By Cristen Bolan, Executive Editor of Applied Radiology
There is no such thing as a free lunch—in the end someone
has to foot the bill. So, here’s my question:
Who got pushed off the fiscal cliff?
A. The Hospitals
B. The Doctors
C. The Patients
Well, lets look at the facts:
The American Taxpayer Relief Act of 2012 passed on January 1,
2013. The law includes the “doc fix” designed to prevent steep cuts in Medicare
reimbursements to doctors.1 While the "doc fix" aims to avert a 27% pay cut slated to hit doctors due to the sustainable
growth rate, the $30 billion price tag is offset in the bill by
cuts in reimbursement to other Medicare providers over the next 10 years,2 and hospitals will pickup nearly 50% of the tab.2 Sounds like
paying Peter to save “fiscal cliff” Paul.
So, the answer is A. The hospitals.
Well, the plot thickens. When we say hospitals, it means the “doc fix” also hits up
radiological services to foot the bill. It does this by increasing the technical component
(TC) equipment utilization threshold for advanced imaging modalities from the
current 75% to 90% beginning January 2014.2 This aims to save
Medicare $800 million over the next 10 years.
The law also slashes Medicare payments for radiation
oncology over 10 years, with a 19% cut to freestanding therapy centers and $300
million in reduced funding to treat cancer.
Don't forget, the ACR put up a good fight. It tried to prevent the TC
payment decreases and advocated for the inclusion of the H.R. 3269/S. 2347, the Diagnostic Imaging
Services Access Protection Act, in the final legislative package.
The H.R. 3269/S. 2347 was created to prevent Medicare from implementing a 25%
reduction to the professional component of certain diagnostic imaging services
for multiple imaging studies administered to the same patient, by physicians in
the same practice setting, on the same day.3
But in the end, someone had to pay.
Here is the break down:
Hospitals Cuts4
• IPPS Documentation and Coding Adjustments for
Implementation of MS-DRGs: This provision phases in the recoupment of
past overpayments to hospitals made as a result of the transition to Medicare
Severity Diagnosis Related Groups (MS-DRGs). Savings: $10.5 billion
• Certain Radiology Services Payments: This provision
equalizes reimbursement for stereotactic radiosurgery services provided on
under Medicare hospital outpatient payment system. Savings: $40 million
• Adjustment of Equipment Utilization Rate for Advanced Imaging Services:
This provision would increase the utilization factor used in the setting of
payment for imaging services in Medicare from 75 percent to 90 percent. Savings: $80
million
So, it is the docs?
Here's
one more hint: The “doc fix” will impact severe trauma patients or those
with cancer and other illnesses, which require multiple imaging procedures.3 “Reverting
to continuous provider cuts to help pay for a morbidly flawed payment policy…
is a disservice to our nation’s seniors," Paul Ellenbogen, MD, FACR, the ACR Board of
Chancellors Chair noted.4
So what is the answer?
Answer:
D. All of the above
References:
1._Medicare. The New York Times. http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier.
Posted January 2, 2013. Accessed January 8, 2013.
2._Solana K. A Look at
Medicare Costs and Cuts in the Fiscal Cliff Deal. The Medicare
Newsgroup. http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/01/02/a-look-at-medicare-costs-and-cuts-in-the-fiscal-cliff-deal.
Posted January 2, 2013. Accessed January 8, 2013.
3._ACR Update on Diagnostic
Imaging Services Access Protection Act Bills in Congress. Society for Vascular Ultrasound.
http://www.svunet.org/i4a/pages/index.cfm?pageID=3958Posted July 2012. Accessed
January 8, 2013.
4._ACR Statement on Imaging Cuts in Fiscal Cliff
Legislation.
http://www.acr.org/News-Publications/News/News-Articles/2013/ACR/20130102-Statement-on-Imaging-Cuts-in-Fiscal-Cliff-LegislationJanuary
2, 2013. Accessed January 8, 2013.