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Imaging Price Shift Calculator

Updated for 2019: Version 2.1

Today's outpatient imaging market is increasingly shaped by payer steerage and consumer demand for lower-priced services. At the same time, the new site-neutral payment policy is reducing Medicare reimbursement for certain hospital-owned facilities.

To respond to these trends, many imaging leaders are evaluating the potential impact of offering more competitive prices in their outpatient facilities.

This tool allows organizations to assess the potential impact of three types of price changes on total imaging revenue:

  • What happens if you change the list price for one or more imaging services?
  • How would a change in Medicare fee schedules for a given facility (e.g., from hospital to provider rate, or from hospital outpatient to the site-neutral rate), with or without an accompanying list price change, impact your revenue?
  • How would a change in negotiated rates between your organization and a payer affect your net revenue?

Using data you provide, the tool will produce the following outputs:

  • Projected total annual current and future revenue for each modality, taking into account your payer mix and contract rates
  • The net revenue impact of price changes
  • The absolute and percentage volume growth required to break even if you change your list price

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How to use this tool

To use the Imaging Price Shift Calculator, you'll need to provide the following inputs:

  • Your payer mix (proportion of patients falling under each type of payer contracts, as well as self-pay)
  • For each contract type, a percentage reflecting how rates under that contract relate to Medicare rates. Alternatively, if you’re only analyzing one procedure, you can just input the actual rates paid for that procedure.
  • Whether you'd like to use provider (MPFS technical or global), hospital outpatient (HOPPS), or site-neutral rates as your baseline Medicare assumptions.
  • A list of CPT codes and one-year volumes for each CPT code you’d like to assess.

Please enter these inputs into the appropriate pink cells on the spreadsheet. Any pink cell is editable.

Analytic assumptions

This tool operates on either an aggregated list of individual CPT/HCPCS codes related to imaging, or, more generally, on a single procedure or group of procedures.

Medicare reimbursement rates are calculated and geographically adjusted for all CPT codes inputted. The tool is updated every year to reflect new Medicare rates. See Methodological Note for further detail.

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