House healthcare reform bill helps physicians but harms imaging

July 15, 2009

A major reform of the nation’s healthcare system, the America’s Affordable Health Choices Act, was introduced in the House of Representatives this week. To the delight of many physicians, the bill would eliminate the sustainable growth rate formula. To the chagrin of radiologists, it would also bring further reimbursement cuts for advanced imaging services.

A major reform of the nation's healthcare system, the America's Affordable Health Choices Act, was introduced in the House of Representatives this week. To the delight of many physicians, the bill would eliminate the sustainable growth rate formula. To the chagrin of radiologists, it would also bring further reimbursement cuts for advanced imaging services.

Rep. Henry A. Waxman (D-CA), chair of the House Committee on Energy and Commerce, released details of HR 3200 on Tuesday. Among other provisions, the legislation includes the creation of a Health Insurance Exchange to regulate the health insurance market and the introduction of a public health insurance plan. The bill's objective is to secure high-quality, affordable healthcare for the whole U.S. population, Waxman said. "The president was elected with a mandate that he undertake this very ambitious goal," he said.

Some of the key provisions of the bill include:

  • Replacement of the growth rate with a fixed expenditure formula set at the same rate as the one approved for 2009;

  • An adjustment of the assumed utilization rate, from 50% to 75%, for the relative value unit scheme used to calculate outpatient Medicare payment rates for the technical component of imaging procedures; and

  • A change in the technical component discount on imaging of contiguous body parts during a single imaging session from 25% to 50%.

The growth rate replacement proposal will impose a fixed figure on the conversion factor for reimbursement of physician services. It is a more sound and sane policy for physicians to have to deal with, said Cynthia R. Moran, assistant executive director for government relations and economic policy for the American College of Radiology.

"We count that as a very positive provision," she said in an interview with Diagnostic Imaging.

That feeling did not extend to the other two provisions, which are considered by radiologists as generally disappointing and unsupported by research, Moran said. Negotiations will continue within the House committees with jurisdiction to reach an acceptable number lower than the proposed 75% rate for equipment utilization for diagnostic imaging services. The ACR will urge CMS to develop policy that is based on hard data.

Things could be much worse, though, Moran said.

"We are sensitive to the fact that it is a better policy than what the administration is advocating in its proposed fee schedule rule, which would move the utilization formula from the current 50% up to 90% for high-tech equipment over $1 million," she said.