March 25, 2010 - Washington, DC – An American College of Radiology backed amendment was submitted by Sen. Sam Brownback (R-KS) on Wednesday (March 24) to strike from the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872) a provision raising the medical imaging equipment utilization rate from 50 percent to 75 percent, effective Jan. 1, 2011 for all imaging equipment priced over $1 million. Although submitted, the amendment was never offered for a vote as an agreement to end debate was adopted prior to the amendment being considered. Like the Brownback amendment, roughly two-thirds of the amendments originally submitted were not considered for a vote.
The Brownback amendment would have restored the original Senate language from the Patient Protection and Affordable Care Act (H.R. 3590), signed into law by President Obama on March 23, 2010, which allowed for a gradual increase of the utilization assumption rate over a four year period from the 2009 rate of 50 percent to a maximum rate of 75 percent in 2014. The equipment utilization rate is the time during office hours that imaging equipment is assumed to be in operation and is a primary factor that Medicare uses to determine the technical component reimbursement for advanced imaging procedures.
Other amendments, including barring tax increases for families earning less than $250,000 and requiring the president and other administration officials to purchase health care from exchanges the statute creates were also defeated. However, two provisions in H.R. 4872 were found to violate Senate budget reconciliation rules meaning that the provisions will need to be changed and the entire bill will be sent back to the House of Representatives to be voted on again. Despite the changes, the House is expected to pass the amended Senate bill.
The College was previously able to educate members of Congress regarding the disastrous effects of raising the medical imaging equipment utilization rate to 90 percent as previously suggested by the Obama Administration and promulgated by the Centers for Medicare and Medicaid Services. However, lawmakers lowered the utilization rate assumption to 75 percent rather than removing the provision completely from H.R. 3590 as the ACR and others had urged.
MedPAC and Centers for Medicare and Medicaid Services (CMS) have admitted that the survey used to justify the utilization rate change is insufficient to justify national policy. A recent Radiology Business Management Association (RBMA) study found that the national average utilization rate is actually only 54 percent. The greater the difference between the rate that a facility actually uses their equipment and the federal assumption, the greater the reimbursement cut to the provider.
The reduction caused by the 75 percent utilization rate, added to an average 23 percent reduction from the Deficit Reduction Act of 2005, may force many nonhospital providers out of practice, particularly in rural areas; restrict imaging care to large hospitals; produce longer commutes and wait times to receive care; and delay diagnosis and treatment of cancer and other serious illnesses.
The ACR will continue to work with members of congress, congressional staff, federal agencies and other stakeholders to arrive at sensible reimbursement policies for medical imaging and radiation oncology procedures.
The College will continue to keep ACR members and other stakeholders informed of any developments regarding these very important issues.