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Effort to cut Medicare spending on imaging scans gets pushback

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A Medicare advisory body is urging Congress to cut pay to doctors for MRIs, CT scans and other imaging procedures, noting that use of such devices has surged since 2000, particularly among doctors who stand to profit from each scan.

The proposal by MedPAC, or the nonpartisan Medicare Payment Advisory Commission, has been controversial, though, including opposition from two Congressmen who note that payment changes in 2005 already slowed the growth of those imaging services.

Kaiser Health News wrote about the debate, citing figures showing that medical imaging costs increased from $6.5 billion in 2000 to $11.7 billion in 2009.

In a June report to Congress [PDF], MedPAC shows that the growth in imaging services per Medicare beneficiary has surged by about 90 percent over the same time.

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While medical imaging can be a great tool for doctors, researchers note that scans bring risks of their own. Medical imaging for some conditions gives false-positive results that lead to unneeded invasive procedures. Overexposure to radiation is also a growing concern among health professionals and the public.

The MedPAC report cites the research of Stanford University professor Laurence Baker, who found that when it comes to MRI machines, if you build it, they will come. Specifically, Baker’s study found that a higher local prevalence of MRI machines is associated with, well, more MRI scans being done.

MedPAC also referred to its own research and others’ on another imaging phenomenon: Doctors who have a financial interest in sending a patient to get imaging tend to do so more than doctors who do not.

The report includes an analysis of Medicare claims data looking at 22 combinations of imaging types, such as MRIs or CT scans, with conditions, such as migraines and joint degeneration in the back. The study found that for 21 out of 22 of the condition-scan combinations, doctors with a financial interest suggested a scan more often than those who had none.

In addition to the pay cuts, the advisory body also is suggesting that Medicare start a “prior authorization” program for some of the most scan-happy doctors. The report cites a Congressional Budget Office estimate that such a program could save $220 million over five years or $1 billion in 10 years.

Kaiser Health News talked to a leader with MedPAC, who described the group’s rationale:

"There's some bad behavior going on out there, with physicians buying imaging equipment and generating unnecessary services," Robert Berenson, MedPAC vice chairman, said in an interview. "It seems prudent to target high utilizers for authorization."

Despite the potential cost savings, two Congressmen – one Republican and one Democrat –are pushing back on the proposal, sending a letter to MedPAC. In the letter, they argue that 2005 federal budget changes already put a lid on imaging use.

A coalition of health providers also opposes the pay cut, urging Congress to instead back the use of “clinical decision support tools” to improve the use of imaging.

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