A full one-third of radiology reimbursement is being revalued now. The last time this component of the relative value unit (RVU) formula was updated was 15 years ago. A lot of things have changed since then which means this revaluation could result in dramatic shifts in payment for all specialties — especially radiology. 

The ACR sent an email on May 17 to members whose practices were selected to participate in the AMA Physician Practice Information Survey (PPIS). If you have received this email, it is urgent that you promptly complete the survey. In a Q&A with the Bulletin, Michael T. Booker, MD, MBA, ACR Alternate RUC Advisor, discusses how results from the survey will have a large impact on physician payment.

What exactly is being revalued? Does it impact my salary?

The RVU formula contains three components: physician work, practice expense and malpractice expense. It is that second component that is being revalued — in particular, the “indirect” portion of practice expense. This category is meant to pay for the overhead of delivering healthcare beyond physician work, clinical staff, equipment and supplies. Included in this category would be rent, utilities, administration and billing services, PACS support, etc. Both the professional component and technical component contain practice expense RVUs, but the technical component contains far more. Outpatient imaging centers and office-based labs are most susceptible to shifts in reimbursement.

How is “indirect” practice expense calculated? Is the process changing? 

The nebulous category of indirect practice expense means that it is quite hard to estimate. The way it is currently calculated is by surveying a large number of physicians and healthcare organizations on their costs. CMS then uses this survey data to calculate how much indirect practice expense each specific specialty spends per unit of physician time. In other words, indirect practice expense per hour (PE/HR). Once they have this value, they will assign different indirect practice expense RVU amounts to every CPT^® code. The process is not changing, but the survey inputs will be changing for the first time in 15 years.

You mentioned indirect practice expense is calculated by specialty — will this update impact all medical specialties?

This update will change the RVU value of nearly every single CPT code. The specialties that are most exposed to changes in indirect practice expense are those that have large costs outside of paying the physician. Radiology, radiation oncology, interventional radiology, nuclear medicine, etc., all have huge practice expense costs that need to be covered. As a result, a lot of RVUs are subject to change.

This was last updated 15 years ago. Have how much have costs changed since then?

We simply don’t know how much costs have changed because no one has bothered to ask. A further confounding concept is that the RVU payments are relative — radiology indirect practice expense costs have clearly gone up over 15 years, but have they gone up more or less than other specialties? What we do know is that the last time the survey inputs were updated in 2007–2008 via the PPIS the changes were so dramatic they needed to be phased-in over several years.

Who is running the survey? What happens if I participate/do not participate?

The AMA, in partnership with Mathematica, has already sent out a survey instrument to many physicians and healthcare groups across all specialties. The AMA recently reached out to the ACR for help in contacting practices who were selected to participate in the PPIS. If you receive an email from the American College of Radiology titled “Requesting Your Participation,” it means that your practice is part of the PPI survey effort but has not yet completed the survey. 

The deadline to reply to that survey is coming up soon. Submitting accurate and comprehensive data will mean that the RVU values of the codes you perform will more closely reflect your costs.  Not participating means that fewer data points are available and incomplete information will be used to adjust your payments. In other words — participate!

What do I do next?

Look in your inbox and spam folder for an email from Mathematica. Ask your partners and imaging directors if they have received an email from Mathematica. If you need help filling out the survey, the AMA has several resources. The ACR is also happy to provide any assistance in the process but not in the values. If you would like to check whether your practice was selected for the survey, contact Stephanie Le, ACR Director, Economics and Health Policy.