Medicare Reimbursement Trends for Interventional Radiology Procedures: 2012 to 2020

Clinical question
What are the reimbursement trends for 20 common interventional radiology procedures between 2012 and 2020?

Take away point
Common interventional radiology procedures are experiencing significant reimbursement cuts by Medicare. Across all procedures, there was a decrease of -2.8% over one year and -18.7% over eight years after adjusting for inflation.

Reference
Medicare Reimbursement Trends for Interventional Radiology Procedures: 2012-2020. Schartz, D. and Young, E. Journal of Vascular and Interventional Radiology, Volume 32: 447-452.

Click here for abstract

Study design
Retrospective review of all common interventional radiology procedures between 2012-2020 that were reimbursed by the Centers for Medicare and Medicaid Services (CMS).

Funding Source
No funding.

Setting
United States.

Figure

Summary

Medicare spending accounts for a large portion of the US total health expenditure and it will increase over time as our population ages. The Medicare compensation model is complicated. It is comprised of current procedure terminology (CPT) codes, which determine the reimbursement rate for the procedure determined by the Centers for Medicare and Medicaid Services (CMS). This is determined based on a formula that is updated annually and includes variables such as geographic practice cost and relative value unit (RVU). An RVU is broken down into three components: physician (time, skill, length of training), practice/resource expenses and malpractice. Many other surgical subspecialties and diagnostic radiology have shown a decline in Medicare reimbursement. The goal of this study is to assess Medicare reimbursement trends of common IR procedures over an eight-year period

A retrospective review was performed of all common interventional radiology procedures between 2012-2020 that were reimbursed by the Centers for Medicare and Medicaid Services (CMS). Common procedures were identified as those deemed “common” by the Society of Interventional Radiology (see figure above for the procedures included). They then used the Physician Fee Schedule look-up tool from CMS. The CPT codes and their reimbursement data was then analyzed. As with similar studies, only those performed at an ambulatory surgery center or hospital were included and office based procedures were excluded. All facility fees for each procedure for each year were averaged. The consumer price index inflation calculator from the US Department of Labor’s Bureau of Labor statistics was used to adjust for inflation. A 2-tailed t-test was used to compare the unadjusted inflation rates to the adjusted inflation rates.

Between 2012-2020, the unadjusted reimbursement rate for common IR procedures decreased by -6.9% (95% CI, -13.5 to -12.9%). After adjusting for inflation the mean decline was -18.7% (95% CI, -24.4% to 12.9%), with a mean yearly decline of -2.8%. A linear regression analysis showed a steady decline in reimbursement over time (R2=0.97). Percutaneous drain placement for visceral abscess was the only procedure to have an increase in adjusted reimbursement during the study period (+7.5%). Additionally, those procedures that underwent CPT code changes had the largest mean reduction in adjusted reimbursement—which is thought to be due to procedure bundling.

Congress has implemented steps to prevent drastic of reimbursement cuts and to increase physician reimbursement by 0.5% annually. Despite this, CMS has recently proposed a Physician Fee Schedule Proposed Final Rule, which will reduce the CMS conversion factor (a geographically adjusted RVU component for each procedure). They have also planned to decrease the total amount allowed for Medicare reimbursement for work RVUs, with an estimated total impact of -8% reduction for the specialty.

Commentary

This study shows that common IR procedures are experiencing significant reimbursement cuts by Medicare. Despite steps taken by congress to increase physician reimbursement, the opposite has occurred and there are further plans to decrease reimbursement by CMS in place. There are a couple main limitations that the authors discuss. The first is the data from Medicare may not be reflective of the specialty as a whole. Smaller cohort studies in different geographical areas may provide some comparative analysis. Second, the most common procedures deemed by SIR may not actually be the most frequently performed procedures. Further analysis into how SIR has deemed these procedures as the most common may help with the ambiguity. Overall, this study is important for trainees and practicing interventional radiologists for increasing their healthcare financial literacy, encouraging engagement in advocacy and leadership and understanding how reimbursement trends compare to other specialties.

Post Author
Marissa Stumbras, MD
Interventional Radiology Resident, PGY2
Oregon Health & Science University

@MarissaStumbras