Recent budget pressures could be driving imaging centers to put off new equipment buys or even triggering layoffs, according to a small new survey put out Wednesday by the Access to Medical Imaging Coalition, a lobby made of patient, industry and physician groups.

Of the medical imaging providers who responded to the Web-based survey, over one-quarter said they delayed imaging technology upgrades and more than one-third cut staff because of financial hardships wrought by 2010 Medicare cuts and radiology benefits managers, AMIC said.

"These survey results reflect a consensus that is supported by a growing body of research indicating that federal and private sector policies aimed at curbing utilization of medical imaging services have limited the ability of physicians to continue to devote resources to providing life-saving scans to the right patients, at the right time," AMIC claimed in the report.
AMIC said it undertook the survey to gauge the impact of radiology benefits managers, services private insurers use that require referring doctors to get "pre-authorization" before they can order an imaging scan, as well as a couple of 2010 Medicare rules that lowered the technical component payable to imaging centers. These rules were the doubling of the Multiple Procedure Payment Reduction, which cuts TC fees for multiple scans done on the same patient on the same day, and an increase in the assumed utilization rate of equipment from about 63 percent to 75 percent. (Imaging centers are paid based on assumptions of how much use they get out of their expensive equipment.)

According to AMIC, the cuts and the RBMs hurt a majority of respondents.

About 86 percent of survey respondents said revenue fell in 2011 because of Medicare payment changes, with rural and urban facilities both reporting an 11 percent median decrease in Medicare imaging revenues. Larger facilities, with more than 30 employees, were hardest hit, with a 16 percent median decline.

Of the 91 percent of facilities reporting a financial impact (either good or bad), 42 percent cut staff and 29 percent said they postponed imaging technology upgrades (translating to about 38 percent and 27 percent of the total surveyed group, respectively).

Curiously, almost 5 percent of the 91 percent who reported a financial impact from the cuts said the impact was positive. Conceptually, it seems odd that payment cuts to a business would somehow help the business, but possibly the lower payments forced some centers to become more efficient or reduce waste they otherwise wouldn't have touched if it hadn't been for the reimbursement dip. (Or perhaps some of the respondents got confused — who knows!)

RBMs' imaging gatekeeping was also felt in many imaging centers' pocketbooks, according to the study. Nine out of 10 facilities had contracts with private payers that relied on RBMs, with 57 percent saying RBMs added to administrative costs over the last two years and 60 percent that it increased employee costs. Overall, 54 percent said RBMs decreased their bottom line.

The small survey of 139 providers from 70 sites was carried out in September and October, and included physician members of AMIC-affiliated groups: The Radiology Business Management Association, the Cardiology Advocacy Alliance, US Oncology and the Association for Quality Imaging, AMIC said.

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