Imaging proponents used an opportunity to testify before the Congressional Rural Caucus June 24 to lay out their agenda for what's right and what's wrong with legislative healthcare reform proposals.
During invited testimony, representative of the American College of Radiology, Access to Medical Imaging Coalition (AMIC), and other imaging-friendly groups objected to raising the assumed utilization rate as a way to cut Medicare reimbursement for high-tech imaging. They also opposed contracting with radiology benefit management companies to rule on the appropriateness of imaging covered by Medicare. As an alternative to RBMs, they suggested automated decision-support order entry to winnow out wasteful referrals.
"Our goal (in presenting testimony) was to focus on how reform proposals impact rural healthcare in a more significant way than imaging performed in urban areas," said Dr. Cassandra Foens, medical director of radiation oncology at Covenant Cancer Treatment Center in Waterloo, IA, and a member of the American College of Radiology's board of chancellors. She spoke on behalf of the AMIC.
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A higher assumed rate could lead to lower reimbursements in rural areas, according to Foens.
RBMs operate with an incentive to reject studies, and they do it without physician input, Foens said. Imaging proponents worry the practice could lead to a number of appropriately indicated studies being turned down. And RBM services will not necessarily mean cost savings if taxpayers end up picking up the bill, she said.
"That's why we have proposed instead that electronic medical records add computerized feedback mechanisms based on imaging appropriateness criteria," Foens told Diagnostic Imaging.
Representatives of the Susan G. Komen for the Cure Advocacy Alliance, the Lung Cancer Alliance, and the Colon Cancer Alliance also argued against a higher assumed rate and RBM involvement.
Foens practices radiation oncology in an area that covers cancer patients from about 10 rural counties in northeastern Iowa. Only one full-time PET scanner covers the entire area.
"If, for any reason, we lose anymore payment for the technical services provided by PET, then my cancer patients could not get the same level of care that people in larger metropolitan areas have," Foens said.
According to Foens, rural areas are already at the low end of the reimbursement scale. Utilization rate scales implemented into Medicare using arbitrarily picked formulas would mean radiologists in Iowa or Nebraska would get lower reimbursements than those practicing in California or New York, she said.
"We have even less that we can afford to be cut in rural healthcare because we are starting from a lower base," Foens said.
The Congressional Rural Caucus offered a useful forum for imaging advocates because several members sit on House committees with jurisdiction over healthcare. Foens noted that Sen. Max Baucus (D-MT), chairman of the powerful Senate Finance Committee, and Sen. Charles Grassley (R-IA), ranking minority member of that group, are both from rural states.
The Congressional Rural Caucus represents states that have significant elderly populations and traditionally rely on healthcare subsidies, according to U.S. Census data. Some of these states, however, also provide significant contributions to advanced medical science research and are home to Fortune 500 pharmaceutical companies. The caucus is cochaired by Travis Childers (D-MS), a member of Health Care Task Force of the influential Blue Dog Coalition, a fiscally conservative Congressional group deemed a power broker between House Democrats and Republicans and key to deciding spending bills.
"Whenever you are talking about Medicare and money there is always the concern of who's going to win and who's going to lose," Foens said. "What we are really hoping is that we can find a proposal where nobody loses, where the patient gets the right exam at the right time."
