by
Loren Bonner, DOTmed News Online Editor | February 07, 2014
On Thursday, lawmakers finally reached a deal to enact a permanent repeal to the unpopular sustainable growth rate (SGR) formula.
Mainly, the bill will increase physicians pay to 0.5 percent over the next five years and require that any specific cuts to medical services greater than 20 percent be phased in over two years.
The House GOP Doctors Caucus had originally asked for a 10 year pay increase, but instead, payment rates will stay the same from 2018 through 2023, after the five year mark is up. However, physicians will be able to receive additional funds through a new payment program called the Merit-Based Incentive Payment System.
In addition, the bill will include a provision that incentivizes ordering physicians to embrace
appropriateness criteria when coordinating medical imaging exams for patients. It would deny payment to those providers who do not follow appropriateness criteria, which are meant to boost quality and cut down on duplicate or unnecessary scanning and their associated costs.
"Repeated imaging cuts have forced many facilities to close or cut services. According to the FDA, there are now roughly 150 fewer mammography facilities and nearly 600 fewer mammography units available than in 2007. This "dampening" policy would help prevent such massive impact on patient access to care and is a step toward sensible imaging reimbursement policies," said Dr. Paul H. Ellenbogen, chair of the American College of Radiology Board of Chancellors, in a statement.
The ACR also backs a policy in the bill that would require the Centers for Medicare and Medicaid Services to produce data used to justify a 2012 policy that implemented a 25 percent multiple procedure payment reduction to certain medical imaging procedures provided to the same patient, on the same day, in the same session.
"A 2012 JACR study proves that this multiple procedure payment reduction has no basis in fact. CMS has never provided any basis for this destructive policy that affects care for the most sick and injured patients. We look forward to a legislative policy that will force Medicare to justify this cut, which has negatively impacted so many providers," said Ellenbogen.
