CMS' proposed 2025 ASC and hospital outpatient prospective payment system rule includes the removal of the MRI lumbar spine for low back pain.
CMS suggested the removal starting in the 2025 reporting period, citing studies that "performance or improvement on the measure did not result in better patient outcomes," the July 10 proposal said.
"This finally represents some sort of self awareness for the CMS opaque rule makers," Brian Gantwerker, MD, of the Craniospinal Center of Los Angeles, told Becker's. "For years, physicians have been asking 'Why?' and 'Does this really help our patients?' For over a decade and change we have been clicking boxes and obliging CMS' capricious and unrestrained approach to interfering in patient care with unfounded mandates and quality measures that don’t affect quality. I applaud this effort and again call for CMS to produce a white paper showing how all of these quality measures' have affected patient care and outcomes."
CMS' proposal also includes an updated outpatient prospective payment system rates for hospitals meeting applicable quality reporting requirements by 2.6%. That decision is based on a projected market basket percentage increase of 3% and reduced by a 0.4% point productivity adjustment.
"What is lacking in the proposed payment adjustment is physician service payment increases," Dr. Gantwerker said. "Year after year, taking into account inflationary adjustments and CMS' cuts to physicians, doctors have had to seek employment and close their practices. This payment adjustment further hastens consolidation by enriching hospitals and leaving physicians to fend for themselves."
The proposed rule will have a 60-day comment period ending Sept. 9, and the final rule will be issued in November.