By Brenda Riggott, Member & Corporate Relations Director
In November 2012, the AANEM conducted a member survey to determine the potential impact of the 2013 CMS cuts
to nerve conduction study (NCS) codes. With reimbursement cuts estimated between 31% and 60% (depending on the studies performed), the AANEM sought member input. This feedback was used to provide information to CMS on the impact these cuts will have on member practices and on patient care. An overwhelming number of members (86.5%) indicated they will be impacted by the changes.
The survey had record member participation with 1,407 respondents (33.7% neurologists, 58.6% physiatrists, and 5.1% technologists).
Revenue and Staffing
AANEM member responses revealed that the percentage of practices dedicated to performing EDX testing varied, with 40.3% indicating that 30% or less of their practice is dedicated to EDX testing while 16.6% spend more than 70% of their practice time on these procedures.
Using the RVU calculator in the AANEM Coding Toolkit
, respondents were asked to estimate the financial impact the CMS changes would have on their practice/laboratory in terms of revenue reduction. The responses showed:
24.2% (314) of respondents estimated their revenue may be reduced by as much as 46-55%
18.4% (239) estimated a 36-45% reduction
18% estimated a loss of more than 56%
A potential negative impact on members’ financial bottom lines revealed other possible changes to member practices. Over half (53.9%) of the private practice respondents indicated they may reduce the number of EDX physicians employed in their practice, compared to 38.8% of the academic and other practice type respondents. The role of technologists may increase, with 60.65% indicating they would likely shift the performance of NCSs to technologists versus having physicians perform the studies. Only 32% of the respondents indicated they may reduce the number of NCS technologists on staff.
Practice Changes and Patient Access
Feared revenue reductions may result in physicians reevaluating their current practice model. Most respondents (62%) indicated it is unlikely
they will need to close their practice or EDX laboratory. However, private practice physicians indicated cuts could cause consolidation of satellite offices. Additionally, a large majority (83%) of the respondents indicated they may reduce the availability of EDX testing appointments. The result could mean fewer locations and fewer appointments will be available for patients to receive EDX services.
Almost 80% of the respondents believed that fewer EDX testing locations and available appointments may result in the performance of EDX procedures moving to large academic practices. If this change occurs, it would require patients to drive greater distances for their EDX testing. About 62% of respondents stated that their patients will need to travel up to 50 miles for studies at the nearest academic institution, while 25.1% would need to travel 50-100 miles for studies. When asked how this cut in reimbursement would change their practice with regard to Medicare patients, more than 63% indicated that it was “very likely” that they would limit their Medicare patient access. The potential need to restrict access was higher for private practice physicians (92%) when compared to physicians in all other practice types (73%).
“I am one of the respondents that indicated I am going to have to limit the Medicare patients that I see, and I have already begun to do so,” stated Vince J. Tranchitella, MD, AANEM board member and private practitioner. “I really hate to limit access to quality electrodiagnostic consultations for these patients, but these cuts are so severe, I don't have a choice. I literally will not be able to maintain my private practice if I continue to see the same number of Medicare patients.”
Much of the data collected focused on the impact the CMS changes would have on patient care. Concerns included:
Other tests which are more expensive will be utilized instead of EDX tests
Unnecessary treatments will be initiated because of improper diagnoses
Unnecessary surgeries will be performed
More than 70% of survey respondents expressed concern that more costly studies such as MRI will be used for carpal tunnel or back surgery; nearly 50%, that expensive treatments such as intravenous immunoglobulin or botulinum toxin would be initiated inappropriately; and 60%, that unnecessary surgeries would be performed.
“Surgeons rely on EDX testing before they operate. If there is a lack of physicians willing to perform these tests, it will result in inappropriate surgeries, which will increase the cost of Medicare patients’ care,” said Tranchitella.
Training and Industry Impact
The CMS cuts also may impact other related areas. Almost 66% of academic respondents indicated the cuts could decrease the number of residency and fellowship slots in their program. Equipment providers also may feel the impact of the CMS changes, with 96.8% of the survey respondents indicating they think it will be difficult to justify purchasing new equipment due to the cuts. The vast majority of respondents (82%) indicated that they will be looking to improve the efficiencies of their EDX services in light of the coming changes.
“It is important to keep in mind that this survey was conducted prior to the January 1, 2013, implementation of the CMS changes,” noted Shirlyn Adkins, JD, AANEM executive director. “This survey provided us with valuable information that was included in our coalition letter
sent to CMS and Congress and also was presented in our meeting with CMS in late December. It will provide us with a benchmark for future surveys.”
AANEM will resurvey members later this year to determine the real impact of the changes versus the estimated impact. However, it is unlikely CMS will use survey data alone to make changes to reimbursement. “Jonathon Blum, CMS deputy administrator and director, has indicated that CMS will need to see the impact to patients on claims data,” stated Adkins. “Our challenge over the coming months is to find the best way to show that impact.”