Lobbyists take aim at proposed reimbursement cuts

September 7, 2007

A battle to stop federal lawmakers from further restricting reimbursements for medical imaging is shaping up on Capitol Hill. The battleground is a provision built into the Children’s Health and Medicare Protection (CHAMP) Act of 2007.

A battle to stop federal lawmakers from further restricting reimbursements for medical imaging is shaping up on Capitol Hill. The battleground is a provision built into the Children's Health and Medicare Protection (CHAMP) Act of 2007.

CHAMP, which passed the House of Representatives Aug. 1, would reauthorize the State Children's Health Insurance Program (SCHIP). The Senate version of the bill, approved Aug. 2, would not restrict imaging payments. Differences between the House and Senate bills will be worked out in conference this month.

The decisions legislators make could directly affect imaging equipment vendors, whose sales of CT, MR, and PET/CT scanners have fallen dramatically this year on the heels of other reimbursement cuts.

The Deficit Reduction Act (DRA), which took effect this year, has turned boom into bust for CT and MR vendors as U.S. sales to outpatient imaging centers have nosedived (DI SCAN 7/6/07, CT joins MR in market slide as demand ebbs).

PET/CT vendors have been particularly hard hit, given that 70% of their last year's U.S. sales were to outpatient clinics (DI SCAN8/1/07,DRA crushes demand for big-ticket scanners.

The cuts now being considered as part of the reauthorization of SCHIP would make a bad situation worse, according to Tim Trysla, executive director of the Access to Medical Imaging Coalition (AMIC).

"In the context of the DRA reductions, we are talking 60% to 70% reductions in some cases," Trysla said. "There is no way you can manage those cuts overnight."

In preparation for the upcoming negotiations between members of the House and Senate, AMIC is working with key senators and representatives to urge leaders not to support the cuts. The Society for Nuclear Medicine has weighed in with a letter to Speaker of the House Nancy Pelosi, warning that the proposed Medicare cuts, if written into law, will jeopardize access to vital medical imaging needs.

SCHIP, which the House CHAMP bill is designed to reauthorize, supports medical care for children of underinsured families in the U.S. Gary Dillehay, the chair of SNM's Coding and Reimbursement Committee, charges that the proposed cuts would have "a harsh impact on underserved populations who have little or no insurance or cannot afford to pay out of pocket for imaging services."

"All (these cuts) would really do is limit limiting access to imaging procedures," Trysla said.

The reimbursement cuts come from Section 309 of the House bill, which directs the Centers for Medicare and Medicaid to assume that imaging equipment is used 70% of the time rather than 50%, the current assumption. This would effectively cut reimbursement by reducing unit service costs.