Report Finds Substantial Decrease in Radiologist Reimbursement

Aug. 31, 2023
American College of Radiology’s Neiman Institute says that, adjusted for inflation, reimbursement declined 25 percent between 2005 and 2021

A research study has found that radiologist reimbursement for imaging provided to Medicare patients has decreased substantially over 16 years when accounting for inflation.  

The research, published today in the Journal of the American College of Radiologyevaluated changes in payments for radiology services for 100 percent of traditional Medicare beneficiaries between 2005 and 2021. The researchers at the Harvey L. Neiman Health Policy Institute observed an absolute increase of 4 percent in payments per beneficiary over this period, but when all payments were adjusted to 2021 dollars, real reimbursement actually declined 25 percent.

The Neiman Institute, established by the American College of Radiology in 2012, studies the role and value of radiology and radiologists in evolving healthcare delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of healthcare.

Medicare reimburses clinicians for each service radiologists provide based on the resource intensity of the service, measured as relative value units (RVUs). The RVUs assigned to a service are multiplied by an assigned dollar amount per RVU (the conversion factor) to determine the Medicare payment.

“The statutory requirement for budget neutrality requires that RVUs and/or the conversion factor adjust so that Medicare expenditures do not exceed the budget as new services are introduced or as volumes of existing services increase. In other words, budget neutrality is a zero-sum game. Expansions in one area necessitate contractions elsewhere,” said Eric Christensen, Ph.D., research director at the Neiman Institute, in a statement. “Our study shows that radiologists are now paid one-quarter less per beneficiary compared with 16 years ago, given changes associated with budget neutrality.”

Previous studies have focused on procedure-specific reimbursement and shown declines up to 44 percent per procedure over 10 years. “Through increased efficiency and/or working more hours, radiologists could theoretically maintain reimbursement per beneficiary despite substantial declines in reimbursement per procedure.” stated Gregory Nicola, M.D., executive leadership, Hackensack Radiology Group and Chair, ACR Economics Commission, in a statement. “We found that radiologists were, in fact, doing 13 percent more work (RVUs) per beneficiary in 2021 than in 2005. If RVUs per beneficiary had remained at 2005 levels, real reimbursement per beneficiary would have declined by 34 percent. Hence, volume increases partially mitigated reimbursement declines, but despite them, real reimbursement still declined 25 percent.”

“The conversion factor has been the primary mechanism to maintain budget neutrality and it has declined 43 percent from 2005 to 2023” stated Joshua Hirsch, M.D., Neiman Institute affiliate senior research fellow and vice chair procedural services, Massachusetts General Hospital, in a statement.. “It must be acknowledged that such substantial declines are not without consequences for patients as lower relative reimbursement has been associated with reduced access to care for both Medicare and Medicaid patients and economically driven disparities in access to newer medical technology.”