CHAMP Bill Could Cut Interventional Radiology
Reimbursement by 40%
The new Children's Health and Medicare Protection Act (CHAMP) of 2007, designed to extend and
expand funding for children's health care under the State Children's Health Insurance Program, could
result in reimbursement cuts of up to 40% for interventional radiology procedures performed on
Medicare patients.
The long-term effects of this legislation call for projected cuts in reimbursement levels by 2017 that
could go as high as 41%, after adjusting for inflation. The legislation would enact 21% cuts for
procedures including minimally invasive surgeries and 21% cuts for imaging-related surgeries.
This current piece of legislation does not recognize the difference between older, more invasive,
less targeted therapies (whether major surgeries or minor procedures) and the newer, less
invasive, highly targeted therapies that will form the basis of personalized medicine.
This legislation divides physician services into different categories, enacting 6 different conversion
factors based on these categories or "buckets". The proposed buckets and projected changes in
reimbursement are as follows:
1:Primary and preventive
2:Other E/M
3:Surgery
4:Other procedures
5:Anesthesia
6:Imaging
49%
-5%
8%
-21%
37%
-21%
The CHAMP Act would also:
1.
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5.
Expand federal accreditation requirements similar to those that exist for mammography to
MRI, CT, PET, nuclear medicine and x-ray. The accreditation requirement would apply to
diagnostic ultrasound by 2012.
Replace the sustainable growth rate method underlying outpatient Medicare physician
payment rate cuts in each of the past three years. It proposes 0.5% rate increases in 2008
and 2009.
Not permit global billing for imaging services. Providers would be required to charge
separately for the technical and professional components of imaging furnished beginning
about 13 months after the law's enactment.
Modifies the Medicare payment for imaging involving contiguous body parts. Under current
policy, payment covering the technical component of a second consecutive section is
reduced by 25%. Proposed legislation would increase the reduction to 50%.
Eliminate the additional payments for services provided in specialist care scarcity areas
and physician scarcity areas. Currently there is a 5% incentive payment to physicians
furnishing services in areas under these classifications. The add-on payments were
available for services furnished on or after January 1, 2005 and before January 1, 2008.
These incentive payments will no longer be made for services furnished on or after January
1, 2008 unless Congress moves to reauthorize the program.