Farley says these cuts will, indirectly, affect other services, like mammography. Although mammography is not covered in these rule changes, the modality is a loss leader, Farley says, and many independent clinics have to make up for the low level of reimbursement and high malpractice insurance of this service by offering CT and MRI scans, something they may not be able to do under the new rules.

This could then result in a further drop in number of mammography centers operating outside of big cities, an unintended consequence that could affect patient access to potentially life-saving studies. And with the drop, as more people are going to fewer centers for mammograms, wait times, which are already high in some places, will shoot up.


Real utilization rate

The thrust behind the cuts has been the impression that the costs of imaging are out of control, and part of what makes health care eat up almost 15 percent of U.S. GDP, 50 percent more than what Canada spends, according to a recent Thomson Reuters report. (DM 10590)

Yet, the ACR says imaging has become a sort of bogeyman, and that its being responsible for the bulk of the growth in health care costs is a myth.

"This notion that imaging is skyrocketing or out of control is untrue," Farley says. "It's misguided and based on old information. Look at the March 2009 MedPAC report. From 2006 onward imaging has flatlined. Growth is only 2 percent annually," he adds, "and that's in line with or below all other physician services." (DM 8499)

In fact, says Farley, the recent Moran study suggests that in 2008, MRI utilization actually declined by half a percentage point.

As for utilization rates, he says CMS's expectations are unrealistic and not in keeping with the facts on the ground, especially at rural centers. He says that the recent RBMA study showed that average nationwide utilization rates were around 54 percent, not 90 percent, and that they dropped to as low as 48 percent at clinics in rural areas.

"Except for your large urban hospitals, most places aren't getting near 80 percent," he says. "And you wouldn't want utilization rates at 90 percent. You're going to see mistakes made at that point. You would have someone literally on the table 24/7. That's not a good thing for medicine to be pushed in that direction."

*Paste the DM number into any DOTmed.com search box to read the story. (DRA stories include DM 3432, 3508, 4508, 5774, 7072, and 9244)

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