% | -1.34 |
| 2023 | 58.95% | 58.35% | 0.61 |
| Year | High income | Low income | Gap (PP) |
| 2005 | 61.91% | 58.29% | 3.61 |
| 2023 | 61.83% | 52.24% | 9.59 |
| Year | Best ADI quartile | Worst ADI quartile | Gap (PP) |
| 2005 | 59.09% | 61.80% | -2.71 |
| 2023 | 58.90% | 56.97% | 1.93 |
During the nearly 20-year study period, the inflation-adjusted conversion factor decrease was associated with widening healthcare-utilization gaps across all physician specialties examined. (Care utilization gaps were calculated as the difference in the percentage of beneficiaries with at least one healthcare claim from a physician or nurse practitioner in the noted specialties.) For radiology, those living in small or rural communities saw the gap in access to imaging widen nearly 2% between 2005 to 2023, when compared to their urban counterparts (-1.34% vs. 0.61%). Meanwhile, lower income communities saw the imaging access gap leap about 6% over the study period, compared to higher income areas (3.61% vs. 9.59%). And finally, those living in socioeconomically disadvantaged communities, as measured by Area Deprivation Index, saw the radiology access gap increase almost 5% compared to other more advantaged communities (-2.71% in 2003 vs. 1.93% in 2023). (A negative figure would indicate that the more deprived communities had greater access to imaging at the beginning of the study period, compared to their counterparts.)
“The findings suggest that Medicare reimbursement policy is not only a physician payment issue but also a patient access issue,” said study co-author Lauren Nicola, MD, CEO of Triad Radiology Associates, Winston Salem, North Carolina, and a member ACR Board of Chancellors. “As payment declines, underserved patients appear to bear a disproportionate share of the consequences.”
Nicola and colleagues contend these results underline the importance of viewing physician payment cuts through the eyes of patients. They’re using the results as further proof of the need to pass reforms that help support radiology practices struggling to break even on Medicare.
“Congress and CMS have policy options to help prevent further erosion of patient access, including indexing Medicare physician payment to inflation and updating outdated budget neutrality thresholds that have remained unchanged since 1992,” added co-author Greg Nicola, MD, board member of Hackensack Meridian Health Partners, Edison, New Jersey, and vice chair of the ACR board, noting that the $20 million threshold should be $47.3 million, if adjusting to today’s dollars.
You can read more about the results, including potential study limitations, in Inquiry: The Journal of Health Care Organization, Provision and Financing.
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.