Medicare reimbursement for CT and MRI exams performed at private practices have decreased dramatically over the past decade for radiologists, and even more so for physicians of other specialties, according to an article published in the January issue of the Journal of the American College of Radiology.
Prior studies examining Medicare reimbursement for imaging exams at private practices indicated a rising trend in payments to radiologists and nonradiologists alike in the early 2000s. However, the Deficit Reduction Act and other changes in policy since the mid-2000s have likely prompted substantial reductions in payments to private offices, noted lead author Dr. Sarah Kamel and colleagues from Thomas Jefferson University Hospital (JACR, January 2020, Vol. 17:1, pp. 118-124).
To investigate their theory, the researchers obtained and analyzed data on payments for CT and MRI exams from the U.S. Centers for Medicare and Medicaid Services Procedure Summary Master Files from 2004 to 2016. This included 39.2 million beneficiaries of the Medicare Part B fee-for-service program in 2016.
Overall, the group identified a massive decline in Medicare payments for CT and MRI exams completed at private practices to both radiologists and nonradiologist providers between 2004 and 2016.
Payments for CT decreased by 48% for radiologists since they hit their peak in 2006 and decreased by 67% for nonradiologist providers since 2008. Payments for MRI decreased by 30% for radiologists and by 59% for nonradiologist providers since they reached their peak in 2006.
| Trends in Medicare reimbursement for CT, MRI performed at private practices | ||
| 2006 | 2016 | |
| CT payments to radiologists | $705.6 million | $365.5 million (2014) |
| CT payments to nonradiologists | $284.1 million (2008) | $94.7 million |
| MRI payments to radiologists | $1.1 billion | $483.5 million (2014) |
| MRI paymenst to nonradiologists | $247.7 million | $101.6 million |
Apart from radiology, the physician specialty with the highest total payments for CT were cardiologists, followed by primary care physicians, internal medicine specialists, urologists, and medical oncologists. For MRI, the most payments went to orthopedic surgeons, followed by neurologists, primary care physicians, internal medicine specialists, and neurosurgeons.
"Reduction of imaging payments to nonradiologist providers is an indicator that self-referral of medical imaging seems to be abating ... [and] is a positive change for the healthcare system," Kamel and colleagues wrote.
In recent years, however, major health insurers such as Anthem and United Healthcare have begun to deny coverage for nonemergent imaging exams performed at hospitals, and this shift in policy could drive many patients requiring a CT or MRI exam back toward privately owned practices and imaging centers, the authors noted.
"With this recent policy change, transition of imaging services back to private offices will likely occur in the near future and will be interesting to continue to monitor," they wrote. "It could lead to a resurgence of private office imaging among both radiologists and nonradiologist providers."
