This will be a year when EDX physicians will absorb significant reimbursement cuts
for their procedures. The cuts to EDX physicians, however, are the reality facing many procedure-based fields. James Vavricek, senior specialist, regulatory affairs at the American College of Cardiology agrees, “CMS continues to review services it perceives may be generous relative to the rest of the system. Specialties like cardiology, radiology, gastroenterology, ophthalmology, and many others have had their codes reviewed and had CMS revise the values for dozens of services over the past five years. These updates have produced reductions of 40% for certain individual cardiology services. The zero-sum nature of the physician fee schedule makes it a challenge for procedure-based specialists.”
CMS has slashed radiology codes approximately 12 times in the last six years, including a brain imaging reduction of nearly 50% and a technical component of a surgical pathology code by 52%. CMS also expanded its multiple procedure payment reduction to include the technical component of diagnostic procedures performed in cardiology (25% reduction), ophthalmology (20% reduction), and interventional radiology (25% reduction). The federal agency also is applying multiple procedure payment reduction on professional reimbursement to any physician in a practice who reads a second or subsequent advanced imaging exam carried out on the same patient in the same session. “This is the year of CMS cutting any codes that are used together under the guise that performing the second procedures should be significantly cheaper than the first,” noted Shirlyn Adkins, JD, AANEM executive director. “NCS cuts are part of the cuts being seen everywhere.”
According to Cynthia Moran, assistant executive director government relations, economics and health policy for the American College of Radiology, “All specialties are facing the same pain. This is part of the redistribution from specialists to primary care and the transition away from fee for service. We are telling our members that it is important to make sure diagnostic imaging tools are utilized appropriately. We also suggest they get engaged with the referring physicians and the patients so that they demand necessary imaging services to provide quality care.”
A team of AANEM leaders and CMS representatives will spend the next several months reviewing data that demonstrates the impact of the cuts on patient care. “CMS has shown some willingness to make adjustments to previously cut reimbursements. In 2013, hospital reimbursement for vascular imaging was increased by 125% after CMS slashed it by 27% in 2012. Hopefully, we can convince CMS to change reimbursement for EDX procedures for 2014,”said Adkins.
How You Can Help
AANEM will be working with a team from the Centers for Medicare and Medicaid to analyze claims data as it relates to impact on patient care. We will be asking for your input. Questions to consider:
Have you noticed a change in the volume of patients seeking an appointment at your office?
Are your patients traveling longer distances to be seen in your office?
Has your practice limited or stopped performing EDX testing particularly on Medicare patients?
If your practice has had to close completely, where are the Medicare patients now being seen?
Have you discontinued rotations to rural areas because of the cuts?
Look for more information on responding to these questions on the AANEM website in the coming months.