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.
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,