Daily Bulletin 2015

Radiology Workload Outpacing Reimbursement, Study Shows

Tuesday, Dec. 01, 2015

Radiologists can employ strategies such as advocacy and adding value to combat a reimbursement imbalance that has emerged over the past decade, said a radiologist who presented an analysis on reimbursement trends at a Monday session.

Manisha Patel, M.D.

Manisha Patel, M.D.

While radiologists' workloads increased by 43 percent between 2001-2013, their Medicare reimbursements have only increased by 24 percent, according to the analysis of Nationwide Medicare Part B databases conducted by Manisha Patel, M.D., of Thomas Jefferson University in Pennsylvania.

"There is a clear imbalance," Dr. Patel said. "Radiologists' workloads grew considerably faster than their reimbursements over the entire study period, while in the downturn of the last few years, they saw a considerably greater drop in reimbursements than in workload."

The study crunched the numbers from the nationwide Medicare Part B databases for 2001-2013, examining Current Procedure Terminology (CPT) codes for all noninvasive diagnostic imaging by radiologists. By assigning a total professional component (PC) relative value unit (RVU) to each code each year and calculating RVU rates per 1,000 Medicare beneficiaries, PC RVU rates were generated as a proxy for workload and cost. Total Medicare payments to radiologists were also drawn from the database.

The study found that the RVU rate per 1,000 Medicare beneficiaries increased by 43 percent from 2001-2013—to 2,218 in 2013 from 1,548 in 2001. The rate peaked at 2,404 in 2009, representing a 55 percent increase over 2001 levels.

Meanwhile, total Medicare payments to radiologists have not kept pace. Reimbursement levels have risen by only 24 percent from 2001-2013—to $4.2 billion in 2013 from $3.4 billion in 2001. Reimbursements actually outpaced productivity until 2006—peaking that year at $5.3 billion—but by 2013, reimbursement had fallen 20 percent.

The Deficit Reduction Act passed in 2005 caused the drop in reimbursement rates and the Patient Protection and Affordable Car Act, commonly known as Obamacare, has limited cost increases since it passed in 2010, Dr. Patel said.

The reduction in Medicare reimbursements could be creating a negative feedback loop that accelerates the imbalance, Dr. Patel said. A reduction in professional fees likely pressured radiologists to try to increase their revenue by increasing productivity. Thus, radiologists must interpret more studies within a given time period.

"This is concerning, as overworked radiologists could miss important diagnoses leading to malpractice suits," Dr. Patel said.

Reducing Reimbursement Cuts

There a number of strategies radiologists can employ to help reduce reimbursement cuts, Dr. Patel said. These include maintaining representation in the Relative Value Scale Update Committee (RUC) to ensure that payments to radiologists are appropriate and advocating for the Center for Medicare & Medicaid Services (CMMS) to forgo further reimbursement cuts.

Also, Dr. Patel said, "Given the shift from a fee-for-service to a fee-for-value reimbursement model, it is important for radiologists to add value to the profession and expand their repertoire of services through noninterpretive work." For example, she suggested joining hospital committees to build relationships with administrators, doing more consulting with referring physicians as well as patients, and screening requests for imaging exams to ensure they are necessary. To further expand their practice, radiologists could also supervise advanced imaging exams.

Dr. Patel predicted negative consequences if reimbursements continue to decline.

"Radiologists may find it financially difficult to care for Medicare patients and be forced to reduce services," she said. "There may be inappropriate emphasis on increasing efficiency rather than providing higher quality care. Radiology may be increasingly viewed as a commodity."

Question of the Day:

I want to change the MR imaging parameters for a new protocol based on a research paper I read, but the console says the SAR is too high. What is SAR?

Tip of the day:

Patients who have many follow-up head CTs should be assessed for dose to the eyes as they swiftly become at risk for cataracts.

The RSNA 2015 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.