House health reform bill cuts imaging payments but addresses self-referral

Passing of the Affordable Health Care for America Act in the House of Representatives confirmed imaging proponents' fears that the bill would impose steep cuts to Medicare reimbursement rates and new sale taxes on imaging equipment. But they were pleased to discover that, for the first time, the House has turned its gaze on physician self-referral.

"It is significant but not surprising that the House passed the legislation. What is interesting is that it passed by such a narrow margin," said Cynthia R. Moran, assistant executive director for government relations and economic policy at the American College of Radiology. "That just underscores how extremely controversial many of the provisions are in the House bill," she said.

Provisions from three separate committee proposals were merged into the bill approved by the House Nov. 7. The legislation hoists the presumed utilization rate used to calculate Medicare reimbursement for the technical component of CT, MRI, and PET from 50% to 75% effective Jan. 1, 2011. The act also increases the reimbursement discount for imaging of contiguous body parts during a single session from 25% to 50%. The bill included an excise tax of 2.5% on the sale of medical devices.

The Access to Medical Imaging Coalition, a group of medical societies, patient advocacy groups, and imaging equipment manufacturers, has estimated the cuts could cost the medical imaging community more than $4 billion over a decade. The ACR is a member of AMIC.

Despite their ominous prospects for radiologists and other imaging proponents, the imaging-specific provisions and taxes may not make it to the finish line, Moran said. The ACR will continue to work to eliminate or at least match House provisions with those already approved by the Senate, including a utilization rate of 65%. The college is prepared to continue its lobbying efforts all the way to Congress's bicameral conference committee, she said.

"Our focus is now, of course, going to shift to the Senate and ultimately to the conference," she told Diagnostic Imaging.

The act also calls for the creation of a center for comparative effectiveness research to identify the most effective evidence-based prevention, diagnosis, and treatment strategies, including drugs, medical devices, surgeries, and other types of interventions. In addition, it provides for an extension of incentive payments under the Physician Quality Reporting Initiative until 2012 and requires reporting on quality measures through electronic medical records.

One element of the legislation, the Physician Payments Sunshine provision, was particularly well received among imaging proponents. The Sunshine law would require physicians who bill Medicare for imaging services to disclose any direct or indirect financial interests they may have in the entities that furnish these services. Physicians will have to report annually to Medicare their ownership stake beginning in March 2011.

The law also calls for a study to evaluate the extent of use, costs, and impact to Medicare from physician self-referral arrangements that specifically involve advanced diagnostic imaging and radiation oncology services. The finished study should be submitted to Congress by July 1, 2011.

"That is language that the college supports," Moran said. "We are glad it made it in."

The ACR had been working closely with the House and Senate to include that provision. Ultimately, only the Senate passed legislation requiring physicians to disclose if they have a financial interest in the facilities where they refer their patients for imaging exams. An amendment to ban the in-office ancillary equipment exemption to federal Stark Laws was introduced in the House Energy and Commerce Committee, but it eventually failed.

"Now all eyes will focus on the Senate, where this is really going to play out," Moran said. "It is going to be probably a much more lengthy process than people are expecting."