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Transportation for Sono-EKG

BRIEF Only a fraction of the EKG and ultrasound tests paid for by Medicare are performed outside of physicians' offices or hospital settings and, thus, are potentially affected by the payment policy changes. In 1995, Medicare paid approximately $597 million for 14 million EKGs...

BRIEF

Only a fraction of the EKG and ultrasound tests paid for by Medicare are
performed outside of physicians' offices or hospital settings and, thus, are potentially affected by the payment policy changes. In 1995, Medicare paid approximately $597 million for 14 million EKGs and about $976 million for 5 million ultrasound tests in various settings. Only 290,000 of the EKGs and only 37,000 of the ultrasound tests were done in locations such as nursing homes or beneficiaries' residences where the provider needed to transport the diagnostic equipment. Nearly 90 percent of the services that required
transporting equipment were provided to residents of nursing homes. They were usually provided by portable x-ray and ultrasound providers. Some states appear to have a higher concentration of these services, with a small number of providers accounting for a large portion of each state's total portable EKG and ultrasound services.

Many EKGs and ultrasound services provided in nursing homes would be unaffected if transportation payments were eliminated. Given the experience of 1995, about 56 percent (142,400) of the EKGs and 89 percent (26,900) of the ultrasound services provided in nursing homes would be unaffected by transportation payment changes and presumably would continue to be provided in those settings. One reason some tests would be unaffected is that, beginning in July 1998, nursing homes will receive an inclusive per diem payment for all services provided to beneficiaries receiving Medicare-covered skilled nursing care. A decision to eliminate or retain separate transportation payments for other beneficiaries will not affect the per diem payment. Another reason is that many nursing home EKGs and most ultrasound services in 1995 were performed by providers who did not receive a transportation payment.

The effect of eliminating transportation payments on the remaining 44 percent of the EKG and 11 percent of the ultrasound services is unknown because it depends on how providers respond. If mobile providers are less willing to transport equipment, then services for homebound beneficiaries and nursing home residents may decline.
Alternatively, providers may continue to supply services or, especially in the case of EKGs, nursing homes may decide to purchase the equipment and provide the tests themselves.

Because relatively few services would be affected, eliminating transportation payments would likely have a nominal effect on Medicare spending. Medicare could save $11 million if mobile providers continue to supply services. However, if mobile providers stopped bringing portable EKG equipment to beneficiaries, then some people would travel in Medicare-paid ambulances to obtain these tests. If that happened, the annual net cost to Medicare could be as much as $9.7 million. Eliminating transportation payments for ultrasound services would have a smaller effect. We estimate the effect on Medicare spending might range from $400,000 in savings to $125,000 in increased costs.

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