SEARCH
Current Location:
>
> This Story


Log in or Register to rate this News Story
Forward Printable StoryPrint Comment

Never Miss a Story

Sign up for email alerts

 

More Industry Headlines

Report helps radiology departments prepare for Ebola Radiology faces some unique challenges

Most health care systems around the globe want asset financing Health care reform and other factors creating demand

Fluke Biomedical and RaySafe expanding presence in EMEA regions The combined companies discussed their business strategy at MEDICA press conference

MR advancements call for new acoustic shielding techniques Materials and methods discussed

Carestream enters ultrasound business New system will be unveiled at RSNA

Samsung launches new ultrasound for radiology segment Marks their entrance into ultrasound radiology

Siemens launches new SPECT system Requires less space than other systems

October's New Product Showcase This month's roundup of the latest industry products.

CMS proposes coverage of low-dose CT screening for high-risk patients Goes against their advisory panel's recommendation

MEDICA 2014 live update: wearing your heart on your sleeve A look at Rooti, and wearables in health care

Why new payment schemes will challenge nuclear medicine

By Peter J. Webner RT(N),CNMT with Tamar Thompson, MS, CCS-CCS-P

The Centers for Medicare and Medicaid Services (CMS) issued its proposed payment policy rules and regulations for Calendar Year 2014 on July 8, 2013. Upon initial review of the proposed regulations, my reaction was positive. The Hospital Outpatient Prospective Payment System (OPPS) rates for SPECT and PET, as well as Oncologic PET, received substantial proposed payment increase over CY 2013 payment rates.

Story Continues Below Advertisement

FDA approved successor to the PRISM 3000 XP:

MultiCam 3000eco opens new financial and diagnostic opportunities. Inter Medical of Germany and Eclipse Systems offer the most effective triple-head gamma camera on the market for heart and brain diagnostics.



However, as I read on, I quickly realized that the CMS is really proposing policies that ultimately lead to comprehensive Ambulatory Payment Classifications (APC) bundling for not only the 29 devices mentioned in the rule but, in effect, for almost all services provided in the OPPS care setting. The removal of status indicator X and the addition of status indicator Q1 along with the bundling of drugs that function as supplies (including stress agents), the collapse of five levels of Evaluation and Management (E/M) codes into one "G" nomenclature code, bundling of add-on procedure codes, and the bundling of laboratory services, could have devastating effects for the hospital community.

Although the bundling proposals are significant, the most concerning issue is that for the first time since the inception of the OPPS, CMS failed to release the data files to compliment their proposals, leaving the public with no way to replicate the proposal to determine the true value of the positive increases in payment or determine the negative impacts of the seven categories proposed for greater bundling.

Some of the immediate issues that I considered for the nuclear medicine community were:

—Bundling of the stress agents detracts focus from clinical decisions (i.e. efficiency and side effects) and instead limits provider and patient choice based upon financial incentives. Previously a hospital had the option to choose the most appropriate stress agent and be reimbursed for the full cost (plus 6% for pharmacy overhead) for that choice in addition to payment for supervision/interpretation of the stress study. Under this proposal, the agency will bundle all of these services into a single payment.

—The elimination of radiopharmaceutical to procedure edits means that hospitals are less likely to continue to fully report cost associated with nuclear medicine procedures thereby resulting in payment erosion over time.

—Packaging policies drive toward the use of generic drug products, and this concept might seem reasonable when you consider that the Technetium based SPECT Myocardial Perfusion Imaging is off-patent and now generic or PET-based FDG or NAF. One notable exception to the bundling concept for a product that is no longer on patent is Rb82, where manufacturing, distribution, or cost recovery is a challenge since every site bears fixed costs for the generator but has variable volumes.

Continue reading Why new payment schemes will challenge nuclear medicine...
  Pages: 1 - 2 - 3 >>

Related:


Interested in Medical Industry News? Subscribe to DOTmed's weekly news email and always be informed. Click here, it takes just 30 seconds.

You Must Be Logged In To Post A Comment

Advertise
Increase Your
Brand Awareness
Auctions + Private Sales
Get The
Best Price
Buy Equipment/Parts
Find The
Lowest Price
Daily News
Read The
Latest News
Directory
Browse All
DOTmed Users
Ethics on DOTmed
View Our
Ethics Program
Gold Parts Vendor Program
Receive PH
Requests
Gold Service Dealer Program
Receive RFP/PS
Requests
Healthcare Providers
See all
HCP Tools
Jobs/Training
Find/Fill
A Job
Parts Hunter +EasyPay
Get Parts
Quotes
Recently Certified
View Recently
Certified Users
Recently Rated
View Recently
Certified Users
Rental Center
Rent Equipment
For Less
Sell Equipment/Parts
Get The
Most Money
Service Technicians Forum
Find Help
And Advice
Simple RFP
Get Equipment
Quotes
Virtual Trade Show
Find Service
For Equipment
Access and use of this site is subject to the terms and conditions of our LEGAL NOTICE & PRIVACY NOTICE
Property of and Proprietary to DOTmed.com, Inc. Copyright ©2001-2014 DOTmed.com, Inc.
ALL RIGHTS RESERVED