Simple answer, MEDICARE. Keep in mind that the vast majority of patients complaining of dizziness and imbalance are over 65, therefore, Medicare beneficiaries. Medicare has been slashing reimbursement for the most useful vestibular tests. A few years ago, there was some large scale fraud related to vestibular testing in California. California’s response was to clarify coverage policy to minimize fraud. Medicare’s response was to reduce reimbursement so much there would be little incentive to commit fraud. As an example, let’s look at the numbers for Rotational Chair (in my opinion the most sensitive vestibular test):
Average cost of equipment – $90,000.00
Average time to perform the test – 55 minutes
(these cost and time numbers are according to Medicare data)
Medicare reimbursement in 2006 – approx $300.00 per exam
Medicare reimbursement in 2011 – approx $85.00 per exam
A practitioner would be hard pressed to justify adding this critical element to their vestibular lab. To support this theory, the leading manufacturer of rotary chairs has sold many rotary chairs in the past few years to the government because the VA and military have found this test to be so helpful in diagnosing balance problems in injured veterans, but their sales of rotary chairs to private practitioners or private hospitals has been nearly non-existent. Clearly, the medical community has determined that $85 for a rotary chair exam is insufficient to cover the cost. Bottom line here, the cost to provide comprehensive vestibular management is currently greater than the reimbursement, so there is little incentive for a practitioner to add these services.
Is there a way to provide comprehensive vestibular management in the current economic environment? We will look at this next week.