Proposed CMS Utilization Rates: Shortsighted and Illogical

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The flurry of attention and concern over decreased reimbursement intensified this past week with the recent CMS announcement calling for new Medicare Physician Fee Schedule rules that would raise the assumed utilization rate for outpatient services from 50 to 90 percent for imaging equipment with an initial purchase price of more than $1 million.

The specific impact on a center would depend on a number of factors including patient mix and imaging services offered. But as we all know, this change means lower reimbursement rates across modalities at these centers. Only an act of Congress can help us avoid what could be severe cuts in Medicare reimbursement starting in just a couple of months.

While we are 100 percent in support of sensible and fair use of medical imaging services, we believe that this is the wrong thing to do for the U.S. population. It goes against what health reform is supposed to be about: reducing costs long-term and improving access to care. We know that imaging leads to earlier diagnosis of disease and earlier treatment—often at a stage when treatment costs less and patients have better chances for improvement. It’s also inconsistent with the mandate for implementing EMR/EHR/IHE capabilities, an important step that requires capital and resources for integrating massive amounts of digital imaging data.    

Rather than cutting the legs out from underneath medical imaging facilities, the focus should be on improving productivity and reducing costs in a sustainable manner. That’s why we are working with our customers to create as lean a department as possible; one that gains and retains as many referrals as possible and provides efficient multi-site reading architectures—driving profitability and great patient care.

As we’re gearing up for RSNA, it’s important to consider that for attendees, decreased reimbursement rates are certainly going to be top of mind. Despite the economic situation and changing reimbursement landscape in the U.S., demand for healthcare services remains strong worldwide. And that is a critical factor in this whole equation. If healthcare facilities streamline processes, operations can remain healthy—as can the patients we serve.

– Diana Nole, President, Digital Medical Solutions