Ben Lauing, Imaging Performance Partnership
President Obama’s proposed budget may signal major reforms in store for imaging. Self-referral, an issue often debated but rarely acted upon, is now an explicit target; the Obama administration has proposed restricting the in-office ancillary services exception to the Stark law. Furthermore, the budget suggests mandatory pre-authorization for advanced imaging modalities.
While this is only a proposed budget, and Congress could take it or leave it, we think it’s highly likely that regulations to curb imaging utilization will soon emerge.
President Obama targets self-referrals and pre-authorization
Shaun Lillard, Imaging Performance Partnership
The American Taxpayer Relief Act passed the House of Representatives late Tuesday night to avert the fiscal cliff, but Medicare did not go untouched. The last-minute “Doc-Fix”, preventing a 26.5% cut to the Sustainable Growth Rate (SGR) for physicians was again offset by cuts to other Medicare programs.
Fiscal cliff deal prevents SGR cuts at expense of EUR—Implications for imaging
Eric Bushlow, Imaging Performance Partnership
Policy makers have long argued that the cost of advanced medical imaging among Medicare beneficiaries has contributed significantly to overall health care cost growth. Recent research presented at RSNA 2012, however, suggests the 2005 Deficit Reduction Act (DRA) dramatically impacted the growth of these services as compared to other health care costs.
The study highlights that before the DRA, advanced imaging was the fastest growing service category, ranking in the 86th growth rate percentile in 2001. However, by 2011 advanced imaging fell to the 2nd growth rate percentile—a testament to the effectiveness of this legislation and potentially demonstrating the impact of more recent appropriateness scrutiny.
These findings add to a growing body of evidence suggesting a significant decline in imaging utilization over the past decade—a trend uncovered in the March 2012 MedPAC report.
Growth rate of advanced imaging slows dramatically since DRA