RBMA Applauds Congressional Action on MPPR and Mammography Standards

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The Radiology Business Management Association commends Congressional leadership for protecting patients’ access to high quality medical imaging.

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RBMA members worked to educate their elected representatives about the appropriateness and magnitude of the cut based on their personal practice experience as well as published literature.

The Radiology Business Management Association (RBMA) is pleased that H.R. 2029, the Consolidated Appropriations Act of 2016 (omnibus text; section-by-section summary) passed by Congress on December 18 includes two important provisions to ensure patients continue to have access to life-saving medical imaging.

The first provision corrects a steep cut to the payment radiologists receive for their expert interpretation of medical images. Professional standards for radiologists dictate that they give each image they interpret equal attention. However, in 2012, the Centers for Medicare and Medicaid Services reduced payment for the professional component (the interpretation) of medical images when multiple images of the same patient were taken on the same day. Without furnishing evidence to justify the cut, CMS reduced payment for the interpretation of all but the first image taken of the patient by 25 percent. This “multiple procedure payment reduction or MPPR” rested on an assumption that radiologists would spend significantly less time interpreting subsequent images done on the same patient in the same day.

“RBMA members worked to educate their elected representatives about the appropriateness and magnitude of the cut based on their personal practice experience as well as published literature,” says Mike Mabry, executive director of the RBMA. “H.R. 2029 corrects this issue by mandating that CMS reduce the multiple procedure payment reduction on the professional component of imaging to 5 percent starting on January 1, 2017.”

Also of great interest to RBMA members, the omnibus bill aims to protect access to annual mammograms for women, starting at age 40, by directing the Secretary of the Department of Health and Human Services to follow the U.S. Preventive Services Task Force 2009 breast cancer screening guidelines and not the 2015 draft guidelines that controversially delayed the start date for mammograms to age 50 and changed the frequency to every two years.

“The RBMA believes that discussions about the appropriate age to begin breast cancer screening and the frequency of screening are best held between a woman and her clinician,” says Suzanne Taylor, FRBMA, president of the RBMA Board. “We are pleased to see that Congressional leaders are as concerned as we are about one set of standards being used to set payment policies for mammograms that could arbitrarily restrict many women’s access to this life-saving test.”

CMS policies are often adopted by private insurance companies, therefore RBMA believes that once the omnibus bill is signed into law, its members can advocate for private insurance plans to quickly update their policies as well.

“Already, many insurance companies had copied the MPPR cut despite the lack of data to justify it,” Mabry says. “We hope they will move swiftly to undo this policy now that its problems have been exposed and corrected by Congress. Likewise, we hope the requirement that HHS follow the 2009 USPSTF breast screening standards that have saved countless lives discourages private insurers from reducing mammography screening coverage for their beneficiaries.”

About RBMA
The Radiology Business Management Association (RBMA) is a national not-for-profit association providing members with applied business information and intelligence applicable in any radiology setting. The RBMA has approximately 2,300 members involved in various management capacities in private practices, academic radiology groups, imaging centers and hospitals. The RBMA continues to be recognized as the leader for radiology-specific educational programs, products and services, publications and data.

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Daphne Gawronski
Radiology Business Management Association
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