Organized Radiology Plots Washington Course

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The diagnostic imaging industry’s lobbying priority for 2006 is clear, say representative of industry associations and imaging center owners: Stop the Medicare reimbursement cuts for imaging procedures included in the Deficit Reduction Act of 2005 from going into effect. But how? Now there’s the rub.

To have any chance of having the cuts reversed or even moderated or delayed before they are scheduled to go into effect on January 1, 2007, a legislative vehicle must be found said Josh Cooper, senior director of government relations for the American College of Radiology (ACR). This would most likely be another Medicare-related bill that an elected official in the House or Senate could attach a provision to about diagnostic imaging reimbursement rates. Unfortunately, if such a bill is introduced, it will almost certainly be related to either the President’s January proposal for $30 billion in additional Medicare cuts, or the House and Senate’s interest in avoiding a legally scheduled but politically unpopular 5.5% cut to Medicare physician fees in an election year. (The cuts are mandated by Medicare’s sustainable growth rate formula, which was designed to slow the growth of the entitlement program, but have been waived each year for the past few years as physicians are a powerful lobbying force.)

“It is a double edged sword,” Cooper said. On the one hand, either of the two sources for a bill would provide the hoped for legislative vehicle. On the other, both involve somehow squeezing even more money out of the Medicare budget instead of adding money too it to reverse cuts made previously.

In addition, selling patience in waiting for the right legislative vehicle to diagnostic imaging industry members upset about the cuts may prove challenging for groups like the ACR and the National Coalition for Quality Diagnostic Imaging Services (NCQDIS). “I certainly do not want to wait until the end of the year and have to depend on an election year bill that might help the physician cuts also delay these cuts,” said Joseph A. Paul, president and founder of the diagnostic imaging group Cypress Partners LLC in Palm Beach Gardens, Fla.

A Question of Fairness

A second option—which the ACR is working on while it waits for the right legislative vehicle to come along—is to argue against the way the biggest cuts for diagnostic imaging services were added to the 2006 Deficit Reduction Act. In December, with the deadline for passing the Act looming and strong pressure to find additional cuts to get the Deficit Reduction Act to nearly $40 billion in savings over 5 years, a few key legislators held a closed-door meeting and added the provision that Medicare payments for diagnostic imaging services be reduced to the lowest of either the Medicare Physician Fee Schedule (MPFS) reimbursement rate or the Hospital Outpatient Prospective Payment System (HOPPS) rate.

“Since this provision was added in essence in the middle of the night, there are many members of Congress who do not know this has happened,” Cooper said. “We have asked our members to write their members of Congress and explain what has happened with this provision.”

In addition, the ACR is bringing up with Congress its concern that the way the provision was added was inherently unfair. The diagnostic imaging industry never had a chance to comment on the proposal, properly inform other elected officials who would be voting on the bill, or present any information about the differences between the HOPPS and MPFS payment systems and the unintended consequences that might result from simply basing Medicare payments for the technical component on the lowest fee in either the HOPPS or MPFS systems.

“Our hope is that at the very least there will be a thorough review of the process by which this provision was inserted and hopefully some type of more reasonable and rational resolution to imaging reimbursement found,” Cooper said.

Because of the way the cuts were added, imaging center owners interviewed by did not hold the lobbying efforts of industry organizations such as the ACR and NCQDIS responsible for the failure to prevent the cuts as the legislative system that allowed such an important proposal to be added without public input.

“It is very hard to blame anyone on that score, given the fact that there wasn’t notice,” Paul said.

“Our democracy demands openness and there wasn’t any,” added Liz Quam, director of the Center for Diagnostic Imaging (CDI) Institute in Minneapolis,