The Centers for Medicare and Medicaid Service has proposed cutting reimbursements to radiologists who perform multiple imaging scans on the same patient during the same visit. But a new bill seeks to block those plans, which critics say would be the eighth Medicare cut to imaging in the last six years.

Bipartisan legislation introduced into the House of Representatives Thursday would freeze the cuts through 2012, and wouldn't allow reductions in 2013 or after, unless the cuts were based on the conclusions of a study that showed doctors really gain efficiencies doing multiple scans.

And that study would have to be run by doctors from a medical society specializing in diagnostic imaging, such as the American College of Radiology, which is backing the bill.

"Individuals that receive multiple imaging studies are often the sickest and most complex patients seen by physicians," the bill's co-sponsors, Reps. Peter Olson (R-Texas) and Betty McCollum (D-Minn.), said in a statement. "Imposition of this multiple procedure payment reduction would disproportionately affect the most vulnerable patient population."

The Diagnostic Imaging Services Protection Act, or H.R. 3269, has 31 co-sponsors, and now has to make its way through the House Ways and Means and, probably, the House Energy and Commerce Committees. Shawn Farley, an ACR spokesman, said the group is working with lawmakers to push a similar bill through the Senate. However, as is the way in Washington, he said the bill was less likely to pass by itself, and was more likely to get taken up in a larger legislative package.

"Something like this would get rolled into a larger Medicare vehicle," he told DOTmed News.

Professional component cuts

In a proposed rule for the 2012 Medicare physician fee schedule, the professional component of Medicare reimbursement for doctors performing an MRI, CT or ultrasound scan on the patient on the same day will be cut by 50 percent. Currently, CMS cuts only the technical component for multiple procedures.


The ACR, which represents 34,000 radiologists and radiation oncologists, has disputed CMS' rationale for the cuts. In a Sept. letter, ACR said there are no more than 5 percent efficiencies when the multiple exams given to the same patient are interpreted, so the cuts are excessive.

In fact, a study cited by the society, and published online this summer in the Journal of the American College of Radiology, found only modest efficiencies for multiple procedures. The average relative contributions for pre- and post-service work ranged from 20 percent in CT to 33 percent in ultrasound, and the maximum percentage of duplicated pre- and post-serve work goes from 19 percent in nuclear medicine to 24 percent in ultrasound. This translates to, at maximum, professional fee schedule reductions of 2.96 percent in CT to 5.45 in ultrasound, the study said.

Seven cuts in six years

Plus, imaging has received about $5 billion worth of cuts in just over half a decade, according to the ACR.

"Medicare spending on imaging is at 2004 levels and imaging growth is less than 2 percent annually," Dr. John A. Patti, chair of the ACR's Board of Chancellors, said in a statement. "Further cuts would damage access to care for those who need it most."

The fear voiced by radiologists is that further cuts will force freestanding centers to close their doors, leaving imaging mainly in hospitals and thus cutting off patient access.

A sample of recent cuts includes the Deficit Reduction Act of 2005, which cut spending on advanced imaging by 19.2 percent in 2007 alone, the ACR said in a letter last month, and the Patient Protection and Affordable Care Act, which jacked up the assumed utilization rate to 75 percent, meaning Medicare pays less for the technical component.

CMS' final rules - likely though not necessarily including the proposed multiple procedure cuts - are due next week.