Impact of DRA on Vascular Lab 060406

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Deficit Reduction Act of 2005
Threatens Access to High Quality
Vascular Lab Studies Robert M. Zwolak,
M.D., Ph.D. Section of Vascular Surgery
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• Deficit Reduction Act - DRA
• Aimed at explosion of payments
• for expensive studies CT, MR, Pet
• Also captured ultrasound including
• all routine noninvasive lab studies
• Starts Jan 1, 2007
• Will reduce Vascular Lab technical
• component substantially

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• Deficit Reduction Act - DRA
• ONLY impacts Office-based Labs
• ONLY impacts Technical Payment
• Directs CMS to pay office-based
• labs the lesser of
• Medicare Fee Schedule, or
• Hospital Outpatient Fee Schedule

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2006 Technical Payments
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2006 HOPPS APC Codes
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HOPPS APC Tech Pay
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(No Transcript)
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(No Transcript)
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Office-based Lab Tech Pay 93880 (blue) 93882
(yellow)
DRA payment
DRA payment
2006
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Technical Payments Office Lab
Arterial Physiologic Studies
93922, 93923, 93924

DRA payment
2006
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• Methods
• Assess one fiscal year in vascular lab at
  Dartmouth-Hitchcock Medical Center
• Sort by volume. Assume all studies are
  Medicare non-facility exams
• Convert APC tech payment dollars to RVUs at
  2006 conversion factor
• Calculate impact and sum across all CPT codes
  performed in lab

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• Results in DHMC Vascular Lab
• 93880 complete extracranial duplex exam Most
  common code n1845/yr Annual reduction in RVUs
  -3,153
• 93971 duplex of extremity veins, limited
• Second highest volume n1477/yr
• Annual reduction in RVUs -1,811
• 93923 physiologic arterial multi-level
• Third in volume n1405/yr
• Annual reduction in RVUs -2,240
• 17 studies fall 8-48, 1 no change

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• Results
• Net Annual loss -14,631 RVUs
• 32 reduction in technical RVUs / year

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• Why are Two Methods So Different?
• Medicare Fee Schedule based on accurate
  estimates of clinical labor, supplies,
  equipment
• Hospital Outpatient APC payments represent
  multiple CPT codes bundled into one APC
• APCs Payment calculation imprecise at best
• hospital cost/charge ratio x hospital charge
• Vascular Lab APCs insufficient since inception

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• Strategy for DRA Imaging Pay Cuts
• Appeal to Congress, CMS, MedPAC
• Congress Large coalition, seek delay
• Access to Medical Imaging Coalition
• AMIC led by Tom Scully
• CMS Physiologic studies are not
• imaging, plus other strategy

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• Illogical Nature of Vascular Lab Cuts
• Massively disproportionate share of DRA
• reductions sustained by vascular lab
• Loss of labs will have unintended
• consequence more CTs, more angio
• Loss of labs will increase vascular
• morbidity mortality
• Best way to control lab volume is
• is with quality mandate, not price cut

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• Conclusions
• Vascular lab pay cuts likely inevitable
• What can you do? Call, write, visit
• your Congressman/woman/Senators
• Donate to SVS PAC
• Explore means to increase lab efficiency
• without sacrificing quality

Thank You!!