Healthcare consumers rally against proposed imaging payment changes

July 29, 2009

Cancer survivors and others with chronic conditions, backed by patient advocacy groups, gathered on Capitol Hill in Washington, DC, Wednesday to protest proposed imaging services reimbursement cuts they fear will reduce access to essential diagnostic imaging services, particularly in rural communities.

Cancer survivors and others with chronic conditions, backed by patient advocacy groups, gathered on Capitol Hill in Washington, DC, Wednesday to protest proposed imaging services reimbursement cuts they fear will reduce access to essential diagnostic imaging services, particularly in rural communities.

Healthcare consumers and imaging advocates, assembled by the Access to Medicare Imaging Coalition, a pro-imaging group, spoke to reporters before delivering a letter addressed to the Senate Finance Committee and the three House committees overseeing healthcare reform. The letter asks lawmakers to oppose legislation that would increase the presumed utilization rate Medicare uses to calculate reimbursement for imaging procedures. They also made a case against requiring Medicare to adopt a prior authorization system run by for-profit radiology benefit managers to screen the appropriateness of imaging studies.

The letter urges policymakers to build on provisions included in the Medicare Improvements for Patients and Providers Act of 2008. The law, adopted last year, requires accreditation of facilities and providers of imaging services by 2012 and the implementation of a pilot program to test the use of appropriateness criteria.

"These steps will help to ensure that medical imaging is used properly and that patients get the right scan at the right time," the letter says. "We believe that Congress should expand its current efforts to promote physician-developed appropriateness criteria for imaging."

Thirteen patient advocacy groups signed the letter. Representatives of the American Brain Tumor Association, Black Women's Health Imperative, Colon Cancer Alliance, Lung Cancer Alliance, and the Society for Women's Health Research attended the event in the Cannon House Office Building, southeast of the Capitol.

If enacted, the proposed cuts would erode the already small incentives entrepreneurs have to keep imaging facilities in rural areas open for business, patient advocates said. As a result, some patients in rural areas would be forced to travel hundreds of miles for imaging exams; others would go without receiving screening and other preventive imaging studies.

Patients with conditions whose diagnosis and treatment depends heavily on imaging will suffer the most, said JoAnn Shuck, a multiple sclerosis patient from Osage, WY.

"I'm more concerned about the elderly in rural areas, the poor, those people who don't have transportation because we don't have regional transportation," she said.

Shuck was diagnosed with MS in 1999 and will be eligible for Medicare benefits in November.

MS patients often get a definitive diagnosis only after 20 or more visits to the doctor. Thanks to medical imaging, Shuck's diagnosis was arrived at in three. Imaging has also been a key to keeping her treatment on the right track and under budget. Following her doctor orders, she had a scan to determine if the $2300-a-month medication she was taking was working. Scans showed it wasn't.

"Imaging saved a lot of money in medical bills," she said.