Medical RAC Audits Reviewed by Statistician Frank Cohen Medical RAC Audits Reviewed by Statistician Frank Cohen

Congress Could Delay Radiography Cuts

By Grant Huang, CPC, CPMA, Director of Content at DoctorsMangement  

CMS began cutting the payments you receive for taking X-ray scans using analog equipment on Jan. 1 of this year. The move  is intended to gradually prod providers into investing in more advanced X-ray equipment known as digital radiography (DR). AAOE has been engaged in a long and persistent discussion with members of Congress to address the impact these cuts have on orthopaedic providers and practices.

Now, key Republican members of the House of Representatives have signaled their willingness to support legislation to delay steeper cuts to X-ray payments in 2018, if “offsets” can be found. AAOE is pushing these members of Congress for a two or three-year delay whose financial impacts to the Medicare program would be theoretically offset by greater penalties after the delay ends, says Bradley Coffey, government affairs manager for the AAOE in Indianapolis.

“House members have made it clear to us that a repeal of the cuts are off the table, because the expected revenue from those cuts is being set aside to offset a cut to the multiple procedure payment reduction rule for radiologists,” Coffey explains. The benefit of a two or three-year delay to orthopaedic providers would be additional time to purchase the DR technology and implement it into their workflow, he says.

Review: X-ray cuts planned over 7 years

The payment cuts that are now in effect apply to the technical component (TC) of X-ray scans done on analog equipment. This means that physical interpretation, paid via the professional component (PC) of the CPT code for the X-ray scan, is not affected by the rule, now or ever. Coffey estimates, based on AAOE member surveys, that approximately 4% to 7% of the membership is still using analog film and has thus been affected by the cut, which is 20% of the TC in 2017.

However, if Congress doesn’t act before Jan. 1, 2018, CMS will expand the cut to X-rays taken using computed radiography (CR), which would affect nearly 80% of the AAOE membership, Coffey says. The CR cuts would reduce the TC of X-rays done via CR by 7% in 2018, and the penalty goes up to 10% in 2023.

In 2018, the average orthopaedic practice using CR technology would lose approximately $19,000 with a 7% cut to the TC of their X-rays, according to AAOE projections.

CMS has pointed out that DR technology has considerable benefits over analog or even CR: it produces digital images of the scan results in seconds, and the images are sharper and more detailed, while exposing the patient to less radiation. However, upgrading to DR can be costly. “Our surveys show the average cost to upgrade is about $80,000 to $100,000 for a practice,” Coffey says.

AAOE survey data has gotten some results as low as $30,000 and as high as $300,000, Coffey says. Practice size and geographical differences probably account for some of these outliers, but even a $30,000 upgrade isn’t cheap for a small practice while the time spent retraining staff on the new equipment is another sunk cost.

Expect action later this year

Coffey hopes Congress will take action later this year. A bill that delays the 2018 CR cuts by two years would be guaranteed to come with a penalty higher than 7% after the two years are up, but the extra time means far more orthopaedic practices will have had time to adopt DR technology.

Grant Huang, CPC, CPMA (  The author is Director of Content at DoctorsMangement.