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GAO Report Documents Decline in Use of Advanced Diagnostic Imaging

A new report from the Government Accountability Office (GAO) shows that office-based advanced diagnostic imaging (CT, MRI, nuclear medicine, and PET) for Medicare beneficiaries has been declining steadily since 2009.  The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) required that offices providing advanced diagnostic imaging (ADI) services be accredited by a CMS approved organization (e.g., ACR). MIPPA also mandated that the GAO examine the effect that the accreditation requirement may have on beneficiary access to ADI services. The GAO did not find any connection between the decline in ADI services and the accreditation requirement put in place by MIPPA. Rather than accreditation, the GAO attributed the reduction in the use of ADI services to the following:

 

  • Medicare payment reductions: reduced Medicare technical component payments for ADI. In addition, CMS began applying a multiple procedure payment reduction (MPPR) to first the technical component and then the professional component.
  • Prior Authorizations. Studies suggest that the increased use of prior authorization by commercial insurers contributed to the decrease in ADI services.
  • Radiation Awareness. Greater public awareness of the risks associated with radiation exposure may have led to a drop in the use of CT and nuclear medicine services.

INDUSTRY NEWS TAGS: Radiology


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