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The CR to DR transition: Less than halfway there

August 23, 2017

    On January 1, 2018, CMS will begin assessing a penalty of 7% on technical reimbursement for X-ray exams conducted on computed radiography (CR) equipment—and in 2023, the penalty will rise to 10%.

    This is a significant revenue impact that requires a strategic response from imaging departments, outpatient imaging centers, and imaging equipment vendors.

    The Imaging Performance Partnership at Advisory Board recently partnered with the AHRA (Association for Medical Imaging Management) to survey imaging leaders in July 2017 on their current status and goals regarding the transition from CR to digital radiography (DR) equipment.

    Here's what we learned from more than 300 responses from hospital-based imaging leaders:

    1. CR units are still highly prevalent

    Six months before penalties begin, the vast majority of respondents (78%) still have operating CR units.

    Close to half of respondents (41%) plan to continue operating these units in 2018 and beyond, despite the penalty.

    2. Cost and low outpatient utilization the top reasons for avoiding upgrade

    Why are so many imaging leaders choosing not to replace their CR units? We asked imaging leaders to cite their primary reason for avoiding the upgrade.

    A small handful (less than 3%) of respondents that plan to continue operating CR units into 2018 attribute the decision to the how long the replacement process is taking. A few others are excluded from the penalty due to critical access facility status.

    The top concern, cited by 57% of those choosing not to replace their CR units, is the cost of a DR upgrade or replacement. The second leading concern, at 29%, is low outpatient utilization of their existing CR units.

    Another 8% of respondents are not replacing their units because Medicare is a small proportion of their business—as is the case for most pediatric facilities. Finally, a few respondents cited other concerns related to quality (in particular for specific patient conditions such as scoliosis) and the need for backup on the DR units.

    3. Costs of CR replacement vary widely

    Survey respondents cited widely differing per-unit cost estimates for a CR to DR transition. While some are undertaking low-cost upgrades of existing units, others are replacing entire rooms. About half of the cited estimates fell between $50,000 and $100,000 per unit. Approximately 20% cited per-unit costs either below $50,000 or between $100,000 and $200,000, and another 15% paid over $200,000 per unit.


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