Reimbursement is a hot button. This month, radiology is reacting on two different fronts.

Many in the radiology community are upset with the American Medical Association’s House of Delegates resolution that in June urged the AMA to advocate that Medicare and private insurers reimburse all physicians for ultrasound services, regardless of their specialty.

Specifically, the AMA House of Delegates urges the AMA to “vigorously advocate with Medicare and other payors that all appropriately trained physicians, regardless of specialty, be reimbursed for performing diagnostic sonography … in situations with defined clinical indications.” There is a lot of room in the language of the resolution, introduced by the American College of Surgeons, such as defining “appropriately trained physicians” and “defined clinical indications.”

Concerned members of the radiology community, such as the ACR, want to be sure physicians billing for ultrasound procedures are properly educated, trained and qualified to do them. And we, as patients, do too. This also means a certain volume and frequency should be maintained to keep the physician sharp. Self-referral is another issue when physicians could both order and interpret scans, as is the question of who handles image archival of the ultrasound images — just in case trouble arises later.

Remember, though, that AMA resolutions in the past have held little bearing on what the Centers for Medicare and Medicaid Services (formerly HCFA) and private insurers actually do. This resolution requests that more physicians get paid for procedures when it is clear that reimbursement volume is declining. In the end, does the lack of reimbursement limit patient access to well-trained specialists, such as cardiologists, gynecologists or surgeons that do not happen to be radiologists? That is CMS’ decision and we’ll have to wait and see.

CMS also is making waves with its mid-August release of the proposed 2003 Medicare schedules. Point your browser to http://www.access.gpo.gov/su_docs/fedreg/a020809c.html if you want to download all 189 pages!

Again this year, radiology services are being hit hard as are outpatient imaging facilities. One area greatly effected are breast biopsies, as CMS proposes to cut by more than half the payment rate for image-guided percutaneous biopsies (CPT code 19102) to $157.07 from $341.15. Image-guided biopsies with devices (19103) was cut to $289.69 from $384.87 in 2002. Seemingly strange (at least to me) in this time of less invasive procedures gaining favor, open surgical biopsies (19101) are getting a big boost — to $907.04 from $716.63 this year.

Diagnostic mammography payment rates increased slightly, to $35.89 from $32.54. But as we know, the radiology community will still struggle greatly to make ends meet.

The new rates are not yet set in stone since a comment period runs through Oct. 8, 2002 at 5 p.m. So get your written comments (one original and two copies) in, making reference to file code CMS-1206-P, Centers for Medicare & Medicaid Services, Attention: CMS-1206-P, PO Box 8018, Baltimore, MD 21244-8018.

I also want to mention MQSA. Last month I wrote about mammography (and got the most feedback I’ve ever received on any column I’ve written in 6 years), but didn’t get to include some positive attributes of MQSA 2002 legislation now before Congress.

MQSA 2002 seeks to extend the MQSA program five years and looks to set up a study of MQSA by the Comptroller of the U.S. to evaluate the frequency of inspections, the accessibility of mammographic services, and the roles of states as accreditation and certification bodies. A second study, this one by the Institute of Medicine, also would be commissioned to make recommendations regarding areas for improvement.

After the recent bad press mammography has received, I am glad to see positive changes via MQSA for the future.

Mary C. Tierney, Editor
mtierney@mwc.com