* The bill reduced by 25 percent the reimbursement for the second, lesser paid of contiguous body scans within a family of codes that are grouped by modality. For a major procedure, the difference in payment between the old and new reimbursements could be in the hundreds of dollars for a single patient, Ullrich says.

* The bill froze the Medicare conversion factor at the 2005 rate.


The ACR estimated that the DRA cuts would drain some $6 billion from imaging providers nationwide. The Medicare cuts also caused private payers to sit up and take notice as they too began cutting reimbursements, sometimes going beyond Medicare's cuts.

"Private payers can influence Medicare, and vice versa," says Kathryn Keysor, an economics and health policy analyst for ACR.

Imaging is viewed as a fat target by government and private payers because it is one of the few areas of medicine where productivity is rising, according to Ullrich. And, imaging costs -- driven by better technology and increased use of it -- also are a new source of concern for payers, many who have seen double-digit cost increases in recent years.

In addition, imaging is vulnerable because critics say a medical arms race is under way, one that finds greater numbers of doctors and hospitals acquiring high-end scanners that can't be justified by patient loads or the kinds of scans they are providing.

There is some waste in the system, Ullrich says, but recent reimbursement cuts don't target waste. Instead, they target the entire system, across the board.

The implications are serious. Vulnerable operators, including those providing care in rural settings, may be squeezed out of business. Another likely casualty: hospitals that rely on imaging to subsidize services such as emergency care or internal medicine.

Ultimately, what's at stake is patient care. Left to run its course, this trend could soon find doctors and hospitals unable to afford the latest equipment and patients unable to benefit from advances in technology.

Radiologists can set the profession on sounder footing by waging an offensive on several fronts, says Ullrich. Hearts and minds must be won in the halls of Congress and in the board rooms of managed care.

Because Medicare is such a large payer and often used as an index by the private sector, Ullrich underscores the need to work in the nation's capitol to undo the damage wrought by the Deficit Reduction Act. Medicare, he says, should revert to payments based on the Medicare Physician Fee Schedule. Although that system was flawed, he says, it was based on hard data.

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