X-ray Reimbursements Will Bring an End to Analog and CR

Jane Ehrhardt

X-ray Reimbursements Will Bring an End to Analog and CR | x-ray, digital imaging, CMS, digital radiography, DR, computed radiography, CR, x-ray machines, Capital X-Ray, Terry Stiff, Birmingham Medical News, Jane Ehrhardt

Terry Stiff with a new DR system.
Medicare has begun the push toward purely digital radiography (DR). Starting next year, reimbursements for exams preformed on film-based x-ray machines will radically decline. The following year, reimbursements involving computed radiography (CR) equipment will get hit.

“If I were a physician that had a CR, I would probably not be happy,” says Terry Stiff with Capital X-ray, a radiology imaging equipment sales and service company in Birmingham.

The upside of the changeover, he says, will fall to veterinarians and chiropractors looking for deals on CRs. “There’s probably going to be a glut of used CR units on the market,” he says.

The changes stem from a provision in the Consolidated Appropriations Act passed in December. Analog x-ray reimbursements will drop by 20 percent. However, the impact on the healthcare community should be minimal. Stiff says that only about one percent of Capital X-Ray’s customers —about 150 businesses — still use the film-based machines. And many of those are veterinarians.

Only a minor ripple will be felt at hospitals nationwide as well. In 2013, analog x-ray rooms just made up about one percent of the installed base at hospitals, according to market research firm IMV. The film-based system’s existence has become so minimal, that IMV didn’t bother to include it on their 2015 survey.

The demand for CR has also taken a drastic hit in the past decade. In 2006, CR represented 55 percent of digital x-ray sales. Nine years later, CR sales had plummeted to six percent of the total. The remaining 94 percent were DR systems.  

With numbers showing its natural decay, CMS’s push to eliminate CR could be seen as killing off the wounded beast. In 2018, CR reimbursement will start with a  seven percent reduction, and will stay at that rate for five years. Thereafter, the penalty will be fixed at 10 percent.

The x-ray system left untouched by the reimbursement cuts will be DR. “They’re trying to push people out of film and go with some type of digital imaging,” Stiff says. Although CR is a digital process, technicians still handle image plates which require more steps and time investment than DR. DR bypasses the need to handle cassettes and can display the x-ray image on a monitor within seconds after the x-ray exposure.

“But I don’t think CMS would care about how long it takes to take an x-ray. I think, the reason is because of the difference in the dose of radiation the patient receives,” Stiff says. Some CR systems use about twice the radiation of DR systems.

Currently about 8,000 CR units are in service around the country. “A couple of years ago, we would sell a CR unit every week,” Stiff says. “Now imagine how the customers who bought a CR in the past two years feel. They thought when they bought it that they had finally gone digital and didn’t have to worry about film costs.”

Now to avoid reimbursement declines, those practices have to worry about replacing relatively new machines that run $25,000 to $50,000 with a DR system that runs about $38,000 to $90,000.

The machines normally last five to seven years. Replacement doesn’t typically occur because of wear-and-tear, but rather because of technology advancements. “Like with any computer, the technology will change so much in a few years, with the image looking much better, that they’re almost required to upgrade,” Stiff says.

Some older physicians among Capital X-Ray’s clients are planning to hang on to what they have until they retire. “Ten minutes ago, one of our sales reps said he had an internal medicine office that wants to purchase a film processor,” Stiff says. The practice could not be talked into upgrading to a CR and instead bought another analog system. “There’s only one film processor brand still being manufactured today.”

Stiff says those practices holding on to the analog film systems may not be prepared for the financial changes coming their way. “They may think film will continue to cost $100 a box and chemicals will continue to cost $60 a case,” he says. But when the demand for those antiquated products dwindles to a lone percent of the market, the investment in a DR may not look so steep.