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    Urologists protest CMS cuts to in-office imaging fees

    AUA, others bristle at allegations of substandard quality, overuse

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    Bob Gatty
    Washington—Changes in federal policy that could hinder urologists' ability to provide in-office imaging services to patients appear to be on the way, threatening to toss another punch at physicians already confronting hefty Medicare fee schedule reductions in 2007.

    The Centers for Medicare & Medicaid Services is finalizing proposed new rules that would place more restrictions on the ability of physicians to refer patients to facilities in their own offices or to facilities shared with other physicians for imaging scans. The restrictions would come on top of reimbursement reductions imposed by the Deficit Reduction Act of 2005 (DRA).

    Under that law, payment will be reduced by 25% for additional imaging procedures furnished on contiguous body parts during the same session. Physician payments for furnishing imaging procedures will be capped at the amount paid to hospital outpatient departments for the same service.

    Those provisions take effect in 2007, at the same time when an overall average 5.1% cut in payment rates for all physician-related services under Medicare is scheduled to be implemented, unless Congress acts as it did in 2006, when reductions also were ordered by CMS.

    AUA estimates that the combined Medicare payment cut ordered by CMS and the imaging cuts required by the DRA will average 5%, or $9,000 annually for each participating urologist. Thus, AUA has urged its members to contact their congressional representatives to ask that the Medicare fee cut be replaced with a 2.8% increase recommended by the Medicare Payment Commission.

    Medicare is also planning to amend existing self-referral regulations "to place restrictions on what types of space ownership or leasing arrangements will qualify for purposes of the in-office ancillary services exception or the physician services exception," according to a CMS press release.

    Under current rules, group practices may self-refer for diagnostic tests provided in their own offices or in a location leased for this purpose. However, physicians are not supposed to make a profit on those tests by charging Medicare more than what the tests cost.

    One provision of the proposed rule would prohibit group practices with their own in-office imaging services from billing Medicare for the work of a part-time radiologist hired to interpret the scans. The radiologist would, instead, bill Medicare directly for his services.

    In addition, the rules would seek to limit "condo" or "pod" laboratories that are shared by several practices in the same location that together cover overhead costs and are able to profit from those services.


    Fast Facts
    AUA stoutly defends what it calls "patient-centered imaging." In a document on its web site, "The Facts on In-office Diagnostic Tests," AUA said it is concerned about allegations that diagnostic imaging performed by physicians other than radiologists is "substandard" and "unnecessary" and that the growing use of such tests is principally attributable to in-office testing by physicians other than radiologists.

    "None of the allegations are true," the statement says. "There is no credible evidence that in-office imaging is being conducted inappropriately or is resulting in inaccurate diagnoses."

    AUA points out that urology residency education requires "extensive" training in diagnostic imaging tests.

    "Nor is there any basis for the allegation that office-based imaging is the primary cause of increased utilization," the AUA statement declares, noting that "many factors have influenced growth in the volume of imaging services, including improved technology; changes in the standard of care for many illnesses; expansions in coverage for new diagnostic imaging modalities; and shifts in the site of service from hospitals to other health care settings."

    Will changes jeopardize care?

    The AUA document also contends that a prohibition on in-office diagnostic testing would reduce patient access to timely, convenient testing and would disrupt continuity of care.

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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