JACR: Outpatient interventional rad reimbursement plummets

Reductions in outpatient interventional radiology (IR) practice expenses under the Medicare Physician Fee Schedule (MPFS) have reduced reimbursement for interventional outpatient procedures--particularly in freestanding offices--far more than the Deficit Reduction Act (DRA) and other recent Medicare reimbursement changes, according to research published in the June issue of the Journal of the American College of Radiology.

Adam D. Talenfeld, MD, from the department of vascular and interventional radiology at Mount Sinai Medical Center in New York City, and colleagues sought to compare trends in reimbursement rates between hospital outpatient departments and freestanding physician offices for commonly performed interventional radiology procedures from 2006 through 2010.

Using final rules data from the 2006 and 2008 Hospital Outpatient Prospective Payment System (HOPPS) for Medicare and MPFS, reimbursement rates were calculated for a sample of procedures commonly performed by interventional radiologists in the outpatient setting. Hospital and freestanding reimbursement rates for 2006, 2008, and 2010 (projected) were adjusted for inflation to 2008 dollars and weighted by relative procedure frequency using Medicare Part B claims data. Reimbursements for the entire sample of procedures were compared year to year, by site of service and by payment system. Individual procedure reimbursements were also trended.

According to the results, reimbursements for the entire procedure sample in 2006 were 6 percent less in hospital outpatient departments than in freestanding offices. In 2008 and 2010, they are projected to be 3 percent and 23 percent greater, respectively, in hospital outpatient departments than in freestanding offices. Over the four-year interval, reimbursements are projected to fall by 36 percent in freestanding offices and by 16 percent in hospital outpatient departments. Reimbursements to hospitals for facility costs are projected to decrease by 14 percent. Reimbursements to physicians for work done in hospital outpatient departments are projected to decrease by 23 percent.

The authors noted that two economic trends appear to be affecting current IR practice: the downward-trending reimbursement under the MPFS and the integration of interventional procedures into clinical practice by non-radiologist specialists.

"Favorable reimbursement for outpatient interventional radiologic procedures performed in freestanding offices has until now enabled a growing minority of interventional radiologists to develop mature clinical practices," the authors wrote. "In the present and near future, however, implementation of the new Medicare practice expense methodology will substantially reduce reimbursement for outpatient interventional procedures, particularly in the freestanding office site of service. For the time being at least, more emphasis will likely be placed on hospital-based interventional practice."