Friday, January 28, 2011

Radiologist Salary Levels Affected By Medicare Changes?

According to a recent article in Medscape, nonradiologists are being paid more by Medicare for non-invasive diagnostic imaging:
January 6, 2011 — Nonradiologist physicians are now paid more by Medicare for noninvasive diagnostic imaging (NDI) than are radiologists, according to a study that appears in the January 2011 issue of the Journal of the American College of Radiology.

"Radiologists have always been considered the physicians who 'control' ...NDI and are primarily responsible for its growth," write lead author David Levin, MD, professor emeritus and former chair of the Department of Radiology at Thomas Jefferson University Hospital, in Philadelphia, Pennsylvania, and colleagues. "Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging."

To find out how actual Medicare dollars for NDIs are allocated, the study authors used Medicare Part B files to track overall payments to radiologists and nonradiologists from 1998 to 2008.

In 1998, payments to radiologists for NDIs were $2.563 billion, 27% higher than the $2.020 billion that went to nonradiologists, the researchers report. However, from 1998 to 2006, Medicare payments to nonradiologists increased by 166% vs 107% to radiologists. By 2006, nonradiologists were receiving more total payments than radiologists.

At the beginning of 2007, the Deficit Reduction Act of 2005 went into effect. The law, passed by Congress, was aimed at reining in Medicare and other government spending. By 2008, payments to radiologists had been cut by 13%, and nonradiologists took an 11% loss.

The article goes on to discuss how self-referral is one of the big drivers in this change in net revenues to nonradiologists, which makes sense. However, the statistics quoted are not necessarily relevant to the issues of radiologist salaries! Think about it: a percentage change depends on the level from which the statistic starts. Since radiologists in general earn about three times the annual salary of internists, a slightly larger cut in Medicare reimbursements is not actually leading to a lower salary for radiologists.

Second, there are many more nonradiologists in practice as compared to radiologists. There are a million practicing physicians in the U.S., but roughly only 50,000 radiologists, meaning there are twenty times as many non-radiologists! In other words, each radiologist is still getting a fairly large piece of the pie.

Lastly, the general increase in the amount of imaging is a major boon to radiologists, despite the increased workload. Even if nonradiologists are compensated for simple imaging, eventually some of that imaging will lead to the need for more complex imaging studies, which generates relative value units (the almighty RVUs) for radiologists. While this trend is something to be mindful of, at least we know for sure that interventional radiologist salary levels will not be affected! The effect will be marginal for modalities that require patient-radiologist interaction like ultrasound studies or mammography, but it remains to be seen how the trend will affect general / plain film radiologists.