title: Professional efficiencies for diagnostic imaging services rendered by different physicians: analysis of recent medicare multiple procedure payment reduction policy.
abstract: OBJECTIVE
  The aim of this study was to quantify potential physician work efficiencies and appropriate multiple procedure payment reductions for different same-session diagnostic imaging studies interpreted by different physicians in the same group practice.
  
  
  METHODS
  Medicare Resource-Based Relative Value Scale data were analyzed to determine the relative contributions of various preservice, intraservice, and postservice physician diagnostic imaging work activities. An expert panel quantified potential duplications in professional work activities when separate examinations were performed during the same session by different physicians within the same group practice. Maximum potential work duplications for various imaging modalities were calculated and compared with those used as the basis of CMS payment policy.
  
  
  RESULTS
  No potential intraservice work duplication was identified when different examination interpretations were rendered by different physicians in the same group practice. When multiple interpretations within the same modality were rendered by different physicians, maximum potential duplicated preservice and postservice activities ranged from 5% (radiography, fluoroscopy, and nuclear medicine) to 13.6% (CT). Maximum mean potential duplicated work relative value units ranged from 0.0049 (radiography and fluoroscopy) to 0.0413 (CT). This equates to overall potential total work reductions ranging from 1.39% (nuclear medicine) to 2.73% (CT). Across all modalities, this corresponds to maximum Medicare professional component physician fee reductions of 1.23 ± 0.38% (range, 0.95%-1.87%) for services within the same modality, much less than an order of magnitude smaller than those implemented by CMS. For services from different modalities, potential duplications were too small to quantify.
  
  
  CONCLUSIONS
  Although potential efficiencies exist in physician preservice and postservice work when same-session, same-modality imaging services are rendered by different physicians in the same group practice, these are relatively minuscule and have been grossly overestimated by current CMS payment policy. Greater transparency and methodologic rigor in government payment policy development are warranted.
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, VA 20191, USA. rduszak@neimanhpi.org
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Silva
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Kim
authors.forename: Robert M
authors.initials: RM
authors.lastname: Barr
authors.forename: William D
authors.initials: WD
authors.lastname: Donovan
authors.forename: Pamela
authors.initials: P
authors.lastname: Kassing
authors.forename: Geraldine
authors.initials: G
authors.lastname: McGinty
authors.forename: Bibb
authors.initials: B
authors.lastname: Allen
mesh_terms: D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000706:statistics & numerical data*; D015895:Relative Value Scales; D014481:United States; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data*; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data*
keywords: Centers for Medicare and Medicaid Services; MPPR; Professional component; RVU; efficiencies; medical imaging; multiple procedure payment reduction; payment policy; physician work; radiology; relative value unit