MITA Says CMS Improved Final HOPPS Rule but Threat Remains for Patient Access to Advanced Imaging Services

12.04.13

MITA Applauds Elimination of Physician Fee Schedule Payment Cap          

Washington, D.C. – The Medical Imaging & Technology Alliance (MITA) today said that the calendar year (CY) 2014 hospital outpatient prospective payment system (HOPPS) final rule issued by the Centers for Medicare & Medicaid Services (CMS) improves on the program’s earlier proposal by including a transition to more accurately account for costs associated with computed tomography (CT) and magnetic resonance (MR) services. At the same time, MITA noted that this new policy still includes inaccurate cost data that will lead to inaccurate reimbursements for advanced medical imaging services in the hospital outpatient setting. MITA also applauded changes in the CY 2014 physician fee schedule (PFS) final rule, which should help avoid new barriers to access to radiation therapy (RT), ultrasound, echocardiography and other important services in the non-hospital setting.

“MITA appreciates that CMS acknowledged some of our concerns about utilizing separate cost centers for the calculation of Medicare reimbursements for CT and MR,” said Gail Rodriguez, executive director of MITA. “Our hope is that the four-year transition period will help hospitals incorporate the necessary changes to ensure only valid data are used to determine payments. Moving forward, it is critical that reimbursement reflects the full value and operational cost of each technology and that patient access to life-saving imaging is preserved.”

In September, both MITA and the Advisory Panel on Hospital Outpatient Payment (HOP Panel) expressed concern regarding the use of separate cost centers for CT and MR in the draft HOPPS rule. The final rule provides a four-year period for hospitals to transition to different methods for calculating costs for these services in an effort to improve the accuracy of Medicare reimbursements.

MITA also said it supports CMS’ decision to reject a PFS proposal that would have capped payments for more than 200 codes within the physician fee schedule at the 2013 hospital payment level for services such as chemotherapy administration, diagnostic imaging, radiation therapy and pathology. CMS eliminated this proposal, which would have threatened patient access to RT services in the freestanding setting.

“MITA applauds CMS for not implementing its proposal to cap reimbursement for RT and other services in the PFS at HOPPS payment rates,” said Rodriguez. “Eliminating arbitrary reimbursement caps should help safeguard patient access to RT services, regardless of whether therapy is administered in a hospital or private practice setting.”

In addition, MITA commended CMS for not including in the final PFS rule the proposal to package certain diagnostic tests, such as echocardiography and other ultrasound procedures, into the Medicare reimbursement rates for other significant procedures performed on the same date of service.

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The Medical Imaging & Technology Alliance (MITA), a division of NEMA, is the collective voice of medical imaging equipment, radiation therapy and radiopharmaceutical manufacturers, innovators and product developers. It represents companies whose sales comprise more than 90 percent of the global market for medical imaging technology and radiation therapy. For more information, visit www.medicalimaging.org. Follow MITA on Twitter @MITAToday.