CMS aims to boost quality, streamline rates for imaging
Changes are incremental, but complex
The Centers for Medicare and Medicaid Services (CMS) has proposed a new rule that would, if approved, update its payment policies and rates for hospital outpatient departments, including imaging, in the calendar year 2009.
In addition, while freestanding imaging centers are not directly impacted by the proposal, whatever happens in the hospital setting will have some effect because under the provisions of the Deficit Reduction Act, CMS pays whichever fee is lower: the payment dictated under the Medicare physician fee schedule or the outpatient prospective payment system (OPPS), according to Pam Kassing, RCC, senior director of economics and health policy for the American College of Radiology based in Reston, VA. The proposed changes are part of a multi-pronged effort by Medicare to improve how it pays for health care services, according to Ken Weems, the acting administrator of CMS.
Under the rule, CMS projects that its 2009 payment rates under the Outpatient Prospective Payment System will boost payments to Medicare providers by 3.2%. However, CMS is also proposing to reduce by 2% the inflation-based increases in payments to hospitals that fail to report on required quality indicators, and the agency is proposing to add four new quality measures related to imaging efficiency to the seven existing measures that hospital outpatient departments must report on this year.
While reporting on these quality measures would be mandatory for hospitals that want to receive full reimbursement for their imaging services, it would be voluntary for freestanding centers. However, Kassing indicates that the American College of Radiology is encouraging all of its members to get used to the reporting requirements. "In the future Medicare care make this [reporting requirement] mandatory, and it is not an easy system to figure out, so we think radiology [groups] should be practicing how to get this right," she says. "Medicare is heading in a direction where they want measures."
CMS also is planning to establish five imaging categories or composite ambulatory payment classifications (APCs) to further streamline reimbursement when patients have multiple imaging procedures of the same type or category completed in a single visit. These categories include:
- ultrasound;
- CT and CT angiography (CTA) without contrast;
- CT and CTA with contrast;
- magnetic resonance imaging (MRI) and MR angiography (MRA) without contrast; * MRI and MRA with contrast.
Kassing emphasizes that this streamlining process does not necessarily mean that imaging departments will receive less reimbursement for services than in the past. "The general idea is that hospitals will continue to report their costs on separate studies, but when they are done in the same session and come in on the same claim, they will be [reimbursed] with one payment," she says. "Theoretically you could still report out the same costs and get the same amount of money coming back."
While payment formulas and methodologies might be tweaked continually, Kassing suggests that hospitals don't need to change their reporting behaviors in any way. "It is just a matter of whether Medicare pays back one comprehensive payment to the hospital or whether it is in two or three separate payments," she says.
Kassing adds that the five new composite APCs represent an incremental rather than a major change in the agency's payment process. However, she acknowledges that calculating payments and rates under the system is very complicated. "We are going to spend the next 60 days looking more at how the rates are calculated and what data [CMS] are using to make sure that this system is reasonable," she says.
(Editor's note: The proposed rule was scheduled to appear in the Federal Register on July 18, and CMS will be accepting comments on the suggested changes until Sept. 2, 2008. A final rule is expected by Nov. 1, with the approved changes taking effect in January. Readers can access more information on the proposed changes on the CMS Website here: www.cms.hhs.gov/HospitalOutpatientPPS/HORD)
The Centers for Medicare and Medicaid Services (CMS) has proposed a new rule that would, if approved, update its payment policies and rates for hospital outpatient departments, including imaging, in the calendar year 2009.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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