Nearly 90% of the medical imaging procedures whose Medicare reimbursement rates would drop under the Deficit Reduction Act of 2005 would be paid less than the estimated costs of performing the procedures in physician offices and independent imaging centers.

That is among the conclusions of a new study by The Moran Company that assesses the impact of the DRA-'05 cuts on medical imaging reimbursement and costs across sites of care. The study was done for the Access to Medical Imaging Coalition (AMIC), a consortium of providers, physicians, patients, and manufacturers.

The primary findings of the study include the following:


* Of the 145 imaging procedures whose payment would be affected by the caps imposed by DRA-'05, 126 (or 87%) would be paid below the estimated cost of performing the procedures in the physician office setting. Examples include Cardiac MRI/Limited Study (Code 75555TC); CT Bone Density, Axial (76070TC); Acute Venous Thrombus Image (78456TC); Tumor Imaging 3D (78803TC); and Ultrasound Exam, Pelvic, Limited (76857TC). An appendix to the report provides a full list of the procedures, payment levels, and estimated costs. To arrive at the estimated costs of performing the procedures, the study used a cost-estimation approach consistent with that used by CMS.

* Under the DRA-'05, aggregate Medicare payment for imaging services in physician offices and imaging centers would fall 16-18% below aggregate payment for similar services provided in hospital outpatient departments. This is in contrast to aggregate imaging spending prior to DRA-'05 which has been virtually identical in both the physician office and hospital outpatient department payment settings.

* Much of the overall reduction in spending brought about by DRA-'05 would be concentrated on a limited number of high-volume procedures used widely by Medicare patients. These include MRI exams to detect brain tumors, nuclear imaging studies for heart problems, ultrasound scans to evaluate leg arteries or bypass grafts, and bone density studies for osteoporosis.

AMIC Executive Director Tim Trysla said that the report confirms what had been widely suspected after the DRA-'05 cuts were passed. "These cuts are extreme, and they will unquestionably change how, where, and if Medicare patients get the imaging services they need," said Trysla. "You cannot cut MRI of the brain by 49%, ultrasound for prostate cancer by 72%, or CT for abdominal aortic aneurysms by 52% without affecting patients."

"The cuts were hastily crafted at the end of last year and it is hard to believe that Congress or CMS anticipated cuts this severe," added Trysla. "The DRA cuts overshoot the target and directly hit procedures that Medicare patients use all the time-for heart disease, back pain, tumors, and artery problems."

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