MPPR expansion to group practice saves 1.23% of work at 25% fee cut

Potential efficiencies stemming from separate radiologists in a single practice interpreting different imaging scans performed in the same session on the same patient are extremely limited, with duplicated services averaging only 1.23 percent of total professional component fees, according to a study published online April 9 in Journal of the American College of Radiology.

The study provides more fodder for opponents of the Centers for Medicare and Medicaid Services’ (CMS) policy of a 25 percent multiple procedure payment reduction (MPPR). These cuts, which reduce professional component fees when multiple imaging services are provided to the same patient in the same session, initially were directed at individual physicians, but CMS has expanded the MPPR policy to apply to services rendered by different physicians in the same group practice, according to Geraldine McGinty, MD, chair of the American College of Radiology Commission on Economics, and co-authors.

“Although potential efficiencies exist when same-session separate imaging services are rendered by different physicians in the same group practice, these are minuscule and attributable only to preservice and postservice work within specific modalities,” wrote McGinty and colleagues.

Results were based on a breakdown of the relative contributions of various preservice, intraservice and postservice physician activities, determined by an analysis of Medicare Resource-Based Relative Value Scale. An expert panel quantified potential duplications in these activities when separate exams are performed in the same session by different physicians in the same practice.

The panel could identify no intraservice work duplication when interpretations were rendered by different physicians in the same group practice. Other activities, such as obtaining informed consent, were deemed to have 100 percent potential duplication, while activities that may require additional work, such as discussing findings with a referring physician, were determined to have 5 percent potential duplication.

Maximum potential duplicated preservice and postservice activities ranged from 5 percent (for radiography, fluoroscopy and nuclear medicine) to 13.6 percent (for CT). Taken together with the lack of intraservice work duplication, the overall potential total work reduction ranged from 1.39 to 2.73 percent, according to the authors.

This rate of duplication is lower than that seen with services performed by a single physician. “Compared with services performed by the same physician, we found that calculated potential preservice and postservice work duplications are considerably less when services were rendered by different physicians,” wrote the authors. “Although efficiencies occasionally occur, for example, when a single radiologist interpreting two studies makes a single phone call to a referring physician, such efficiencies clearly cannot exist when two or more separate radiologists perform separate and distinct professional services, sometimes from entirely different locations.”

McGinty and colleagues called for greater methodologic rigor from CMS, along with more transparency and accountability in Medicare payment policy development.