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Quiz: Who got pushed off the fiscal cliff?

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By Cristen Bolan, MS, Executive Editor of Applied Radiology


There is no such thing as a free lunch—in the end someone has to foot the bill. So, here’s my question: 


Who got pushed off the fiscal cliff?

     A. The Hospitals

     B. The Doctors  

     C. The Patients


Well, lets look at the facts:

The American Taxpayer Relief Act of 2012 passed on January 1, 2013. The law includes the “doc fix” designed to prevent steep cuts in Medicare reimbursements to doctors.1 While the "doc fix" aims to avert a 27% pay cut slated to hit doctors due to the sustainable growth rate, the $30 billion price tag is offset in the bill by cuts in reimbursement to other Medicare providers over the next 10 years,2 and hospitals will pickup nearly 50% of the tab.Sounds like paying Peter to save “fiscal cliff” Paul.


So, the answer is A. The hospitals.


Well, the plot thickens. When we say hospitals, it means the “doc fix” also hits up radiological services to foot the bill. It does this by increasing the technical component (TC) equipment utilization threshold for advanced imaging modalities from the current 75% to 90% beginning January 2014.2 This aims to save Medicare $800 million over the next 10 years.

The law also slashes Medicare payments for radiation oncology over 10 years, with a 19% cut to freestanding therapy centers and $300 million in reduced funding to treat cancer.

Don't forget, the ACR put up a good fight. It tried to prevent the TC payment decreases and advocated for the inclusion of the H.R. 3269/S. 2347, the Diagnostic Imaging Services Access Protection Act, in the final legislative package. The H.R. 3269/S. 2347 was created to prevent Medicare from implementing a 25% reduction to the professional component of certain diagnostic imaging services for multiple imaging studies administered to the same patient, by physicians in the same practice setting, on the same day.  

But in the end, someone had to pay. 


Here is the break down:

Hospitals Cuts4

• IPPS Documentation and Coding Adjustments for Implementation of MS-DRGs:  This provision phases in the recoupment of past overpayments to hospitals made as a result of the transition to Medicare Severity Diagnosis Related Groups (MS-DRGs). Savings: $10.5 billion

• Certain Radiology Services Payments: This provision equalizes reimbursement for stereotactic radiosurgery services provided on under Medicare hospital outpatient payment system. Savings: $40 million

• Adjustment of Equipment Utilization Rate for Advanced Imaging Services:  This provision would increase the utilization factor used in the setting of payment for imaging services in Medicare from 75 percent to 90 percent. Savings: $80 million


So, it is the docs? 

Here's one more hint: The “doc fix” will impact severe trauma patients or those with cancer and other illnesses, which require multiple imaging procedures.“Reverting to continuous provider cuts to help pay for a morbidly flawed payment policy… is a disservice to our nation’s seniors," Paul Ellenbogen, MD, FACR, the ACR Board of Chancellors Chair noted.4


So what is the answer?



     D. All of the above





1._Medicare. The New York Times. Posted January 2, 2013. Accessed January 8, 2013.

2._Solana K. A Look at Medicare Costs and Cuts in the Fiscal Cliff Deal. The Medicare Newsgroup. Posted January 2, 2013. Accessed January 8, 2013.

3._ACR Update on Diagnostic Imaging Services Access Protection Act Bills in Congress. Society for Vascular Ultrasound. July 2012. Accessed January 8, 2013.

4._ACR Statement on Imaging Cuts in Fiscal Cliff Legislation. 2, 2013. Accessed January 8, 2013.

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