Congress finds money for physicians at imaging’s expense

December 12, 2006

The good news is that Congress passed a bill that eliminated a reduction in Medicare physician payment for 2007. The bad news is that it had no money left over to reverse or delay the huge imaging reimbursement cuts called for in the Deficit Reduction Act.

The good news is that Congress passed a bill that eliminated a reduction in Medicare physician payment for 2007. The bad news is that it had no money left over to reverse or delay the huge imaging reimbursement cuts called for in the Deficit Reduction Act.

"Congress chose not to make it a priority to change the DRA," said Josh Cooper, senior director of government relations for the American College of Radiology. "We believe we made a compelling case to Congress showing we need a delay to work out what the impact of this policy would be."

Included in the "Tax Relief and Health Care Act of 2006," which Congress passed on Dec. 8, was a provision to eliminate a scheduled 5.1% reduction in the sustainable growth rate (SGR) formula for physician payment for 2007. This is the fifth consecutive year that Congress has intervened to suspend the requirements of the SGR formula.

The SGR formula compares the actual rate of growth in physician spending to a target rate, which is based partly on the gross domestic product. If the actual rate of growth exceeds the target rate, the update is decreased; if it is less, the update is increased.

Payment for physician services in 2005 increased by 10% over 2004, even faster than previously projected, mainly due to an increase in the number and complexity of services, including more frequent and intensive office visits, and rapid growth in the use of imaging techniques, according to the Centers for Medicare and Medicaid Services.

By getting rid of the 5.1% reduction in physician payment, Congress then had to find the money elsewhere to balance the Medicare books. In fact, the Senate discussed imposing more cuts to imaging reimbursement during the week of Dec. 4 to offset the the SGR reversal, according to Cooper.

"We made it very clear to the Senate Finance Committee that this path would be unacceptable," he said.

While Cooper expressed disappointment that the ACR and other stakeholders did not attain their ultimate goal of a reversal or a delay of the DRA, he said their efforts have raised the profile of this issue "and of the benefit of imaging as a value to Medicare and to Medicare patients."

The crux of the ACR's efforts over the next several years will be to ensure that imaging doesn't become a pinata for Congress, he said. Also, the college will be looking for opportunities to improve the Mammography Quality Standards Act, which is up for reauthorization next year.

For more information from the Diagnostic Imaging archives:

Medicare rule comments reveal fears, fixes of radiologists

Hasty budget action spurs petition for delay

Trouble by the numbers: Imaging's reimbursement bubble bursts