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The recent announcement of the final rules on Medicare reimbursement by CMS could result in a mass shuttering of rural clinics, according to the American College of Radiology.

In a statement released this week, the physicians group warns that the cuts to imaging services, believed to reach 16 percent across modalities, could endanger rural or small-town clinics, and limit access to life-saving techniques to patients nationwide.

"These short-sighted, unfounded and misguided cuts will imperil community-based imaging, restrict access to cutting-edge imaging scans, and delay diagnosis of cancers and other critical conditions which may ultimately cost lives," James Thrall, M.D., chair of the American College of Radiology's board, said in the statement.

In the rules announced Friday, CMS, as predicted, raised the expected utilization rates of imaging equipment costing more than one million dollars at non-hospital advanced imaging centers from 50 percent to 90 percent. This means the CMS, believing pricey diagnostic tools like MRI and CT scanners are in near-constant use, will slash their reimbursements per procedure. (DM 9554)

While the ACT believes this will result in a 16 percent cut across the board, certain modalities - such as CT scans of the spine - will see up to 40 percent in cuts.

This loss of income, coming only a few years on the heels of the Deficit Reduction Act of 2005*, which also heavily ate into freestanding clinics' finances, might prove too much for many centers.

"You're looking at another round of double-digit cuts," Shawn Farley, a spokesman for ACR, tells DOTmed News. "If your center does more MRI and CT, those are the hardest hit on the fee schedule announced on Friday, that's 30, 40, even 50 percent cuts in a three-year period. I don't know how a medical practice can absorb that level of cuts in so short a time and keep the doors open, especially in outlying areas."

In fact, according to surveys recently conducted by the Radiology Business Management Association (RBMA) and the ACR, almost 40 percent of such centers said they would consider closing shop once the cuts hit, and over a third said they might drop or limit access to Medicare beneficiaries. (DM 9421)

Yet the ACR doesn't think the absolute number of imaging units will decrease; rather, they say the real trend will be toward consolidation, far-flung rural or suburban branches closing down in favor of urban or regional centers. Already, a little under half of all clinics polled in the ACR survey said they were thinking of consolidation.

Farley says these cuts will, indirectly, affect other services, like mammography. Although mammography is not covered in these rule changes, the modality is a loss leader, Farley says, and many independent clinics have to make up for the low level of reimbursement and high malpractice insurance of this service by offering CT and MRI scans, something they may not be able to do under the new rules.

This could then result in a further drop in number of mammography centers operating outside of big cities, an unintended consequence that could affect patient access to potentially life-saving studies. And with the drop, as more people are going to fewer centers for mammograms, wait times, which are already high in some places, will shoot up.

Real utilization rate

The thrust behind the cuts has been the impression that the costs of imaging are out of control, and part of what makes health care eat up almost 15 percent of U.S. GDP, 50 percent more than what Canada spends, according to a recent Thomson Reuters report. (DM 10590)

Yet, the ACR says imaging has become a sort of bogeyman, and that its being responsible for the bulk of the growth in health care costs is a myth.

"This notion that imaging is skyrocketing or out of control is untrue," Farley says. "It's misguided and based on old information. Look at the March 2009 MedPAC report. From 2006 onward imaging has flatlined. Growth is only 2 percent annually," he adds, "and that's in line with or below all other physician services." (DM 8499)

In fact, says Farley, the recent Moran study suggests that in 2008, MRI utilization actually declined by half a percentage point.

As for utilization rates, he says CMS's expectations are unrealistic and not in keeping with the facts on the ground, especially at rural centers. He says that the recent RBMA study showed that average nationwide utilization rates were around 54 percent, not 90 percent, and that they dropped to as low as 48 percent at clinics in rural areas.

"Except for your large urban hospitals, most places aren't getting near 80 percent," he says. "And you wouldn't want utilization rates at 90 percent. You're going to see mistakes made at that point. You would have someone literally on the table 24/7. That's not a good thing for medicine to be pushed in that direction."

*Paste the DM number into any DOTmed.com search box to read the story. (DRA stories include DM 3432, 3508, 4508, 5774, 7072, and 9244)

Read more from Medicare:

CMS ANNOUNCES PAYMENT, POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE BENEFICIARIES IN 2010

http://tinyurl.com/ygsmwbm

Also note:
CMS ADOPTS POLICY, PAYMENT RATE CHANGES FOR SERVICES IN HOSPITAL OUTPATIENT DEPARTMENTS AND AMBULATORY SURGICAL CENTERS FOR 2010

http://tinyurl.com/ydquyys