MPPR continues to haunt imaging

The Centers for Medicare and Medicaid Services’ (CMS) focus on multiple-procedure payment reductions (MPPRs) as a way to curb imaging growth is one of radiology's greatest challenges, according to an article published in the April issue of the Journal of the American College of Radiology (JACR).

Legislation has been proposed to block expansion of these cuts, but radiologists have to be proactive in advocating against them, according to Bhavya Rehani, MD, of Massachusetts General Hospital in Boston, and colleagues.

Summing the history of MPPRs, the authors explained that they were first applied to the technical component (TC) of advanced diagnostic imaging services in the 2006 Medicare Physician Fee Schedule final rule. Reductions applied to multiple diagnostic imaging services administered to the same patient, by the same physician during a single healthcare encounter, and initially only to procedures within a specific set of codes when imaging contiguous body parts.

The Patient Protection and Affordable Care Act increased these cuts from 25 percent of the TC to 50 percent, explained Rehani and colleagues. The 2011 Medicare Physician Fee Schedule final rule also expanded the scope to include noncontiguous body parts and different modalities.

In 2011, the Medicare Payment Advisory Commission recommended to Congress and CMS that a 50 percent MPPR should be applied to the professional component (PC) of advanced diagnostic imaging services, setting off multiple years of conflict around the issue.

“The [American College of Radiology (ACR)] vigorously protested against this policy proposal in its formal comments to CMS,” wrote the authors. “In addition, more than 5,000 individual radiologists from around the country submitted comments to the agency in opposition to this flawed reimbursement reduction.”

CMS decided to lower the PC MPPR to 25 percent, but then began efforts to expand PC MPPR to the group practice setting and applied it to two different physicians interpreting multiple images from the same patient, during the same session.

“There is no sound rationale behind the application of a PC MPPR, especially given the fact that radiologists are morally and professionally obligated to spend equal amounts of time, energy, and expertise interpreting multiple patient images, irrespective of modality or section of the body under review,” wrote the Rehani and colleagues. They also pointed to a study in JACR that showed PC efficiencies range from 2.96 percent to 5.45 percent, rather than the 25-50 percent reductions that were the targets of MPPR efforts.

Representatives Pete Olsen (R – TX) and Betty McCollum (D – MN), along with Senators Ben Cardin (D – MD) and David Vitter (R – LA), introduced companion bills in both the House and Senate under the name the Diagnostic Imaging Services Access Protection Act. While not passed initially, the legislation has been reintroduced in the current Congress, and Rehani and colleagues advised radiologists to contact their senators and members of Congress to voice opposition to expanded application of an MPPR to the PC.