Report from SNM: Society protests Medicare reimbursement policies

June 18, 2008 Report from SNM: Society protests Medicare reimbursement policies James Brice -------------------------------------------------------------------------------- Society of Nuclear Medicine officials say the Centers for Medicare and Medicaid Services is manipulating the definition of radiopharmaceuticals to artificially deflate its payment rates for radioactive imaging agents essential to nuclear and molecular imaging practice. SNM opposition to the CMS practices, announced Tuesday at the society's annual meeting in New Orleans, revolves around fees paid by Medicare's Hospital Outpatient Prospective Payment System. The HOPPS schedule implemented in January for the first time bundled the cost of radiopharmaceutical drugs into a single fee covering the technical cost of performing nuclear medicine exams. CMS promised publicly at the time that bundled reimbursement would not translate into lower payments. Incoming SMN president Robert Atcher, Ph.D., however, noted in a press conference that Medicare has misclassified terminology defining radiopharmaceuticals to artificially depress their reimbursement rates. "Although managed care (companies) label them as drugs or biologics, and HOPPS specifically defines them as drugs, CMS has twice reclassified radiopharmaceuticals as ‘tests,' ‘therapies,' or, more recently, ‘supplies' in the same categories as band-aids or x-ray film," he said. The tactic has led CMS to establish rates for radiopharmaceutical products that are sometimes less than half the costs of producing them, Atcher said. He noted that Medicare reimbursement for radioimmunotherapies such as Bexxar and Zevalin, for treatment of non-Hodgkins lymphoma, is so low that it discourages hospitals and physicians from performing the procedures. "As we develop new therapeutic radiopharmaceuticals that have the potential to dramatically change disease outcomes, we need to ensure that they will be adequately reimbursed in order to be effectively utilized," he said.

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