Imaging volume per Medicare beneficiary fell by 1% from 2010 to 2011, but the decline represents just a small part of the overall rapid growth of imaging procedures over the past decade, according to the Medicare Payment Advisory Commission's (MedPAC) annual report to Congress.
The agency recognized the 2011 decline in Medicare imaging volume in its March 15 report, but it focused on the fact that overall cumulative growth in imaging volume from 2000 to 2009 totaled 85%, compared to a cumulative decrease in imaging volume in 2010 and 2011 of less than 4%.
"Despite decreases in 2011 and 2010, use of imaging services remained much higher than a decade ago," MedPAC wrote in its Report to the Congress: Medicare Payment Policy. "The growth in imaging volume from 2000 to 2009 was exceeded only by the growth in the use of tests -- such as allergy tests -- during those years."
| Changes in Medicare imaging volume | |
| Average annual change in units of service per beneficiary, 2006-2010 | 1% |
| Change in units of service per beneficiary, 2010-2011 | 0.6% |
| Average change in volume per beneficiary, 2006-2010 | 1.3% |
| Change in volume per beneficiary, 2010-2011 | -1% |
| Percent of 2011 allowed charges | 12.6% |
What caused the imaging procedure decline? Partly the shift of some cardiovascular imaging studies from physician offices to hospital outpatient departments, MedPAC found -- and if that factor is removed, imaging volume actually slightly increased.
"Much of the 1% decrease in the volume of imaging services is due to decreases in units of service for two cardiovascular services: nuclear medicine and echocardiography," MedPAC wrote. "The more important factor, however, is the shift in setting for these services from the nonfacility setting to the facility setting. If these two types of services are excluded from the calculations, the change in the volume of imaging services from 2010 through 2011 would be an increase of 0.5%."
SGR repeal is urgent
In its report, MedPAC also emphasized the importance of repealing the sustainable growth rate (SGR). Although President Barack Obama signed a bill in January that delayed the reduction in fees under the SGR for calendar year 2013, Congress must repeal it permanently, MedPAC said.
The commission cited four flaws in the formula that make it unsustainable:
- The SGR system has failed to restrain growth in procedure volume -- and may have exacerbated it.
- Temporary, stop-gap fixes to override the SGR undermine the credibility of Medicare because they engender uncertainty and anger among physicians and other health professionals, which may cause anxiety among beneficiaries.
- The SGR is inequitable; it neither rewards health professionals who restrain volume nor punishes those who prescribe unnecessary services.
- While the Congressional Budget Office's most recent budget projection has reduced the cost of repealing the SGR, the budget score is volatile, and the cost of the SGR repeal will likely continue to grow, creating pressure to repeal it now.
"Deferring repeal of the SGR will not leave the Congress with a better set of choices: The cost will likely increase and the array of new payment models is unlikely to change," MedPAC said in its report. "Beneficiary access to care must be protected, and proposals to replace the SGR must be fiscally responsible."
