Congress says ‘wait’ on hefty reimbursement cuts

June 30, 2006

Nearly four dozen members of the House of Representatives have signed on to a bill that calls for delaying cuts in Medicare reimbursement for two years. Lawmakers, who were kept in the dark about last-minute provisions affecting imaging, insist on knowing the impact reductions of up to 50% will have on access for Medicare recipients.

Nearly four dozen members of the House of Representatives have signed on to a bill that calls for delaying cuts in Medicare reimbursement for two years. Lawmakers, who were kept in the dark about last-minute provisions affecting imaging, insist on knowing the impact reductions of up to 50% will have on access for Medicare recipients.

The Access to Medicare Imaging Act, a bipartisan bill introduced by Rep. Joe Pitts (R-PA), calls for the Government Accountability Office to analyze how the cuts will affect rural and medically underserved areas.

The 2005 Deficit Reduction Act passed by Congress in February mandates that nonhospital outpatient technical fees be reimbursed at the lesser amount of either the Hospital Outpatient Prospective Payment System (HOPPS) or the physician fee schedule. Since the HOPPS payment is generally lower than the fee schedule, imagers expect reductions of 30% to 50%, depending on their mix of Medicare patients.

"A delay in the implementation of these cuts is essential in order to give Congress a chance to fully understand how cuts of this magnitude could affect Medicare beneficiaries' access to imaging services," Pitts said in a statement.

The GAO also will study whether the HOPPS methodology is appropriate for nonhospital outpatient imaging reimbursement.

The imaging reimbursement reductions in the current DRA were not part of the original budget proposals. They were cobbled together in late 2005 by a small group of House and Senate leaders without debate or analysis.

The American College of Radiology and its allies - under the umbrella organization Access to Medical Imaging Coalition - have focused congressional attention on the lack of thoughtful analysis involved in the reductions. It's been a good strategy, as H.R. 5704 has 42 original sponsors, including several members of key committees.

A Senate companion bill, expected within weeks, also should have strong support, said Cindy Moran, ACR assistant executive director for government affairs and economic policy.

For more information from the Diagnostic Imaging archives:

ACR lobbies Congress to freeze budget cuts for two years

Moore takes over reins at ACR

Utilization rules should target self-referral

Lawmakers' backroom barter leads to bad deal for imaging services