Buying Time: Chances for DRA Reversal Grow Slim, but Moratorium Might Fly

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Those hoping for a repeal of cuts to diagnostic imaging contained in the Deficit Reduction Act (DRA) may have to drastically lower their expectations for 2006 was the word coming out of both the American College of Radiology (ACR) Annual Meeting and Chapter Leadership Conference and the National Coalition for Quality Diagnostic Imaging Services (NCQDIS) Member’s Conference. Both conferences, held just 2 weeks apart, drew large contingents to Washington, DC, to lobby against the cuts, particularly the provision in the DRA to reduce the technical component for diagnostic imaging services to the lower of either the reimbursement under the Medicare Physician Fee Schedule (MPFS) or the Hospital Outpatient Prospective Payment System (HOPPS). However, the current political climate meant there was only so much the members of each organization could do when they got there.

“There’s not a lot going on in health care this year,” said Barrett Thornhill, health legislative assistant in the office of Senator Mike Crapo (R-Ind), to the NCQDIS members that gathered at the Washington Marriott on June 5. “And that’s probably a good thing for you guys,” he added.

What he meant was that as hard as the diagnostic imaging industry had been hit earlier in the year by reimbursement cuts — the field makes up only 10% of Medicare spending, but was a source of a third of the Medicare cuts in the DRA — it was not yet off the chopping block. A new health care bill, far from being the hoped for vehicle to carry a reversal of the DRA cuts, could instead include another 10% cut to diagnostic imaging services.

“I think diagnostic imaging is going to continue to be a target,” Thornhill said.

Switching Strategies
With such bleak prospects for a reversal, ACR and NCQDIS, together with their lobbyists and “Big Tent” coalition partners, such as the National Electrical Manufacturers Association (NEMA), are changing their strategies to try to buy time. On the heels of the NCQDIS lobbying event, the Access to Medical Imaging Coalition (new name for the “Big Tent” coalition) announced that Senator Gordon Smith (R-Ore) and Representative Joe Pitts (R-Pa) had agreed to sponsor bills in their respective chambers of Congress calling for a 2-year moratorium on the implementation of Section 5102 of the DRA—the portion of the Act that would reduce reimbursement to the lower of either MPFS or HOPPS—so that the issue could be studied further. At press time of this column, sources expected the legislation to be introduced in the next 10 days.

While not as ideal as having the provision overturned completely, a moratorium is not a bad option, especially this year, said Liz Quam, director of the Center for Diagnostic Imaging (CDI) Institute in Minneapolis, Minn, and chair of the public policy committee of NCQDIS. “As my CFO says, ‘a moratorium is money in the pocket, too,’” she said.

While in theory, the $8.6 billion less Medicare will spend on diagnostic imaging in coming years under the DRA Section 5102 are future savings, the reality is that the government has already spent that money to fund other programs and therefore the moratorium will “cost” it about $1.5 billion. This could be a stumbling block as this money would likely have to be found by cutting another part of Medicare, said Dan Boston, a representative of NCQDIS’s lobbying firm Health Policy Source Inc, in his presentation to NCQDIS’s members who came to Washington. However, “if Congress deems something a priority, they will find the cash,” he added.

Pulling Out All the Stops

To make sure that Congress does deem it a priority and also takes diagnostic imaging off the short list of services it may cut into further in the future, ACR, NCQDIS and the Access to Medical Imaging Coalition are working hard to build better relationships with policymakers. “We really need to create a dialogue,” Boston said.

A legislator will naturally have a relationship with his personal physician or dentist who he will see at office visits, but unless he needs a special test, he will not meet a diagnostic imaging testing facility employee or owner. Therefore, those in diagnostic imaging need to “work a little bit harder,” Boston said.

Quam described how at CDI she and others have not only held fund-raising events for their elected officials, but also put a lot of effort into personal communication to build these types of relationships. “It is not something you can write a check for,” she said. “It really is shoe leather.”