Grassroots Coalition Puts Collaboration Above Competition

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The rival groups had targeted the same pool of patients in their marketing efforts, positioning their respective imaging facilities, in one of the most competitive markets in the country, as the best that the Big Apple had to offer. In July 2009, however, they put competition aside for a common cause, and the Emergency Coalition to Save Cancer Imaging (ECSCI) was born.
imagePradeep Albert, MD
Formed in response to cuts to medical imaging payment proposed by CMS, the coalition is a grassroots, nonprofit organization consisting of 72 New York OICs in Long Island, the five boroughs of New York City, and Westchester County. With more than 40,000 signatures (and counting) on its petition, the organization is calling for CMS and Congress to reevaluate a change in the Medicare fee schedule that will have a negative impact on the availability of mammograms, the group warns. Cofounder Andy Wuertele, COO of East River Medical Imaging in New York, concedes that there are a few positive aspects of the recently released CMS final rule for 2010, but the general feelings of the coalition are frustration and concern about the long-term direction taken by CMS. “We appreciate the use of a four-year phase-in for the cuts, and that the contiguous–body-part cut was not included,” Wuertele says. "A delay or phase-in was a priority because it gives us an opportunity to fix this before the cuts become so big that they completely destabilize the providers.” Wuertele says that coalition members felt that their efforts were less effective than those of some medical specialties that had better coordinated national responses. “Too many outpatient imaging stakeholders sat on their hands while other specialties delivered a broader and wider message that resonated with Congress and CMS,” he continues. “We are reaching out to additional groups across the country to work more closely together.” In response to the CMS final rule, ECSCI has sought out House and Senate lawmakers, urging them to moderate the cuts through health reform. “Nobody knows if they will produce a final bill, but there is enough of our long-term future being debated in Washington, DC, that we need to make every effort we can,” Wuertele says. “If we don’t take action now, we’ll spend a lot of years looking back and wishing that we had.” Pradeep Albert, MD, a radiologist at Medical Arts Radiology, Huntington, and coalition founder, says, “We are competitors, and several of us compete actively against each other, but in this cause, we are fighting for the industry. If there is an increase in the equipment-utilization rate and the reimbursement rates come down for imaging, then imaging centers, which have already been deeply affected by the DRA, are not going to be able to survive. I think the entire industry is at risk because we already took a big hit with the DRA.” Cost or Solution According to ECSCI, 67 New York City clinics, representing 26% of the city’s facilities offering mammography, have closed their doors since 1999. Meanwhile, patients in the metropolitan area have experienced a 171% increase in the average waiting time for a screening mammogram. Albert explains that much of the imaging done by the outpatient centers, such as women’s imaging and cancer imaging, is subsidized by CT and MRI studies. Mammography, with its high overhead, rising equipment costs, and low reimbursement rates, is essentially a loss leader that does not provide much financial incentive to perform it. According to the group, if CMS moves forward with cutting technical fees for imaging services, more facilities will close. During a recent press conference in Brooklyn, ECSCI spokesperson Eric Schnipper, MD, a radiologist from Nassau Radiologic Group, Hempstead, explained that the cuts would only worsen what is already an unhealthy situation. “These rate changes could not only cost the government and patients more money, but could cost lives,” he says. Schnipper was making reference to the fact that the industry is still recovering from the effects of the DRA, which resulted in $1.64 billion in Medicare cuts to imaging services in 2007. The coalition is particularly concerned that the DRA has forced budget cutbacks, leading to staff reductions, delayed technology upgrades, and longer waiting times for patients. The proposed new cuts, it fears, will only exacerbate current conditions and drive even more imaging providers out of business. Albert believes that imaging not only saves lives, but actually saves money in a way that CMS is not considering. For example, hospitalization and emergency care are costly services; OICs can help prevent these expensive visits to the emergency department, while also bringing about quicker diagnosis and treatment. “The government is thinking of us as a cost, but I believe we’re a benefit to society, and we save money in the long run,” he says. “We’re also fighting for our patients’ rights. There are people who have medical illnesses, and if we don’t exist, then they won’t get the type of care that they need.” Grassroots and Beyond Like many grassroots efforts, ECSCI encountered some initial skepticism. According to Wuertele, it all began with Albert simply picking up the phone and calling people he knew. During the first meeting, seven different imaging groups came together to discuss what they viewed as an impending crisis and an illogical utilization rate. This initial gathering has since grown into weekly teleconferences and regular daily phone calls. Wuertele adds that coalition members have been meeting with the staffs of Sen Charles E. Schumer (D–NY) and Rep Charles B. Rangel (D–NY). “We’re feeling very good about the traction that our coalition has with the New York delegation,” he says. “The grassroots efforts that we’ve made are clearly getting the attention of the decision makers.” The response, according to Wuertele, has been positive, though reserved. “The staffs we’ve spoken with, from both the House and the Senate, are listening carefully and are clearly working hard to get the details right, but they are drinking from the fire hose, with the amount of information coming at them, and struggling to synthesize all the pieces,” he says. The coalition has been delivering petitions to a dozen House and Senate district offices every two or three weeks, starting in late July. According to the group, the steady stream of petition updates serves as a reminder that constituents’ concerns will not subside. The ECSCI petition, available for online signature (at www.savecancerimaging.org/Petition), states, “I am extremely concerned with new drastic Medicare cuts proposed for outpatient medical imaging in the new Health Care Reform Bill. These cuts, in addition to existing major cuts for imaging from the Deficit Reduction Act of 2005, will threaten my ability to access important radiology services. I request that you exclude any additional Medicare cuts for medical imaging from any new Congressional Health Care Reform legislation.” With its campaign picking up speed, the coalition does not have a lot of time to perform much recruiting, Wuertele admits. In fact, it barely finds the time to pull all the signatures together for its petition and get them to the appropriate political entities. Somehow, however, members make it work. One or two radiologists from each member practice provide strategic input and communication links to ECSCI. The coalition has also employed the services of KnickerbockerSKD, the New York City office of Squier Knapp Dunn Communications. Further, each practice has contributed a few thousand dollars to ECSCI to cover communications costs for Web-site development, mailers, and consultants, as well as minor administrative items such as the legal fee for registering the nonprofit entity. According to Wuertele, the budget is a modest one, “made up for by lots of hard work on the ground.” “Certainly, working as a grassroots coalition is difficult because everybody has a full-time job,” Wuertele says. “Radiologists are working harder now than they ever have, based on national statistics, and so are their staffs. There isn’t a lot of time left on people’s plates to go chase down petition signatures, jump on conference calls, write letters to the legislators, or go to Washington. The way we’ve made it work, thus far, is that everybody is giving a little bit. With so many people coming together with a common interest, giving a little is contributing a lot.” Although ECSCI hasn’t actively reached out to other imaging centers, it encourages those interested in joining the cause in the area, or even across the country, to contact the coalition at savecancerimaging@gmail.com. “My advice to other groups would be to do what we’re doing, which is to get together and be selfless for your patients,” Albert says. “The more noise we all make together, the louder we can be heard. We invite other groups to join us, and maybe we can have a national coalition that could be very strong.” Wuertele offers some advice to physicians seeking payment reform. “Put aside the competitive differences for the greater good,” he says. “Step outside of your comfort zone and trust that grassroots work, if done thoughtfully, will pay off in political action.” Elaine Sanchez is a contributing writer for ImagingBiz.com.