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White House budget raises concerns for patient access to imaging

by Gus Iversen, Editor in Chief | February 04, 2015
Tim Trysla
executive director at AMIC
Medicare currently maintains two separate fee schedules; one for hospital outpatient services and another for physician offices services, but the 2016 White House budget may change that. If implemented, the new legislation would establish "site-neutral" payments for Medicare reimbursement, which the Access to Medical Imaging Coalition (AMIC) thinks could hinder care.

The new model, which depends on a prior authorization system, could potentially undermine the basic differences between hospitals and physician offices, as well as their patient populations.

DOTmed News discussed the budget's implications with Tim Trysla, the executive director of AMIC, about how this may have come to be.

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"There are a lot of strong incentives in the Affordable Care Act for hospitals to become ACO's to better coordinate care, to improve quality and safety, but there's also this ongoing price discussion," said Trysla, who fears the new budget comes at the expense of imaging access.

"What is not reflected in prior authorization is the actual cost in time of the physician," said Trysla. That could mean reducing the time that physician spends treating other cases, adding delays and denials to patients needing care.

Trysla believes leveling payment rates for off-campus hospital outpatient centers down to physician office payment levels could have a contrary effect on integrating services across the continuum.

"This is a payment fight, saying, as hospitals are integrating and seeing these different arrangements shake out, we are going to slash reimbursement," said Trysla, who adds that after so many cuts to the physician fee schedule it's unreasonable not to expect some sort of economic response.

Trysla said everyone essentially agrees on the need for an alternative payment system that moves away from pay for services, but these new changes may not represent a step toward realizing that goal.

"It's a growing discussion that has more to do with actual procedures and treatment, but we want to make sure diagnostic imaging — given the reforms we've put in place in both physician offices and hospitals — have an opportunity to take effect and drive appropriateness of care instead of having this reimbursement discussion that really doesn't reflect the way health care is being delivered today."
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Chris Crutcher

Medicare Reimbursements should be illegal

February 05, 2015 06:15

When I just read your article about the two different pay scales it just makes me sick. We are classified as a Independent Diagnostic Testing Facility or (IDTF) and because of that, we have been forced to accept on average 40% CMS reimbursements cuts. How would you like that? I don't care who you are. When you come to work and your biggest customer says we like what you do and your patients like what you do and we are very happy you paid thousands of additional dollars in regulation compliance but unfortunately were cutting your reimbursements by 40%. Tragically, Medicare is now simply burning up my equipment and it worries me to no end about mine and our employees future. When I asked CMS why the difference in reimbursement I was told that hospitals have more overhead. That is just ridiculous! So its OK to not give any benefits to an IDTF employee because hospital employees deserve more, even when both sides have to have the same regulated employee credentials. No vacation pay, no insurance, no 401K and thats OK with CMS. Work till your broke and your forced out of helping the underclass. They have got to know this is happening all over the country. This two tiered or two faced approach includes protectionism and geared for the destruction of the solution to expensive diagnostic testing…the IDTF. Making it hard so hard to survive, it makes no sense, I am a woman owner trying to help patients get more affordable testing but CMS mandates my IDTF to get much less then equal pay for equal work. Is that right? But I would find it easier to get the votes to put boots on the ground then I would getting any help with legislation for equal anything. Cutting hospitals now?, forget about it as their pockets are deep. Don't be confused IDFT's that I am talking about are not self-refferal. Self-referral can just increase self-refferal but us struggling everyday to make a difference is absolutely getting no help from CMS. Shame on them and shame on what their doing to the American people. I am not even advocating for equal pay as hospitals but I would like 50% of what they get as I just want to survive and CMS is making it so hard. Now got a letter the other day that a Medicare replacement insurance is going to cut our reimbursement to 85% of what Medicare is now. When were gone no more affordable anything. Mark my words. We need a call to action. Standing for an IDTF is standing for the solution in expensive diagnostic testing. Kris Crutcher

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