The U.S. government has proposed payment changes in the Medicare health insurance program that could have an effect on reimbursement of medical imaging, diagnostic testing and dialysis providers.

The wide-ranging, 834-page proposal is an annual update of how Medicare pays for the treatment of 44 million elderly and disabled individuals in the federal health plan.

One of the changes proposed is an expansion of diagnostic imaging services for which the government will trim payment when multiple procedures are done on the same patient. It also proposes no update to payment for drugs used during dialysis.

On pricing for the drugs, JP Morgan analyst in Washington Ipsita Smolinksi said:  “We believe the dialysis industry will object to the sudden change in assumption.” The major dialysis providers are DaVita Inc and Germany's Fresenius SE. The biggest medical imaging companies are General Electric Co, Philips and Siemens AG.

The U.S. Centers for Medicare and Medicaid Services, which runs Medicare and the Medicaid program for the needy, is expected to spend nearly $800 billion on health care services this year. At the same time, it is thought that the proposal could impact payment for free-standing radiation therapy and pathology lab tests, according to analysts.

Additionally, the government is also put forward suggestions requiring doctors who perform diagnostic tests to be subject to certain new performance standards, as well as increasing financial incentives for doctors to report quality measures.

CMS acting administrator Kerry Weems said in a statement: “We are taking a multi-pronged approach to improve how Medicare pays for health care services.”