MedPAC Recommends A New Direction For Medicare
With A Focus On Diagnostic Imaging
from
the July 2005 issue
The
issue of reimbursement policy, one that quite often shares the
spotlight with accreditation, has come into sharper focus recently
as it relates to diagnostic imaging procedures, including noninvasive
vascular technology. With payments for imaging services increasing
in double-digit percentages each year, insurance carriers are
looking for ways to reduce costly, repeat procedures and ensure
that they are only paying for the most accurate diagnoses possible.
Buzz phrases such as "pay for quality" and "reduction
of inappropriate use" are being used by insurers as they
seek objective, reliable, expert guidelines for providers of
imaging services. Adoption of such guidelines is intended to
ensure that imaging providers are delivering high quality imaging
services to patients while at the same time helping to control
the rapid growth of imaging spending.
The
Medicare Payment Advisory Commission (MedPAC), an independent
federal body established by the Balanced Budget Act of 1997
(P.L. 105-33), serves to advise Congress on issues affecting
the Medicare program. MedPAC not only advises Congress on payments
to private health plans participating in Medicare, but also
analyzes access to care, quality of care, and other issues affecting
the overall program as well as the nation's healthcare system
in general. MedPAC recommends changes to payment and other policies
that are designed to make payments more accurate and improve
the value of care. MedPAC's goal is "for Medicare payments
to cover the costs efficient providers incur in furnishing care
to beneficiaries."
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Within
the March 2005 MedPAC report, the topic of the rapid growth
related to Medicare spending for imaging services was
addressed within Chapter 3, entitled, "Issues
In Physician Payment Policy."
The
MedPAC report outlined several factors as justification
for the Centers for Medicare and Medicaid Services' (CMS)
future setting of standards for physicians who bill Medicare
for the professional component of imaging studies:
- advances
in imaging technology that have made it possible to
provide services in non-hospital settings;
- the
migration of imaging from hospitals, which establish
criteria for who may interpret studies, to non-facility
settings, where there are often no such rules;
- rapid
growth in physician fee schedule spending for imaging
services; and
- variations
in the quality of physician interpretations and reports,
which can affect treatment decisions.
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Within
the chapter entitled "Issues In Physician Payment Policy,"
MedPAC provides Congress with potential solutions toward enhancing
the quality of care as well as controlling spending. Here, MedPAC
announces specific recommendations related to diagnostic imaging
studies and this particular aspect of healthcare delivery:
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MEDPAC
RECOMMENDATIONS TO CONGRESS: March 2005 Reports
3A The
Secretary should use Medicare claims data to measure fee-for-service
physicians' resource use and share results with physicians
confidentially to educate them about how they compare with
aggregated peer performance. The Congress should direct
the Secretary to perform this function.
COMMISSIONER VOTES:
YES 16 . NO 0 . NOT VOTING 0 . ABSENT 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
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3B
The
Secretary should improve Medicare's coding edits that detect
unbundled diagnostic imaging services and reduce the technical
component payment for multiple imaging services performed
on contiguous body parts.
COMMISSIONER VOTES:
YES 16 . NO 0 . NOT VOTING 0 . ABSENT 1
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3C
The
Congress should direct the Secretary to set standards for
physicians who bill Medicare for interpreting diagnostic
imaging studies. The Secretary should select private organizations
to administer the standards.
COMMISSIONER VOTES:
YES 16 . NO 0 . NOT VOTING 0 . ABSENT 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . .
3D The
Congress should direct the Secretary to set standards for
all providers who bill Medicare for performing diagnostic
imaging studies. The Secretary should select private organizations
to administer the standards.
COMMISSIONER VOTES:
YES 16 . NO 0 . NOT VOTING 0 . ABSENT 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
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3E The
Secretary should include nuclear medicine and PET procedures
as designated health services under the Ethics in Patient
Referrals Act.
COMMISSIONER VOTES:
YES 16 . NO 0 . NOT VOTING 0 . ABSENT 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
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3F The
Secretary should expand the definition of physician ownership
in the Ethics in Patient Referrals Act to include interests
in an entity that derives a substantial proportion of its
revenue from a provider of designated health services.
COMMISSIONER VOTES:
YES 16 . NO 0 . NOT VOTING 0 . ABSENT 1 |
NOTE:
The full version of the March 2005 MedPAC report to Congress
can be accessed at: http://medpac.gov/publications/congressional_reports/Mar05_Ch03.pdf.
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