The Centers for Medicare and Medicaid Services has decided to trim proposed cuts to advanced imaging services, but radiologists warn the cuts will still hurt a profession already reeling from years of pay reductions.

An earlier proposed rule suggested slashing the professional component to doctors by 50 percent for subsequent scans when they perform multiple MRI, CT or nuclear medicine procedures on the same patient during the same visit, as CMS argues there are efficiencies that justify the reduced reimbursement. Currently, CMS cuts the technical component in such circumstances by 50 percent.

However, a backlash from doctors has led CMS to re-analyze their data. Now, the agency says it will lower the cut to 25 percent next year, according to the final 2012 Medicare physician fee schedule with comment period, released Tuesday.

Still, the cuts, while smaller, aren't sitting well with radiologists.

"Obviously, the 25 percent reduction is lower than 50 percent, but we still think that's unsupportable," Shawn Farley, a spokesman for the American College of Radiology, told DOTmed News. "When you put that on top of the $5 billion in imaging cuts that have already been absorbed by imaging providers nationwide since 2007, that's going to start to affect access."

ACR also says the cuts aren't based on good evidence. For instance, a Journal of the American College of Radiology study published in June, which was submitted to CMS, found only modest efficiencies for doctors performing multiple scans, as pre-scan preparations and post-scan organizational work didn't occupy a significant chunk of the doctors' time. In the study, duplicated pre- and post-service services during the scans ranged from 19 percent in nuclear medicine to 24 percent in ultrasound, translating to, at most, professional fee schedule reductions of between 3 and 5 percent, the study argued.

Also, in comments sent to CMS, critics noted that imaging technology has become more complex and doctors have to interpret many more images than before, leading to extra burdens.

CMS' justification

But CMS says that after re-analyzing its claims, it found there are efficiencies in the multiple scan scenario. In the final rules, CMS said it found most multiple scans are usually done in the same body region with the same modality, likely looking for a single underlying pathology. Thus, it said there was considerable duplication of work, such as reviewing patient history, selecting protocols and communicating them with staff, narrating reports, and sharing findings with referring physicians.

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