Interpreting the 2022 Medicare Physician Fee Schedule (MPFS) Proposed Rule is a lesson in reading regulation from an agency playing politics. Those of us who have read more of these regulatory tomes than we’d like to admit traditionally head straight for the same place when the newest MPFS rule is released: the specialty impact table. However, this time the impact table is deceiving. The steep cuts to radiology caused by increased valuation of evaluation and management (E\M) services under previous rulemaking are not included in the specialty impact table of the rule, but instead hidden inside a reduction in the MPFS Conversion Factor.

As a refresher, these cuts were estimated to reduce reimbursement for our specialty by 11% in order to maintain the budget neutrality inherent in the MPFS. Thanks to the strong work of the ACR government relations team and the work of the ACR membership in engaging their Congressional representatives, these cuts were temporarily reduced via the Consolidated Appropriations Act of 2021. This act infused $3 billion into the MPFS for one year to reduce the cuts, which would have hit hard amidst a global pandemic. We survived 2021 with lesser (but still unacceptable) Medicare reimbursement cuts of 4% — knowing that if Congress did not allocate additional funds to the MPFS, radiology’s portion of the budget neutral pot of money would once again shrink, and the full brunt of the E\M value increase would be realized.

This brings us back to why our first glance at the 2022 MPFS Proposed Rule was confusing. Inside the 1,700 pages of regulatory hurdles is a specialty impact table stating that radiology would face a 2% reimbursement cut. Mathematics experts will be quick to point out that we have only realized 4% of the prescribed 11% projected Medicare radiology payment reductions. We know that 3% of the 11% reduction will come when the delayed implementation of a controversial add-on code paying extra money to office visits expires at end of 2023 — but that would still only account for 7% of the expected 11%. Our policy experts expected projected cuts for 2022 approaching 4%, not 2%. Well, here comes the kick in the gut. Medicare decided not to include the 4% cut to the conversion factor in the specialty impact table — later justifying that the impact estimates only incorporated reimbursement adjustments made by CMS in this rulemaking cycle. Dishearteningly, this also means the 2% radiology fee schedule reduction is a new, unexpected reduction set on top of the 11% cut already well on its way to being phased in. As the time of this writing, Medicare has prescribed a 13% reduction in payments to our specialty over the next three years, and we still haven’t seen what is in store for us during the 2023 rulemaking cycle.

The ACR economics team has been successful in protecting the absolute value of radiology services at the CPT® Editorial Panel and the AMA Specialty Society Relative Value Scale Update Committee, as well as through the Carrier Advisory Committee — but all that hard work is overshadowed by a flawed MPFS that dictates redistribution of dollars from one specialty to another when the other specialty grows or innovates. This means that innovation in the MPFS is stifled, as there is no new money to support new services. Instead, new services only detract from innovation in other services. This is a broken system.

This fall, you will be asked to support the ACR government relations team as we once again ask Congress to fix this mess so that all specialties can benefit from a cycle of innovation — as we continue to strive toward our goal of moving radiology forward and bringing high-quality healthcare equitably to all.