Medicare to cut specialist payments, boost GPs' reimbursement

July 2, 2009 by MassDevice staff

Cardiologists and radiologists can expect to earn less from the federal healthcare program next year, but general practitioners could see their reimbursement rates go up.

The Centers for Medicare and Medicaid services are making a push to increase payments to primary care physicians by cutting back on reimbursement for a number of costly medical procedures.

In the 1,100-plus-page 2010 Medicare Physician Fee Schedule, the centers proposed dramatic cuts to payments for expensive imaging tests like MRI and CT scans.

The changes reflect suggestions put forth by the Medicare Payment Advisory Commission (MedPAC), which delivered a set of recommendations to Congress last month.

CMA proposed a 21 percent reduction in physician payments overall and a 6 percent to 8 percent increase in payments to primary care doctors receive:

"CMS is proposing to reduce payment for services that require the use of expensive equipment which would produce a redistribution of the resulting savings to increase payments for other services, including primary care services."

Surveys conducted by the General Accounting Office found that physicians were ordering more tests than current payment rules assumed. That means as the number of tests went up the "per-treatment costs for purchasing, maintaining and operating the expensive equipment declines, making a reduction in payment appropriate."

CMS should also mandate quality standards for imaging services, which could be enacted by 2012, according to the proposal:

"According to the GAO, spending on advanced imaging services, such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), is growing almost twice as fast as spending on other types of imaging services, and is a significant contributor to the rapid growth in health care spending in recent years, but there is little administrative oversight to ensure the quality of care."

The regulation is open for public comment until Aug. 30 at www.regulations.gov.

Predictably, a number of physicians' organizations are crying foul. Alfred Bove, president of the American College of Cardiology, told the Wall Street Journal that the new rules would see cardiologists receiving 42 percent less for an echocardiogram and 24 percent less for a cardiac catheterization — and an 11 percent cut in reimbursements overall.

Radiologists would also get a haircut under the proposed changes. Bibb Allen, chairman of the American College of Radiology's economics commission, told the journal radiology docs would see an estimated cut of 20 percent for tests like MRI and CT scans.

Both organizations are urging their members to lobby Congress against the cuts.