Medical imaging industry groups say the final 2010 Medicare physician fee schedule rule does not fix the potentially damaging payment cuts to imaging services the groups objected to in the proposed rule.

The Centers for Medicare & Medicaid Services Oct. 30 announced the final 2010 physician fee schedule rule, which is slated to be published in the Nov. 25 Federal Register and to be effective Jan. 1, 2010. The rule finalizes a 21.2 percent reduction in the fee schedule amounts as a result of the sustainable growth rate (SGR) formula, a slight change from the proposal (21.5 percent) published in the summer.

Tim Trysla, executive director of the Access to Medical Imaging Coalition (AMIC), told BNA Nov. 2 the final rule contains two damaging components. One concern is the formula used to calculate the physician practice expense relative units, which he said will affect specialty physicians like cardiologists. The other concern, Trysla said, involves the utilization rate for expensive imaging equipment.

In the July proposed rule, CMS proposed to increase the equipment usage rate to 90 percent--or 45 hours per week--for all services containing equipment that cost in excess of $1 million dollars. This followed on a recommendation from the Medicare Payment Advisory Commission.

AMIC, as well other groups like the American College of Cardiology (ACC) had complained that MedPAC's recommendation, which would cut reimbursements, was based on outdated information and limited data.

Practice Expense.

Imaging groups had previously expressed their displeasure in a survey on practice expenses that was conducted by the AMA and other medical professional organizations. CMS in the proposed rule said the results of the Physician Practice Information Survey data would replace the existing data used on practice costs for establishing the practice expense relative value units (PE RVUs). CMS in the proposed rule called the new survey “the most comprehensive source of PE survey information available to date.”

Despite the objections, CMS incorporated the results of the survey in the final rule, but in a slight break for industry said it will phase in the change over a four-year period. CMS also will not apply this change to expensive therapeutic equipment.

Still, in a notice to its members, the ACC said the phase-in is not enough.

“While CMS has attempted to mitigate the impacts of the cuts by spreading them out over a four-year period, the impact of the cuts is still enormous both for 2010 and beyond,” ACC said in a statement. “Cuts of this magnitude-- whether enacted this year or spread over four--cannot be absorbed and we will continue to fight the implementation of this data until a rigorous review is conducted.”

With the exception of evaluation and management services, nearly all services that cardiologists perform will see cuts ranging from 10 percent to more than 40 percent for individual services phased in over four years, the ACC said.

“Taken together with the payment cuts cardiology has already experienced, [the CMS final rule] represents a grave threat to cardiology practices and to patient access. The consequences, whether intentional or not, are already being felt,” the group said.

Trysla of AMIC said the four year phase-in of the cuts is just “a slow walk” towards the inevitable--limiting access to imaging equipment for patients in need.

Accreditation.

The final 2010 rule also implements a requirement of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012.

CMS said that this accreditation requirement will apply to mobile units, physicians' offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them.

“CMS will address suppliers' accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance,” the agency said in a release.

When it released the proposed rule, the agency said that according to the Government Accountability Office, spending on advanced imaging services, such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), is growing almost twice as fast as spending on other types of imaging services, “and is a significant contributor to the rapid growth in health care spending in recent years, but there is little administrative oversight to ensure the quality of care.”

Trysla said AMIC supports the accreditation requirement because it puts the focus on the appropriate use of imaging equipment. He said he hopes the requirement would show that concerns about the growing volume of imaging resources are not accurate.

In a related accreditation matter, CMS filed an Oct. 30 Federal Register notice announcing an opportunity for accreditation organization to submit applications to participate in the advanced diagnostic imaging supplier accreditation program. The agency said applications will be considered for the Jan. 1, 2010, designation deadline if they are received by Dec. 1.

This CMS notice on accreditation is scheduled to be published Nov. 25 in the Federal Register.

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A prepublication copy of the final physician rule for 2010 is available at http://op.bna.com/hl.nsf/r?Open=bbrk-7xel9q.

A prepublication copy of the notice soliciting imaging accreditation groups is at http://op.bna.com/hl.nsf/r?Open=bbrk-7xetsp.

Copyright 2009, The Bureau of National Affairs, Inc.