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ACR Strongly Opposes Imaging Cuts in Health Care and Education Affordability Reconciliation Act
Washington, DC -- The ACR strongly opposes medical imaging cuts contained in The Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872) which will shift necessary imaging care to large hospitals, increase the cost to Medicare of appropriate imaging, produce longer commutes and wait times for patients to receive care, and cause potentially life threatening delays in diagnosis and treatment of cancer and other serious illnesses.
Specifically, the bill, would immediately raise the imaging equipment utilization rate assumption, the time during office hours that imaging equipment is assumed to be in operation, from the current 50 percent rate to 75 percent. This would apply to all diagnostic imaging equipment priced over $1 million, which includes MR and CT machines. Senate health care reform legislation would have set the equipment utilization rate for all advanced diagnostic imaging services at 65 percent through 2012, 70 percent in 2013 and 75 percent in 2014 and beyond.
This assumption is a major factor to determining reimbursement. The wider the gap between the new mandated 75 percent rate and the actual time a provider uses scanners, the deeper the cut. A recent Radiology Business Management Association (RBMA) study /span>http://rightscanrighttime.org/wp-content/uploads/2009/06/sfc-rbma-u...> found that rural providers use scanners only 48 percent of office hours and that the national average is only 54 percent.
The Medicare Payment Advisory Commission (MedPAC) has previously stated /font>http://www.acr.org/SecondaryMainMenuCategories/MeetingsandEvents/Fe...> and the Centers for Medicare and Medicaid services agreed that the survey used to justify a large increase in the utilization rate, based on data from six large urban areas, was not sufficient to drive national reimbursement policy. These cuts, on top of an average 23 percent reduction from the Deficit Reduction Act of 2005, totaling $13.8 billion, will restrict and possibly end the ability of many nonhospital providers to offer imaging services, particularly in rural areas where equipment is needed, but utilized less frequently.
Any unnecessary imaging is being addressed by wider adoption of ACR Appropriateness Criteria® /font>http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_c...> , which help physicians prescribe the most appropriate imaging exam for more than 200 clinical conditions, and online ordering and physician education systems based on this tool. Accreditation of imaging facilities, to be mandated under Medicare, effective Jan. 1, 2012, cuts down on duplicative scans. This approach has reduced unwarranted imaging, and associated cost, without taking decisions from doctors’ hands and without restricting access to care.
The March 2009 Medicare Payment Advisory Commission (MedPAC) report to Congress /font>http://www.medpac.gov/documents/Mar09_EntireReport.pdf> [page 99 ─ lower left] states that Medicare imaging utilization growth since 2006 is 2 percent or less ─ at or below that of other major physician services. MRI use actually decreased in 2008. Medicare imaging expenditures, which often trend with private insurance, are down since 2007. Imaging is not an escalating medical expense and should not have been cut in this fashion.
Medical imaging exams are directly linked to greater life expectancy, declines in cancer mortality, and are generally less expensive than the invasive procedures they replace. Patients get the right scan, at the right time, for the right indication. Blind cuts to imaging based on faulty information will restrict access to care and may retard or reverse advances in care that imaging has helped produce.
For more information or to arrange an interview with an ACR spokesperson, please contact ACR Director of Public Affairs Shawn Farley at 703-648-8936 or sfarley@acr-arrs.org
Specifically, the bill, would immediately raise the imaging equipment utilization rate assumption, the time during office hours that imaging equipment is assumed to be in operation, from the current 50 percent rate to 75 percent. This would apply to all diagnostic imaging equipment priced over $1 million, which includes MR and CT machines. Senate health care reform legislation would have set the equipment utilization rate for all advanced diagnostic imaging services at 65 percent through 2012, 70 percent in 2013 and 75 percent in 2014 and beyond.
This assumption is a major factor to determining reimbursement. The wider the gap between the new mandated 75 percent rate and the actual time a provider uses scanners, the deeper the cut. A recent Radiology Business Management Association (RBMA) study /span>http://rightscanrighttime.org/wp-content/uploads/2009/06/sfc-rbma-u...> found that rural providers use scanners only 48 percent of office hours and that the national average is only 54 percent.
The Medicare Payment Advisory Commission (MedPAC) has previously stated /font>http://www.acr.org/SecondaryMainMenuCategories/MeetingsandEvents/Fe...> and the Centers for Medicare and Medicaid services agreed that the survey used to justify a large increase in the utilization rate, based on data from six large urban areas, was not sufficient to drive national reimbursement policy. These cuts, on top of an average 23 percent reduction from the Deficit Reduction Act of 2005, totaling $13.8 billion, will restrict and possibly end the ability of many nonhospital providers to offer imaging services, particularly in rural areas where equipment is needed, but utilized less frequently.
Any unnecessary imaging is being addressed by wider adoption of ACR Appropriateness Criteria® /font>http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_c...> , which help physicians prescribe the most appropriate imaging exam for more than 200 clinical conditions, and online ordering and physician education systems based on this tool. Accreditation of imaging facilities, to be mandated under Medicare, effective Jan. 1, 2012, cuts down on duplicative scans. This approach has reduced unwarranted imaging, and associated cost, without taking decisions from doctors’ hands and without restricting access to care.
The March 2009 Medicare Payment Advisory Commission (MedPAC) report to Congress /font>http://www.medpac.gov/documents/Mar09_EntireReport.pdf> [page 99 ─ lower left] states that Medicare imaging utilization growth since 2006 is 2 percent or less ─ at or below that of other major physician services. MRI use actually decreased in 2008. Medicare imaging expenditures, which often trend with private insurance, are down since 2007. Imaging is not an escalating medical expense and should not have been cut in this fashion.
Medical imaging exams are directly linked to greater life expectancy, declines in cancer mortality, and are generally less expensive than the invasive procedures they replace. Patients get the right scan, at the right time, for the right indication. Blind cuts to imaging based on faulty information will restrict access to care and may retard or reverse advances in care that imaging has helped produce.
For more information or to arrange an interview with an ACR spokesperson, please contact ACR Director of Public Affairs Shawn Farley at 703-648-8936 or sfarley@acr-arrs.org
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