Lobbying Against DRA Scores Victories but Battle is Far From Over

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Grassroots lobbying can at times seem more frustrating than helpful. Tremendous effort is invested in contacting legislators via e-mail, fax, phone, and in-person visits and often nothing seems to happen. But when it works, it can create successes that millions of dollars for professional lobbying could not match.

Grassroots lobbying for a repeal of the Deficit Reduction Act (DRA) cuts to diagnostic imaging services scored just such a victory in April when a group of radiologists from New York convinced Representative Carolyn McCarthy (D-NY), a registered nurse turned Congresswoman, to introduce HR 5238, a bill to eliminate the adjustments in Medicare payments for imaging services made by section 5102 of the DRA. Section 5102 capped the technical component of payments for imaging services provided in a physician's office or free-standing outpatient diagnostic imaging center to the lower Hospital Outpatient Prospective Payment level and reduced the technical component for second and subsequent imaging procedures performed in these non-hospital locations on contiguous body parts by 25% this year and 50% next year.

“[HR 5238] really is a great example of grassroots success,” said Liz Quam, chair of the public policy committee of the National Coalition for Quality Diagnostic Imaging Services (NCQDIS).

Laurence Gugliotta, sales manager of PresGar Companies, a 40-plus facilities multi-state imaging group based in Tampa, Fla, with 13 centers in New York, and his marketing representative Scott Tessell were among those who stopped by the home offices of New York legislators, including McCarthy, following the introduction of HR 5238. “I was a little surprised they were so approachable,” Gugliotta said. “In one office [Representative Carolyn B. Maloney’s], I was able to meet with the chief of staff of the New York office, which I was pretty impressed with.”

Gugliotta and Tessell made their trip the week after the bill was introduced to continue to push the issue. “It was time to take the ball and run with it,” Gugliotta said.

The success of the New York radiologists surprised even PresGar Senior Vice President and General Counsel Jeff Greenberg. “I didn’t know a bill like this could be introduced,” he said and added that it was an encouraging development. “I am very hopeful that with this bill and our involvement that we will be able to make some headway in reversing these cuts.”

The bill, if passed, could mitigate the cumulative effect of several different imaging reimbursement cuts occurring in a single 2-year time period, said W. Cannon King, vice president of business development for Outpatient Imaging Affiliates (OIA), a Nashville, Tenn-based group of 13 imaging centers in nine states.

“I suspect that when the imaging cuts were originally evaluated and discussed, if they were at all, the legislators were maybe oblivious to the fact that many of these outpatient provider cuts [the contiguous body part reduction and the elimination of the 2-D reconstruction code] were already coming down the pike,” King said.

More Work to Be Done

King and OIA are not counting on the bill, which was introduced on April 27, getting too far on its own, however, and are continuing to operate as if all the cuts in the DRA will still go into effect. “It does give us a ray of hope, but there is cautious optimism attached to it,” he said. “Hopefully it is clear to everyone now that the cuts really run too deep, and in our mind we think both sides of the aisle should stand up and support the bill. But whether that is going to be the case is yet to be determined.”

Cautious optimism is a good approach to this bill, say experts in public policy, such as Quam and Josh Cooper, senior director of government relations for the American College of Radiology (ACR). There are only a couple of months left in the regular session of Congress and bills that are very narrow in focus—HR 5238 is barely 2 pages in length and concerns a single issue—typically cannot get enough policy makers interested in them to push them out of committee, onto the Congressional calendar, through votes in both the Senate and House, and onto the President’s desk for a signature. However, small bills can increase the profile of an issue and may even be incorporated into larger bills that do come up for votes in Congress.

“It is a discussion item,” Quam said. “That does not mean that it is going to be the bill that ends up making it all the way through. What it does is heighten