Letter From ACR Chair Thrall: Update on Health Care Reform

Letter From ACR Chair Thrall: Update on Health Care Reform to ACR - American College of Radiology Members

Dear ACR Member,

Congress has adjourned for its August recess and I wanted to take this opportunity to update you regarding ACR’s efforts on Capitol Hill.

In the House, the three committees with jurisdiction over the healthcare reform package, HR 3200, have completed their work and passed the bill out of their respective committees. The full House is scheduled to vote on the package when it returns to Washington in September.

In the Senate, the Health, Education, Labor and Pensions (HELP) Committee has completed its version of healthcare reform. However, the Senate Finance Committee has not completed its version and will try to finish its work in September. Both the House and the Senate hope to have a bill ready for the President’s signature sometime in October, although many believe this timetable may be delayed.

There are several provisions in both the House and Senate versions of the Healthcare reform effort that specifically and significantly affect the practice of radiology. ACR has been working hard to alleviate or eliminate these provisions, while at the same time trying to advocate for the inclusion of a provision that would close the Stark law’s in-office ancillary service exception for advanced diagnostic imaging services. Below is a brief summary of the issues ACR is working on:

Utilization Assumption Rate
The House bill increases the imaging utilization assumption rate from 50% to 75% for the reimbursement of the technical component (TC) of advanced diagnostic imaging services. The Senate Finance Committee in a “policy options” white paper released in June proposed raising the utilization assumption rate to 90% for all imaging equipment costing more than $1 million. However, the language in the “policy options” white paper has not been introduced as legislation. These proposed changes in the TC formula would result in significant reimbursement reductions for those who own advanced modality equipment in an office setting or IDTF.

ACR, along with its allies in the Access to Medical Imaging Coalition (AMIC), continues to meet with congressional members and staff to reduce these reductions. The College maintains that neither of these proposed increases are based on any statistically significant data and that utilization rates also vary by modality and population centers (urban vs. rural).

Multiple Procedure (Contiguous Body Parts) Discount
The House bill increases the current TC multiple procedure discount from 25% to 50%. Although the Senate has not officially adopted this policy, ACR staff believes it is likely to be included in the Senate bill as well. As with the proposed utilization assumption rate increase, this proposal is not based on data and, in fact, has been proposed by the Centers for Medicare and Medicaid Services (CMS) twice and later withdrawn to due to lack of evidence. ACR will continue to bring these points to the attention of Congress.

Self-Referral
As you know from the College’s multiple communications asking for your support, ACR has been working tirelessly with Congressman Anthony Weiner (D-NY) and Congressman Bruce Braley (D-IA) regarding their effort to offer an amendment during the House Energy and Commerce Committee markup that would close the in-office ancillary services exception loophole in the Stark law. The amendment is very similar to the bill (HR 2962) recently introduced by Congresswoman Jackie Speier (D-CA). Although ACR was extremely disappointed that the Energy and Commerce Committee finished its markup of HR 3200 without the amendment being offered, we are still hopeful there will be an opportunity for the amendment’s sponsors to offer it at a later time. ACR will certainly keep you apprised of the situation as it progresses.

Independent Medicare Advisory Council (IMAC)
Under this proposal being considered by the Senate and the House, an independent, non-partisan body of health experts would make payment and coverage decisions for providers in the Medicare program. The Congress would have minimal ability to modify these recommendations since the proposed IMAC legislative language would mandate an “en bloc” vote by the Congress.

President Obama believes this approach would free Congress from the burdens of dealing with highly technical issues such as Medicare reimbursement rates. ACR, as well as the vast majority of medical specialties, believes that this effort would take away the ability of physicians to collectively participate in the formation of Medicare policy and put too much power into the hands of a few unelected officials. ACR will continue to fight the adoption of this proposal.

During the month of August, ACR will be communicating with its membership and asking members to contact their senators and representative regarding these issues.

Please be on the lookout for such communications.

Sincerely,

James Thrall, M.D., FACR
Chair, Board of Chancellors