Physician lawmakers introduce bipartisan fix for radiologist Medicare pay woes

Physicians in Congress on Wednesday introduced bipartisan legislation aimed at addressing radiologist pay challenges in the Medicare program. 

Members of the Democratic and GOP Doctors Caucuses are proposing the Patients First Act, bolstering incentives to save independent practices and “reversing decades of consolidation.” 

Backed by Reps. Kim Schrier, MD, D-Wash., John Joyce, MD, R-Pa., and Greg Murphy, MD, R-N.C., the bill would tie physician reimbursement to a measure of inflation. Their proposal comes the day after CMS released the 2027 Medicare fee schedule, which includes a more than 1% cut to the payment conversion factor. 

“Consolidation in our healthcare system is forcing small, independent physicians to sell their practices to corporate entities, decreasing choice and competition, and increasing costs for patients without delivering better quality,” Schrier said in a statement July 15. “This bill gives stability to independent practices, reduces red tape and burdensome paperwork, and invests in primary care.”

In addition, the legislation would establish a new primary care hybrid payment pilot program that would grant PCPs per-member, per-month reimbursement, “better capturing” their productivity. The Patients First Act also would create a physician-led task force at CMS to develop quality metrics that are “streamlined and reduce administrative burden” Plus, it would increase the budget neutrality threshold from $20 million to $54.3 million, among other changes. 

Lawmakers note that 70% of medical practices nationwide are now owned by hospitals or other corporations. About 1 in every 10 physicians works for UnitedHealth or an affiliate. Running an independent doc group is becoming increasingly difficult, forcing practices to close due to low Medicare reimbursement rates. 

“When physician practices are acquired, costs go up for patients,” the three lawmakers contend.

The proposal has drawn support from medical and business associations in imaging and other specialties. Linda Wilgus, co-executive director of the Radiology Business Management Association, said the legislation represents a “meaningful step toward restoring stability and predictability in Medicare physician payment.” This while “reducing unnecessary administrative burdens” in alternative payment models. 

“For radiology practices facing rising costs and ongoing reimbursement pressures, the move to an inflation-informed payment update, improvements to value-based care participation, and recognition of specialty-driven quality measures will help preserve patient access to high-quality imaging services in communities across the country,” Wilgus told Radiology Business. 

Lawmakers also have incorporated language relating to the stalled imaging appropriate use criteria program, which would require docs to consult decision support before ordering scans. Representatives want to modify data-collection requirements in the program, seeking to “reduce burdens and barriers.” AUC is an evidence-based tool that will help ensure that “only necessary advance imaging services are ordered for patients,” according to the proposal.

The American College of Radiology, a strong supporter of AUC, applauded these provisions on Wednesday. It notes that the previously proposed Radiology Outpatient Ordering Transmission (ROOT) Act is projected to save $2 billion for Medicare and $1.5 billion for its beneficiaries over the next decade.          

“Inclusion of the ROOT Act [in the new proposal] offers a practical path forward that can help improve access and ensure patients receive the most appropriate imaging exams while reducing unnecessary, low-value scans and associated costs,” ACR CEO Dana H. Smetherman, MD, MPH, MBA, said in a statement July 15.