Not every lobbying effort on the part of the imaging industry is a success. When the DRA was passed, for example, radiology took a hit; reimbursements were pared, and the industry emerged feeling that its rapid growth had left it with a target on its back.
Cindy Moran, who now directs what she calls “a totally full-service deep advocacy program” for the ACR® default.aspx, recalls, “The pressure was extraordinary to cut, and because diagnostic imaging was vulnerable, we were reduced significantly.”
Moran says that the passage of the DRA, which came at 3 am on a Friday near Christmas, taught a lesson to the ACR and to the diagnostic-imaging industry in general: prepare better and lobby harder. “At 3 am, the ability to stop that bill was next to zero, so you spend a lot of time trying to understand and react,” she says.
Moran, who is the ACR’s assistant executive director for government relations and economic policy, says that the ACR now employs seven in-house lobbyists. It also employs about two dozen analysts who look at the economic and policy impacts of ongoing and proposed legislation and regulations, Moran adds.
The ACR also hires outside consultants. She says, “Let’s say that there’s a parliamentary maneuver on the floor of the House that could affect whether a bill we support is brought up or killed. We would call on outside consultants who have expertise in House rules, so we could learn from them what to expect.”
Moran says that consultants might also be hired because they have relationships with key legislators. “Because the Congressional world is so broad and so deep in expertise, you can’t go to the Hill and be unable to have an in-depth discussion of what the policies are. The back-slapping days are no more. There is so much oversight and scrutiny that you need all the help you can get,” she says.
If the radiology industry has learned to keep its ear to the ground, it has also learned that strength lies in numbers. Following the DRA setback, Moran says, the ACR helped found the Access to Medical Imaging Coalition (AMIC), an organization of subspecialty societies, imaging-equipment manufacturers, and patient-advocacy groups that focuses on image quality and the appropriate utilization of imaging exams.
“Creating such a broadly represented coalition has helped us tremendously,” Moran says. “When there were efforts to put mandatory preauthorization into legislation, with the coalition, we were able to kill that.” She adds, “At times, in Washington, DC, there can be an effort to seek the less bad. We try to mitigate the losses, and that’s what happens, year after year, with the DRA.”
The radiology lobby isn’t composed solely of professional societies and coalitions; manufacturers of imaging equipment also get involved. GE Healthcare (Waukesha, Wisconsin), which manufactures imaging devices and scanners of all kinds, as well as providing a broad range of health products and services, has its own lobbying arm that works with the ACR and other industry groups. GE is a member of AMIC and another important industry coalition, the Medical Imaging Technology Alliance (MITA), which is composed of makers of imaging equipment and related software.
Orrin Marcella is manager of government relations for GE Healthcare. He works in Washington, DC, but mentions that GE Healthcare also has staff dedicated to advocacy on the state level. The driving forces behind GE’s lobbying, Marcella says, are often the needs of its customers. GE watches reimbursement policies closely and will speak with national and state lawmakers on issues involving the imaging providers that make up its customer base. “From our perspective, we want to see our customers do well and provide optimal care,” Marcella says. “If an imaging provider goes out of business, that’s not good for patients, for the providers themselves—or ultimately, for GE, because there’s no more business there.”
One controversial area that GE prefers not to get involved in, Marcella says, is imaging-exam self-referral by nonradiologist physicians who have their own scanners. “We have customers in all the various specialties, so we try to stay out of those areas,” he notes.
That doesn’t mean that GE takes no stand on appropriate utilization of imaging exams, Marcella adds. In fact, he says, the company is a strong advocate for—and lobbies for—greater use of appropriateness standards in imaging. “We would like to see more informed decisions