My Trip to Capitol Hill with AQI

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Last week, I went to Washington, DC, where I attended the AQI Legislative Conference. It was a new experience for me—walking the halls of Senate and House buildings, meeting with the lawmakers and their staff, and explaining to them what we as imaging services providers do. On Wednesday we heard from Rep. Carol McCarthy (D-NY), Rep. Earl Pomeroy (D-ND), Sen. Kent Conrad (D-ND), a senior analyst from GAO, and Ariel Gonzalez, Esq. from the ACR among others. Today, in the morning, we met with Sen. Lincoln (D-ARK) in the morning, and then we simply broke up in small groups and spread out to meet with the staffers of various lawmakers. We tried to explain the difficulties faced by the Imaging community. We had quite meaningful discussions with all these people. We had Q and A sessions where we were able to express our concern regarding the items included in healthcare reform ideas and legislation that will adversely affect the providers of imaging services. This is what I gleaned from the meetings: 1. The President has made it clear and the Congress and Senate leadership has agreed that this healthcare reform legislature is a major priority. 2. They are trying to push this major piece of reform at a breakneck speed - they want to complete this by the end of this month!! 3. The total cost is supposed to be somewhere around $1.2 Trillion dollars. They don't know where the money is going to come from. 4. Specifically, imaging services are in the crosshair for further cuts, because of flawed information the politicians have received from MedPAC study. There is a real possibility of further reduction in payments for imaging services. 5. One proposal of "bundled payments to hospitals" is likely to affect hospital based radiologists—the hospitals will simply put them on salary and this move will not only affect their income, but likely effectively put all the business managers and billing services working for those radiologists out of business. 6. The politicians blame the increased utilization costs on in-house services offered by "Physicians". They do not have enough information to differentiate radiologists from other non-radiologist physicians. On the other hand, AMA and other organizations have apparently put up a big fight against limiting in-house services offered by non-radiologists. 7. If the imaging community gets their act together and mobilizes, it is possible for us to prevent these draconian cuts from being implemented. 8. Fortunately, I learned that the President's proposal of RBM's (Radiology Benefits Management— another word for authorization intermediaries for Medicare recipients) is not high on the list of the Congress. As I mentioned above, the group consisted of owners of imaging centers. I was the only radiologist in the group, and was able to ask some questions in my dual role as a physician as well as a business owner. We tried to emphasize the following points to the congresspersons, senators and their staff: 1. DRA made a significant impact on the revenue of outpatient imaging services. The industry cannot absorb more cuts. 2. The Hospital industry is trying to corner the imaging market but their services are much more expensive and inefficient compared to the outpatient imaging centers. "We have a better mousetrap" as one of the attendees pointed out. We urged the politicians to support such services, and not hurt them. 3. The GAO is aware that the increased utilization is mainly done by non-radiologists offering services in their offices. We tried to highlight this point. 4. We made a strong case against RBMs and pointed out their drawbacks - delay in care, inefficiency, unjustified denials and waste of time trying to fight those, frustrations experienced by providers and patients, etc. We also pointed out the recent change instituted by United Healthcare, moving away from pre-authorization to pre-notification. 5. We tried to inform the lawmakers that more often than not these RBM's morph into brokers and take a commission while limiting care. 6. We pointed out that while imaging services expenses may seem high, every dollar spent on imaging services saves upwards of $3 in preventing unnecessary procedures. 7. As radiologists we are way ahead of curve in implementing electronic records by way of PACs, RIS, VR, etc. We have done these things in spite of reimbursement cuts. 8. We tried to educate them about ACR's efforts in e-ordering coalition and the imaging community's efforts in educating the referring physicians about appropriateness criteria. 9. We have already implemented the quality standards by obtaining ACR and other accreditations for our facilities and services. I believe some headway was made. However this was a small group, working with a limited number of lawmakers and their staff. I understand that a majority of radiologists, who are hospital based and have not seen large cuts in the professional services, have not gotten involved in the issue. As a matter of the fact most are apathetic to this impending disastrous change and a freight train coming our way. There is only a short time to act, and the entire imaging community needs to wake up and stop it. Every lawmaker—Congresspersons and Senators—need to be contacted and educated about what we do and the valuable service we provide as the imaging services providers - hospital based or outpatient facilities. I am pretty sure many on these forums have also contributed to their local lawmakers, whether they are Democrats or Republicans. They are taking an ill-conceived and hasty step in Washington about this so-called reform, which will further affect and single out the imaging services community. Various proposals are being considered in the Senate Finance Committee and House Ways and Means Committee. If your representative is a member of these committees, he or she needs to be contacted by as many people as possible. There must be letter writing and phone call campaigns if the members in this forum wish to preserve their livelihood while providing quality patient care. Thank you all, Girish Patel M.D. Truxtun Radiology Medical Group Bakersfield, CA gpatel@truxtunrad.com www.truxtunrad.com