SNM takes action to alter DRA provision for imaging payment caps
Payment rates for PET and PET/CT scans could be cut by 70 percent under Federal Deficit Reduction Act of 2005
RESTON, Va. -- As a member of the Access to Medical Imaging Coalition, SNM joined 75,000 physicians in asking Congress to reconsider the deep cuts made in medical imaging services for Medicare beneficiaries as part of the federal Deficit Reduction Omnibus Reconciliation Act of 2005. SNM, an international scientific and professional organization of more than 16,000 physician, technologist and scientist members, opposes a provision in the act—payment caps to physicians’ offices with imaging equipment—that is set to begin Jan. 1, 2007.
“The proposed reductions for diagnostic imaging reimbursement fail to recognize the fundamental differences between the costs associated with providing imaging services in a physician’s office as opposed to a hospital outpatient department,” said SNM President Martin P. Sandler. “The final Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System rules, released earlier this month, give a true sense of the severity of the cuts that will affect our members. SNM opposes this legislation and is working as a member of AMIC to reverse or halt this implementation until the full impact of the cuts can be determined,” he indicated.
Under DRA, reimbursement for Medicare beneficiaries who use outpatient imaging services at centers not affiliated with hospitals will be linked to HOPPS rather than MPFS in instances where the payment rate for the technical component of the PFS is greater than that of the HOPPS rate. The MPFS was developed to reflect the cost of imaging services based on factors that are specific for freestanding diagnostic imaging facilities (for example, separate payment codes and rates, overhead costs, staffing and equipment maintenance). “These caps will apply to molecular and nuclear imaging—including PET and PET/CT, X-rays, magnetic resonance imaging, computed tomography and fluoroscopy,” said Sandler, explaining that imaging providers could be forced out of business or to limit their services.
“With DRA’s implementation, the dramatic difference between reimbursement rates under MPFS and HOPPS could reduce payments for PET and PET/CT scans by as much as 70 percent,” explained Gary L. Dillehay, chair of SNM’s Coding and Reimbursement Committee. In addition, other nuclear medicine procedures—particularly cardiac and SPECT ones—will also be impacted, he said. “These payment caps written into the 2005 DRA are for reimbursement only on the technical—not the professional or pharmaceutical—component of imaging procedures performed in freestanding and in-office outpatient imaging facilities,” he explained. He emphasized that DRA provisions do not affect the payment methodology or rates for drugs or radiopharmaceuticals used with imaging procedures.
“This bill’s provision—along with the 5 percent cut scheduled for 2007 due to the sustainable growth rate formula that will affect all physicians—will change how, where and whether Medicare patients will receive imaging services,” said Peter S. Conti, former SNM president and chair of the American College of Nuclear Physicians/SNM Joint Government Relations Committee. “The bill directly affects the care of patients, potentially impeding access to necessary molecular and nuclear imaging services and increasing wait times dramatically,” he noted. “These limitations to appropriate imaging could result in a late diagnosis that leads to a more costly and invasive treatment,” added Conti.
As a member of the Access to Medical Imaging Coalition, SNM has joined other groups such as the Academy of Molecular Imaging, American College of Radiology, American Association of Physicists in Medicine, Alzheimer’s Disease International, Institute for Molecular Technology, Lung Cancer Alliance, National Ovarian Cancer Coalition and Society of Interventional Radiology.
About SNM—Advancing Molecular Imaging and Therapy
SNM is an international scientific and professional organization of more than 16,000 members dedicated to promoting the science, technology and practical applications of molecular and nuclear imaging to diagnose, manage and treat diseases in women, men and children. Founded more than 50 years ago, SNM continues to provide essential resources for health care practitioners and patients; publish the most prominent peer-reviewed journal in the field (the Journal of Nuclear Medicine); host the premier annual meeting for medical imaging; sponsor research grants, fellowships and awards; and train physicians, technologists, scientists, physicists, chemists and radiopharmacists in state-of-the-art imaging procedures and advances. SNM members have introduced—and continue to explore—biological and technological innovations in medicine that noninvasively investigate the molecular basis of diseases, benefiting countless generations of patients. SNM is based in Reston, Va.; additional information can be found online at http://www.snm.org.
Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
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