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PHILADELPHIA — Health care reform, in the guise of the Patient Protection and Affordable Care Act signed into law by President Obama last spring, will require physicians to deal with new regulations on utilization of imaging equipment and self-referrals.
Despite rumblings of overturning the law, Dr. Kim Williams said at the meeting that health care reform is here to stay. “It would be very difficult, though not impossible – but very difficult to flip a house of Congress and to repeal this.” Regulations will be phased in over the next 4 years, he said.
The equipment utilization rate that Medicare uses to establish reimbursements is due in 2011 for an adjustment for three types of imaging – MRI, CT, and PET – but excludes single-photon emission computed tomography (SPECT). Dr. Williams of Wayne State University in Detroit, described the equipment utilization rate as “a mechanism to actually decrease reimbursement.” Medicare actually rolled back the rate for MRI, CT, and PET from 90% to 50% in 2010, but will bump it back up to 75% in 2011, he said.
Meanwhile, the Affordable Care Act tightens requirements on self-referrals. Dr. Williams raised a hypothetical situation. “Running an EKG – is that self -eferral? Yes,” he said, “but it hasn't come onto anyone's radar screen because it isn't a lot of money.” He cited other “elements of the house of medicine” with accusing cardiology and other specialties of inappropriate self-referral.
Like the equipment utilization rate, the disclosure provisions on self-referral cover MRI, CT, and PET but not SPECT, at least not yet, Dr. Williams said. “Most of us look at that [from the viewpoint that] a patient expects a self-respecting practice to own its equipment, so it isn't that onerous,” he said. “But the devil is in the details.”
Among those details he outlined: “One will have to inform patients in writing at the time of the referral that they can obtain services from someone other than the referring physician or someone in the referring physician's practice.” That takes the form of a list of at least 10 other providers within a 25-mile radius, including phone numbers and distance. The final regulation should go into effect on January 1.
The Affordable Care Act also empowers the Medicare Payment Advisory Commission (MedPAC) to make nonbinding recommendations to Congress on payment revisions. One problematic area MedPAC is looking at is developing payment tools that take into account providers' utilization rates, Dr. Williams said. “If your utilization is high, you get less reimbursement,” he said. “The problem with that is that nobody mentioned risk adjustment.”
Dr. Williams said that he had no relevant disclosures.
PHILADELPHIA — Health care reform, in the guise of the Patient Protection and Affordable Care Act signed into law by President Obama last spring, will require physicians to deal with new regulations on utilization of imaging equipment and self-referrals.
Despite rumblings of overturning the law, Dr. Kim Williams said at the meeting that health care reform is here to stay. “It would be very difficult, though not impossible – but very difficult to flip a house of Congress and to repeal this.” Regulations will be phased in over the next 4 years, he said.
The equipment utilization rate that Medicare uses to establish reimbursements is due in 2011 for an adjustment for three types of imaging – MRI, CT, and PET – but excludes single-photon emission computed tomography (SPECT). Dr. Williams of Wayne State University in Detroit, described the equipment utilization rate as “a mechanism to actually decrease reimbursement.” Medicare actually rolled back the rate for MRI, CT, and PET from 90% to 50% in 2010, but will bump it back up to 75% in 2011, he said.
Meanwhile, the Affordable Care Act tightens requirements on self-referrals. Dr. Williams raised a hypothetical situation. “Running an EKG – is that self -eferral? Yes,” he said, “but it hasn't come onto anyone's radar screen because it isn't a lot of money.” He cited other “elements of the house of medicine” with accusing cardiology and other specialties of inappropriate self-referral.
Like the equipment utilization rate, the disclosure provisions on self-referral cover MRI, CT, and PET but not SPECT, at least not yet, Dr. Williams said. “Most of us look at that [from the viewpoint that] a patient expects a self-respecting practice to own its equipment, so it isn't that onerous,” he said. “But the devil is in the details.”
Among those details he outlined: “One will have to inform patients in writing at the time of the referral that they can obtain services from someone other than the referring physician or someone in the referring physician's practice.” That takes the form of a list of at least 10 other providers within a 25-mile radius, including phone numbers and distance. The final regulation should go into effect on January 1.
The Affordable Care Act also empowers the Medicare Payment Advisory Commission (MedPAC) to make nonbinding recommendations to Congress on payment revisions. One problematic area MedPAC is looking at is developing payment tools that take into account providers' utilization rates, Dr. Williams said. “If your utilization is high, you get less reimbursement,” he said. “The problem with that is that nobody mentioned risk adjustment.”
Dr. Williams said that he had no relevant disclosures.
PHILADELPHIA — Health care reform, in the guise of the Patient Protection and Affordable Care Act signed into law by President Obama last spring, will require physicians to deal with new regulations on utilization of imaging equipment and self-referrals.
Despite rumblings of overturning the law, Dr. Kim Williams said at the meeting that health care reform is here to stay. “It would be very difficult, though not impossible – but very difficult to flip a house of Congress and to repeal this.” Regulations will be phased in over the next 4 years, he said.
The equipment utilization rate that Medicare uses to establish reimbursements is due in 2011 for an adjustment for three types of imaging – MRI, CT, and PET – but excludes single-photon emission computed tomography (SPECT). Dr. Williams of Wayne State University in Detroit, described the equipment utilization rate as “a mechanism to actually decrease reimbursement.” Medicare actually rolled back the rate for MRI, CT, and PET from 90% to 50% in 2010, but will bump it back up to 75% in 2011, he said.
Meanwhile, the Affordable Care Act tightens requirements on self-referrals. Dr. Williams raised a hypothetical situation. “Running an EKG – is that self -eferral? Yes,” he said, “but it hasn't come onto anyone's radar screen because it isn't a lot of money.” He cited other “elements of the house of medicine” with accusing cardiology and other specialties of inappropriate self-referral.
Like the equipment utilization rate, the disclosure provisions on self-referral cover MRI, CT, and PET but not SPECT, at least not yet, Dr. Williams said. “Most of us look at that [from the viewpoint that] a patient expects a self-respecting practice to own its equipment, so it isn't that onerous,” he said. “But the devil is in the details.”
Among those details he outlined: “One will have to inform patients in writing at the time of the referral that they can obtain services from someone other than the referring physician or someone in the referring physician's practice.” That takes the form of a list of at least 10 other providers within a 25-mile radius, including phone numbers and distance. The final regulation should go into effect on January 1.
The Affordable Care Act also empowers the Medicare Payment Advisory Commission (MedPAC) to make nonbinding recommendations to Congress on payment revisions. One problematic area MedPAC is looking at is developing payment tools that take into account providers' utilization rates, Dr. Williams said. “If your utilization is high, you get less reimbursement,” he said. “The problem with that is that nobody mentioned risk adjustment.”
Dr. Williams said that he had no relevant disclosures.