Imaging advocates pull off major healthcare reform coup

The possibility that radiologists will score a major victory in healthcare reform legislation grew stronger this week with the endorsement of a proposal to link physicians' pay to the use of appropriateness criteria in the ordering of imaging studies. The last-minute addition to the Senate Finance Committee reform bill was approved by the panel Oct. 13 and will be debated with the rest of the reform bill on the Senate floor, mostly likely this week.

"This is an effort to start looking at the appropriate utilization of imaging as opposed to just constantly attacking its reimbursement level," said Cynthia R. Moran, assistant executive director for government relations and economic policy at the American College of Radiology, in an interview with Diagnostic Imaging.

The America's Healthy Future Act of 2009 calls for appropriations of $10 billion to fund the CMS Innovation Center, a Medicare-based program that will develop new ways to pay doctors. Among many models required for testing, the bill allows higher payments for physicians who refer patients to advanced diagnostic imaging services in accordance with appropriateness criteria "as determined in consultation with physician specialty groups and other relevant stakeholders."

According to Moran, concerns by lawmakers that the reform bill will surpass the $856 billion mark created an opportunity for imaging proponents, represented by the Access to Medical Imaging Coalition. AMIC pushed the innovation center idea to help Congress keep healthcare reform costs down and to avoid further cuts in radiology reimbursement. The ACR is an AMIC member.

Referring physicians need to be educated on how to use tools that ensure that they are ordering the right studies. This need called for a policy that would create an incentive to use such tools, Moran said. Imaging proponents hope this makes a difference not only for reimbursement, but also appropriate utilization.

"We are very supportive of that," Moran said.

Another provision of the finance committee bill raises the assumed utilization rate in Medicare's payment rate formula for imaging equipment that costs more than $1 million from 50% to 65% in a 45-hour work week. Imaging proponents still oppose any change from the longstanding 50% assumed rate, but the finance committee's position signals a new willingness among policymakers to take a more formal approach to evaluating the proposed higher rates than just accepting an arbitrarily set level, she said.

The Senate's proposed 65% level is considerably lower than the 95% rate supported by the White House, the 90% rate recommended by Medicare Payment Advisory Commission, or the 75% rate included the House tri-committee reform bill.

AMIC members asked the Finance committee to follow a cumulative healthcare savings approach instead of just constantly draining money out of imaging services. They were glad to see the committee agree to move on the same policy they have been pushing all along, Moran said.

The rate change is not an ideal option, she said. Even at a 65% utilization rate some imaging practices are going to feel some impact. However, coalition members feel they have achieved some success in putting a lid on further and bigger reductions.

"It could have been worse," Moran told Diagnostic Imaging. "Our job was to try to keep the best of the bad situation."

The bill would set the rate assumption beginning in 2010 through 2014 with a fiscal goal of $3 billion in savings. If these savings cannot be met, the Department of Health and Human Services could raise the rate, but to no higher than 75%. Starting in 2013, DHHS would be required to conduct biannual studies to evaluate the impact of these reimbursement reductions on patients' access to advanced imaging services, Moran said.

As expected, the Senate bill includes a provision that adds cuts for the technical component of payment for imaging of contiguous body parts during a single session to 50%.

Relating to physician self-referral, legislation would require physicians who operate their own in-office imaging equipment to inform patients about their ownership interest. They will also be required to provide patients with a list of alternative facilities where they can have their imaging done.

The bill also included a provision that calls for an annual $4 billion tax on manufacturers and importers of various medical devices, including diagnostic imaging equipment. AMIC and the Advanced Medical Technology Association, a lobbying group for equipment vendors, argues the surcharge would lead to reduced R&D spending and product innovation.