By Leah Nylen, CQ Staff
The Medicare Payment Advisory Commission discussed several options to reduce the ballooning costs associated with medical imaging services during a panel discussion with researchers Friday.
The use of medical imaging services, such as MRI and CT scans, have dramatically increased in recent years, according to a Government Accountability Office report released last month. In 2000, Medicare paid nearly $7 billion for medical imaging procedures; by 2006, that amount had increase to more than $14 billion.
In addition to the increase in the use of medical imaging, more physicians are prescribing medical imaging and then offering patients the services in their offices, a practice known as "self referral." According to the GAO, imaging procedures in doctors' offices accounted for 58 percent of all imaging spending in 2000. That share jumped to 64 percent, roughly $9 billion, in 2006.
Some critics, including the GAO, have suggested that "self referral" has caused a proliferation of medical imaging, as doctors seek to benefit financially from the reimbursements rather than basing referrals on medical decision-making.
Researchers who have focused on the growth in imaging testified during the discussion that increased availability and ownership of medical imaging technology has driven its use.
"This is the fastest growing service offered by physicians," said Lawrence Casalino, a professor of health studies at the University of Chicago. "How much of this is self-referral? No one knows for sure ... but probably a lot of it."
Imaging also has proliferated in certain specialties, particularly orthopedics, neurology and cardiology, according to Laurence Baker, a professor of health research at Stanford University Medical School.
About 25 percent of orthopedists and 10 percent of neurologists who filed Medicare claims for imaging services in 2005 offered the services in their offices, Baker said.
By analyzing claims of particular physicians both before and after they acquired medical imaging machines, Baker also found an increase in how often imaging services were prescribed.
"Acquiring an MRI changes a physicians practice patterns," Baker said.
Some commissioners expressed interest in pursuing methods used by private insurance companies to reduce the cost of medical imaging, such as "prior authorization" and "prior notification."
Prior authorization requires the referring physicians get approval from the insurance before a medical imaging procedure is performed. Prior notification requires physicians to notify the insurance company first but does not require approval.
Currently, Medicare does not require prior authorization or approval. Instead, Medicare relies on "post payment claims review," a process where Medicare looks at imaging procedures after the fact to determine if they were medically appropriate. GAO Health Care Team Director Bruce Steinwald criticized the review process as "pay and chase."
"CMS should consider more front-end approaches to managing imaging benefits," he said. "We don't think post pay claims review is going to get the job done."
Commissioner Peter Butler also suggested the commission could propose limitations on block leasing or "per click" agreements. Block leasing refers to a practice where a physician rents out a block of time to use a medical imaging device for a set fee and then has all their patients scanned. Under a "per click" agreement, a physician refers all patients to a particular imaging provider for a set fee per patient. In both cases, the doctor then bills Medicare for the imaging and keeps the higher reimbursement rate, allowing them to get around federal rules that prohibit self-referral.
But several commissioners also warned against overreacting, saying that self-referral can benefit patients. Butler noted that some of the demand for imaging procedures comes from patients themselves who have noticed the "spectacular advances that have been made in imaging."
Commissioner Ronald D. Castellanos, an urologist from southwest Florida, said he offers medical imaging services and often self-refers.
"Is there are financial benefit to me? Yes. But there's a benefit to the patient" also in the convenience, Castellanos said. "We don't want to throw the baby out with the bath water."
![[RSS]](http://67.192.49.194/templates/images/rss_icon.gif){kind=icon}
Post A Comment