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Medical groups call on Congress to waive policy that would cut $10 billion over a decade

by John R. Fischer, Senior Reporter | June 22, 2020
Groups of medical organizations are urging Congress to do away with an upcoming policy change that they say would cost medical imagers more than $10 billion over the next decade.
A greater number of radiology and other healthcare-related organizations are getting behind a push for Congress to stop a payment policy change that would cost medical imagers over $10 billion over the next decade.

Twenty-three medical societies have now joined an initial 30 opposing the change, with all 53 signing their names to a letter this week that petitions lawmakers for relief from changes to the evaluation and management codes set to take effect on January 1, 2021. Among them are the American College of Radiology, Society of Interventional Radiology and Radiology Business Management Association.

“We are deeply concerned that adhering to existing budget neutrality requirements for implementing the new policy will generate sizable cuts for various sections of the provider community,” they wrote. “We urge Congress to recognize that now is not the time to implement any payment policy changes that will exacerbate the financial instability of healthcare providers’ practices.”

The groups assert in their letter that the pandemic has created “substantial financial uncertainties” that are expected to have lasting impacts on healthcare practices and hinder patient access to care. They explain that such reasoning has prompted them to urge Congress to waive the budget neutrality requirements stipulated in Section 1848(c)(2) of the Social Security Act for the finalized evaluation and management (E/M) code proposal.

These requirements relate to the federal government’s decision to add about $5 billion to reimbursement for care-related E/M services. To keep the budget neutral, the requirements would create cuts to pay for radiologists and other providers who do not typically use E/M codes.

A study commissioned by ACR and released last month found that the changes would amount to a loss of almost $770 million in Medicare payments for medical imaging in the first year of its implementation, and about $10 billion for all Medicare outpatient imaging services, regardless of medical specialty, by the end of a decade.

“The findings reinforce the ACR’s recent message to Congress about the significant negative consequences the impending 2021 CMS E/M policy will have on radiologists and other medical providers that do not frequently bill E/M services,” said the ACR in a statement.

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