American College of Cardiology

The Government Accountability Office (GAO) on September 26 released a report titled “Medicare: Trends in Fees, Utilization and Expenditures for Imaging Services before and after Implementation of the Deficit Reduction Act [DRA] of 2005.” The report examined the effect of a provision of the DRA that mandated that Medicare fees for certain imaging services covered by the physician fee schedule may not exceed what Medicare pays for these services under the hospital outpatient prospective payment system (OPPS). The provision took effect on imaging tests performed on or after Jan. 1, 2007. The report found:

• The cap reduced the fee for the performance of about one in four imaging tests, with advanced tests more likely to be paid at the OPPS level
• Expenditures in 2007 on imaging tests declined although utilization continued to increase, unlike from 2000 to 2006, where both utilization and expenditures rose
• The volume of imaging subject to the cap grew in volume at almost four times the rate as imaging not subject to the cap

The GAO concludes, “Although implementing the OPPS cap raised concerns that reduced fees might curtail beneficiary access to physician imaging services, our analysis suggests that this did not occur in 2007.”

However, the wide-scale cuts implemented through the DRA do not address appropriateness in imaging, nor are the levels of appropriateness for the tests performed during the study years addressed in the GAO’s report. The blunt cuts to imaging implemented by the DRA do not improve the quality of care given to patients, which should be a factor in any changes to Medicare.

The ACC believes that the best way of ensuring cost-effective imaging is to encourage the use of appropriateness criteria, which helps physicians determine when and how often to do a given procedure. The ACC also supports the use of accreditation to improve imaging services, which can help reduce inappropriate imaging by serving as a barrier to entry for new imaging laboratories that otherwise would not meet standards set by accrediting bodies.