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What's New


The Sustainable Growth Rate (SGR):

-For the 17th year in a row, Congress had passed a patch to delay implementation of the SGR by almost another year (10 months) earlier in 2014.

-There was hope that the outlook for passing a permanent fix/repeal was good this year, and after over a decade, the Senate finally voted in April 2015 to repeal the SGR!

Implementation of the SGR was viewed as a doomsday scenario as it would mandate a steep 24% cut to Medicare which would cause a ripple effect throughout the healthcare system.

-One good thing about the SGR Patch this year is that it supports the use of the ACRSelect, which is the ACR’s Clinical Decision Support Tool, starting in 2017.

The MPPR:

-The MPPR is the Multiple Procedure Payment Reduction bill, which sought to cut Medicare payments for the second contiguous body part read by the same radiologist the same day by 50% because of perceived efficiencies of doing them both at one time (for example, a CT Abdomen/Pelvis would get the payment for the Pelvis portion cut).

-CMS stated that this was based on research they conducted, yet they have never produced the data to back up these “efficiencies,” which they are required to do by law.

-The latest iteration of the MPPR is to cut the payment on the second procedure for any patient who underwent even unrelated studies on the same day, even if they are read by different radiologists.

Other Current Legislative and Legal Issues:

Bill HR 4302:

-- Requires HHS secretary to show data that supports the decision to implement the 25% reduction in the professional component

-- Requires cuts greater than 20% to be phased in over a 2 year period. We are advocating for a permanent fix to the Sustainable Growth Rate formula.

CT Lung Cancer Screening:

The Affordable Care Act requires insurers on exchanges to reimburse for preventative services given a rating of B or higher by the USPSTF. Ironically, no similar law requires Medicare to reimburse for an Annual Screening CT, despite the USPSTF rating.

There is a letter circulating Congress which urges the Secretary of Health and Human Services to add Annual Screening CT to the list of covered procedures for Medicare.

Dense Breast Legislation:

Requires imaging centers in New Jersey to inform patients about the density of their breasts and the resulting limits of mammography in detecting lesions in dense breasts.

 

 

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