(RESTON, VA) -- ACR Chair Letter to Members: Imaging, the Medicare Fee Schedule and the Road Ahead
"As you may know, the Centers for Medicare and Medicaid Services (CMS) recently released their 2010 Medicare Fee Schedule which contained significant cuts to the technical component of medical imaging reimbursement. The provisions in the final rule are not what we want, or are working toward, but the proposed rule contained far deeper imaging cuts.
The final rule phases in the cuts over four years rather than implementing them immediately as called for in the proposed rule. The phasing in of changes to the equipment utilization rate (from the current 50 percent to 90 percent) and practice expense decreases, while far from ideal, is better than immediate implementation of these cuts.
Very importantly, the phase-in period will permit ACR to collect and submit more data to CMS regarding their flawed approach and will permit the College to work with patient advocacy groups and other members of the Access to Medical Imaging Coalition (AMIC) — the broad-based coalition of patient groups, manufacturers and physician societies we created — to continue educating CMS regarding the need to mitigate and even roll back these cuts.
On a daily basis, the College government relations team takes our message to Capitol Hill informing legislators that medical imaging exams have been directly linked to greater life expectancy, declines in cancer mortality rates, are generally less expensive than the invasive procedures they replace and that utilization growth is in line with, or below that of other physician services. This is truly the current state of imaging and is the context in which all policy discussions regarding these life saving services should start.
In parallel, the ACR and AMIC continue to work with allies in Congress to enact legislation that will supersede one of the recent CMS policy changes and mitigate these cuts legislatively. The College has had substantial success getting our story across to legislators. The just passed House of Representatives Health Reform Bill has less onerous changes to equipment utilization, and the Senate bill also contains provisions that would largely mitigate the utilization cuts in the MPFS Final Rule.
It was the ACR that educated the Senate Finance Committee about the utilization issue and worked with them to reduce their utilization rate assumption from 90 percent to 65 percent in the current Senate health care reform legislation. This legislation is pending in Congress now and would supersede the CMS action if enacted.
Last year, the College led Congress to, in lieu of more cuts, to mandate national quality and safety standards (accreditation) for all non-hospital imaging providers who receive Medicare reimbursement, effective 2012. This year the ACR was the principle proponent for the development of a future payment system for imaging studies that requires referring physicians to use Appropriateness Criteria before an advanced imaging study can be ordered.
The College has also had substantial success in sharing information with CMS. It was the ACR that educated CMS through a more accurate supplemental survey to nearly quadruple the radiology practice expense formula, from $64/hr to $204/hr, greatly benefiting radiologists and their patients nationwide. The utilization and PPIS data used by CMS in the making the 2010 Final Rule are flawed. The ACR has made, and will continue to make, CMS aware of this. We continue to work with CMS to provide more accurate data and work toward more accurate and beneficial outcomes such as those mentioned immediately above.
The College has responded firmly and accurately to CMS both privately and publicly regarding these issues and will continue to do so. I invite all in the house of radiology to visit the links below and read the media response and detailed summary of the cuts contained in the rule.
* Imaging Cuts in Medicare Fee Schedule: An Access Catastrophe and Danger to Patients
* CMS Releases 2010 Medicare Physician Fee Schedule Final Rule
Make no mistake; we face a bureaucratic and political process where powerful interests are aligned against us as legislators struggle to find money to provide medical coverage to more than 45 million uninsured Americans and stave off insolvency of the Medicare program. We also must be mindful that policy-makers have stated their desire, in all venues of influence, to shift the balance of Medicare physician payment toward primary care medicine and away from specialty medicine, including diagnostic imaging.
To address the current CMS and congressional actions, as well as those sure to arise in the future, we need all ACR members to become more actively involved. Please stay in contact with your Members of Congress and state officials, become more active in your state chapters, and learn more about RADPAC ─ radiology’s political action committee ─ and its activities in Washington and in your area. Now, more than ever, we need to pull together as a specialty and rally through the ACR to fight for our ability to provide the best possible care to our patients.
James H. Thrall, M.D., FACR
American College of Radiology"