11/3/2017 Medicare to cut analog x-ray payments in 2017; CR in 2018 | Teleradiology Specialists

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Medicare to cut analog x-ray payments in

2017; CR in 2018
by Teleradiology Specialists | Nov 8, 2016 | News | 0 comments

Medicare to cut analog x-ray payments in 2017; CR in 2018

As part of a push to nudge U.S. healthcare providers to adopt digital radiography (DR), the
Medicare system will begin reducing payments for exams performed on analog x-ray
systems starting in 2017. The year after that, sites using computed radiography (CR)
equipment will also see payment reductions.

Medicare payments will be reduced by 20% for providers submitting claims for analog x-

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ray studies starting in 2017 under a provision in the Consolidated Appropriations Act of
2016, which was enacted into law in December 2015. Complete text of the act can be
viewed at: https://www.congress.gov/bill/114th-congress/house-bill/2029/text

Starting in 2018, payments for imaging studies performed on CR equipment would be

reduced by 7% for the next ve years, and 10% after that.

Analog vs. CR vs. DR

By now, pretty much everybody in the urgent care eld knows that old-school, analog
image acquisition and processing via lm are about as ine cient as it gets. In addition,
supplies ( lm and chemicals) are increasingly expensive and di cult to come by, in part
because the precious metal silver is used in the process.

Actual lm is cumbersome and costly to store and transport for over-read.  So CR is the
rst step to converting analog lm to a digital image, which can then be stored and
transmitted electronically.

With CR, an existing analog system takes X-ray exposures in the usual way but uses a CR-
speci c cassette in place of a traditional lm cassette. After the exposure is taken, the
cassette is run through a CR reader (which looks like a large photocopier) where the image
is scanned into a digital format. The cassette can then be cleared and reused for future
scans.

Though it is much faster than analog lm, CR is much slower than a DR panel. The time it
takes to remove the cassette from the bucky tray, take it to the reader, read it, clear it, and

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replace it into the bucky can add up to several minutes per exposure.

The adoption of DR over the past two decades has transformed medical imaging’s oldest
modality, enabling basic x-ray images to be acquired quickly and then easily transferred
into PACS for distribution, interpretation, and archiving. Before DR arrived, many facilities
upgraded their x-ray equipment with CR, which replaced lm-screen cassettes with
imaging plates that can be carried to a reader for digital output.

Because a DR panel spends most of its time in your X-ray system’s bucky tray, you won’t
require any additional space for it. The workstation that comes with your panel can be
wall-mounted or can live in about two feet of counter space. A CR reader is only about the
size of an o ce copier, but is far bulkier than a DR panel setup.

The average DR room will have an image captured and rendered in about 5 seconds. This
speed is far ahead of both lm and CR.  Like a CR reader, a DR panel can be shared across
multiple systems and/or modalities.

While the up-front cost may be higher, the overall cost of ownership of a DR panel is lower
than that of a CR reader.  That’s because a CR reader has many moving parts, it’s more

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likely to require a regular on-site maintenance plan and replacement parts.

What This Means for Urgent Care

While the law’s provisions on analog x-ray are expected to have a minor impact due to the
small number of traditional systems still in operation in the U.S., the reductions in CR
payments could have a much broader e ect: More than 8,000 CR units are still in service in
the U.S.  97% of all urgent care centers have x-ray and many operate with CR.  All of these
systems must be replaced or experience payment reductions.

The provisions inserted into the Consolidated Appropriations Act are designed to speed
the transition of U.S. healthcare providers toward digital radiography by changing the
Hospital Outpatient Prospective Payment System. Classi ed as a “special rule,” it speci es
a 20% cut starting in 2017 to the technical component of reimbursement for an x-ray taken
using lm.

The cuts for CR are phased in over time, starting in 2018. Payment for the technical
component of an x-ray acquired using computed radiography will be reduced by 7%
during the years 2018 to 2022 and by 10% after that.

And while Medicare is typically only 10-15% of a typical center’s patient mix, commercial
and workers’ compensation payers typically follow the Medicare fee schedule and
payment methodology…so it’s expected that this law will have signi cant impact urgent
care operators who do not upgrade in the coming years.

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