Radiology Lobby: Focus on Professional Component Not Technical

The radiology community continues to challenge the reimbursement cuts that the government and private insurers impose on us. The current advocacy efforts address the cuts in the professional and technical components.

However, I somewhat disagree with utilizing our resources to prevent technical component cuts. In contrast, I feel we should forgo lobbying against technical component cuts and dedicate our efforts on fighting to increase our professional component reimbursement.

On average, the professional component makes up around 20 percent to 25 percent of the total reimbursement for a radiology procedure. For example, Medicare will pay approximately $70 for technical component and $28 for professional component for a breast ultrasound (76645) and will pay approximately $381 for technical component and $76 for professional component for MRI brain without contrast (70551).

Radiologists should focus on separating the two reimbursements and put forth an effort to educate lawmakers on the importance of radiology readings and how radiologists not only read radiology studies but also oversee the quality of radiology tests as well as provide consultation services to their peers in other specialties of medicine. Currently, the professional component is broken down into physician work, practice expense, and malpractice insurance and is then multiplied by a geographic practice cost index.

Given that most of the radiology studies are still read by radiologists, and there is an increasing trend of non-radiologists owning radiology equipment, we are not efficiently using our lobbyists to target maintaining or increasing our professional component.

More and more non-radiologists are buying equipment and are benefiting from the technical component. However, radiologists still read a majority of radiology studies performed, whether or not they are performed at their own facilities.

The multiple procedure payment reduction administered by CMS has negatively impacted physicians and greatly affects radiologists. The implementation involves a 50 percent reduction of any subsequent service performed on the same day for the same patient. The reduction not only reduces the technical component by 50 percent, but it also reduces the professional component by 25 percent.

Speaking from my own experiences, when reading a MRI cervical and lumbar spine on the same patient on the same day, I don't think I am a lot more efficient reading the second MRI study in comparison to the patient coming back in the future for the additional MRI study. I can understand the efficiency achieved in the technical component given that we only need to screen the patient once prior to performing both MRIs and taking the patient on and off the MRI machine may be easier by doing both studies on the same day.

What I am not content with is the notion that radiologists can read the study a lot faster if both studies are performed on the same day. Although the multiple procedure payment reduction affects other specialties such as cardiology and ophthalmology, it does not nearly affect their practices as it does radiology since our entire practice is based on imaging. It also does not apply to professional component for other specialties.

Over the past five years, radiology facilities have seen a 64 percent reduction in reimbursement while family practices have seen a 16 percent increase. Radiation oncology has seen a decrease in reimbursements to a lesser extent with a 16 percent decline, according to the EyeNet February 2013 issue.

I urge our radiology representatives to focus on preventing additional cuts and possibly growing our professional component of our field rather than focusing on the technical component.