Cause of Growth Decline in Medicare Imaging Services Unclear
The growth of advanced diagnostic imaging services provided to Medicare beneficiaries in the office setting, such as CT and MRI, continues to decline. Though the use of these imaging services grew rapidly during the decade starting in 2000, the rate of growth has declined in recent years.
The growth of advanced diagnostic imaging services provided to Medicare beneficiaries in the office setting, such as CT and MRI, continues to decline. Though the use of these imaging services grew rapidly during the decade starting in 2000, the rate of growth has declined in recent years.
The use of MRI in Medicare, in particular, slowed from an annual growth rate of 14 percent during 2000 through 2005 to an average of 2.6 percent per year from 2006 through 2009. In addition, the number of CT services per 1,000 fee-for-service beneficiaries declined by 9 percent between 2009 and 2010, 4 percent between 2010 and 2011, and 9 percent between 2011 and 2012.
Nevertheless, some critics charge that the implementation of a 2012 Medicare accreditation requirement for suppliers of CT, MRI and NM services is to blame. The requirement went into effect on January 1, 2012 and applies to imaging services provided in office settings, including physician offices and independent diagnostic testing facilities, who must be accredited to receive Medicare payment for these services.
However, in a new report, the Government Accountability Office examines the effect the accreditation requirement may have had on beneficiary access to Medicare imaging services provided in the office setting. The GAO audit from July 2013 to April 2014 found that the number of imaging services provided to Medicare beneficiaries in the office setting began declining before and continued declining after the accreditation requirement went into effect in 2012.
"The effect of accreditation on access is unclear in the context of recent policy and payment changes implemented by Medicare and private payers," conclude government auditors. "For example, the Centers for Medicare and Medicaid Services reduced Medicare payment for certain CT and MRI services, which could have contributed to the decline in the number of these services."
In January 2006, CMS began applying a multiple procedure payment reduction (MPPR) policy to the technical component of certain CT and MRI services, which reduces payments for these services when they are furnished together by the same physician, to the same patient, on the same day. And, starting in January 2012, CMS expanded the MPPR by reducing payments for the lower-priced professional component of certain CT and MRI services by 25 percent when two or more services are furnished by the same physician to the same patient, in the same session, on the same day.
The use of MRI in Medicare, in particular, slowed from an annual growth rate of 14 percent during 2000 through 2005 to an average of 2.6 percent per year from 2006 through 2009. In addition, the number of CT services per 1,000 fee-for-service beneficiaries declined by 9 percent between 2009 and 2010, 4 percent between 2010 and 2011, and 9 percent between 2011 and 2012.
Nevertheless, some critics charge that the implementation of a 2012 Medicare accreditation requirement for suppliers of CT, MRI and NM services is to blame. The requirement went into effect on January 1, 2012 and applies to imaging services provided in office settings, including physician offices and independent diagnostic testing facilities, who must be accredited to receive Medicare payment for these services.
However, in a new report, the Government Accountability Office examines the effect the accreditation requirement may have had on beneficiary access to Medicare imaging services provided in the office setting. The GAO audit from July 2013 to April 2014 found that the number of imaging services provided to Medicare beneficiaries in the office setting began declining before and continued declining after the accreditation requirement went into effect in 2012.
"The effect of accreditation on access is unclear in the context of recent policy and payment changes implemented by Medicare and private payers," conclude government auditors. "For example, the Centers for Medicare and Medicaid Services reduced Medicare payment for certain CT and MRI services, which could have contributed to the decline in the number of these services."
In January 2006, CMS began applying a multiple procedure payment reduction (MPPR) policy to the technical component of certain CT and MRI services, which reduces payments for these services when they are furnished together by the same physician, to the same patient, on the same day. And, starting in January 2012, CMS expanded the MPPR by reducing payments for the lower-priced professional component of certain CT and MRI services by 25 percent when two or more services are furnished by the same physician to the same patient, in the same session, on the same day.
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