From the Departments of Medicine (B.B.N.).
Radiology (F.N.V.), Division of Body MRI, Johns Hopkins University, Baltimore, Maryland.
AJNR Am J Neuroradiol. 2018 Apr;39(4):612-617. doi: 10.3174/ajnr.A5555. Epub 2018 Feb 22.
The Centers for Medicare and Medicaid Services imposed a 25% professional component multiple procedure payment reduction for the professional component of advanced diagnostic imaging modalities in January 2012. In 2017, the Centers for Medicare and Medicaid Services rolled back the multiple procedure payment reduction to 5% for subsequent imaging. To evaluate the effect of this change, we analyzed 5 months of Centers for Medicare and Medicaid Services procedures at Johns Hopkins Medical Institution.
We analyzed the procedure codes and reimbursement rate for studies performed between January 1 and May 31, 2017. Patients with Medicare insurance who had multiple diagnostic procedures in a day were selected. Per the Centers for Medicare and Medicaid Services guidelines, procedures with the highest price were considered fully reimbursed and subsequent studies were marked for differences between 25% (2013-2016) and 5% reduction (2017).
We included 8787 patients with 22,236 procedures (mean, 2.53 studies/day). CT, MR imaging, and ultrasound scans composed 75.9%, 21.5%, and 2.6% of all studies, with 61.2%, 54.9%, and 85.4% of the procedures of each technique subject to multiple procedure payment reduction, respectively. The projected reimbursement for these studies was $1,666,437, which translated to a $179,782 (12.1%) increase in revenue comparing 25%-versus-5% multiple procedure payment reduction rates for 5 months: $128,542 for CT, $47,802 for MR imaging, and $3439 for ultrasound. The annual overall prorated increase in revenue would be $431,476. The impact was maximal for neuroradiology.
With the recent favorable adjustment in multiple procedure payment reduction regulations, CT-heavy subspecialties like neuroradiology benefit the most with revenue increases. Different practice settings might experience revenue increases to a different extent, depending on the procedure and payer mix.
2012 年 1 月，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）对高级诊断成像方式的专业组件实施了 25%的专业组件多次程序支付削减。2017 年，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）将随后的成像多次程序支付削减恢复到 5%。为了评估这一变化的效果，我们分析了约翰霍普金斯医疗机构 5 个月的医疗保险和医疗补助服务程序。
我们分析了 2017 年 1 月 1 日至 5 月 31 日期间进行的研究的程序代码和报销率。选择了在一天内进行多项诊断程序的有医疗保险的患者。根据医疗保险和医疗补助服务中心的指导方针，价格最高的程序被视为全额报销，随后的研究则根据 25%（2013-2016 年）和 5%的降低（2017 年）之间的差异进行标记。
我们纳入了 8787 名患者的 22236 项程序（平均每天 2.53 项）。CT、MR 成像和超声扫描分别占所有研究的 75.9%、21.5%和 2.6%，其中 61.2%、54.9%和 85.4%的程序分别受到多次程序支付削减的影响。这些研究的预计报销金额为 1666437 美元，与 25%-5%的多次程序支付削减率相比，这意味着在 5 个月内收入增加了 179782 美元（12.1%）：CT 为 128542 美元，MR 成像为 47802 美元，超声为 3439 美元。按比例计算，年收入将增加 431476 美元。这种影响在神经放射学方面最大。
随着最近多次程序支付削减规定的有利调整，像神经放射学这样 CT 密集型的亚专业受益最大，收入增加最多。不同的实践环境可能会根据程序和支付者组合的不同而获得不同程度的收入增长。
