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-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 five years, and 10% after that.

Analog vs. CR vs. DR

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

Actual film is cumbersome and costly to store and transport for over-read.  So CR is the first step to converting analog film 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-specific cassette in place of a traditional film 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 film, 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 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 film-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 office 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 film 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 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 effect: 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. Classified as a “special rule,” it specifies a 20% cut starting in 2017 to the technical component of reimbursement for an x-ray taken using film.

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 significant impact urgent care operators who do not upgrade in the coming years.

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