Is Time Running Out?

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In a typical year, more than 10,000 bills and resolutions are introduced in Congress and fewer than 5% of these actually become law. So while radiology advocates celebrated another victory in August — a Senate bill to reverse cuts to Medicare payments for radiology — these long odds were definitely in the back of their minds.

“I am a little more relieved, but I have got the blinders on until September,” said Josh Cooper, senior director of government relations for the American College of Radiology. “I’ve been in enough of these to know that it is not over until it is over.”

The Senate bill — S. 3795, the Access to Medicare Imaging Act — calls for a 2-year moratorium on medical imaging reimbursement cuts included in the Deficit Reduction Act of 2005 (DRA). The bill also requires a comprehensive Government Accountability Office (GAO) study to analyze the impact of the DRA payment methodology on patient access. Introduced on August 3, it is the companion bill to the House bill — H.R.5704, the Medical Imaging Act of 2006 — which was introduced on June 28. Should both bills make it out of committee, be voted on, and pass, they would then be combined into a House-Senate joint resolution, voted on again by both Houses, and sent to the president to be signed into law.

If this sounds like a lot, it is. No single-issue bill, like the DRA moratorium, is likely to survive such a process. To pass, a single-issue bill must typically be attached to a larger provision with more political clout behind it.

“Although we believe it is a huge issue, [the DRA cut to imaging] is not large enough to garner a stand-alone vote,” Cooper said.

Buddy, Can You Spare a Ride?

Unfortunately, medical imaging is not the only Medicare-funded service out there looking for help this year. There are many competing interests all clamoring for Medicare to correct past cuts and increase funding of their particular areas of service. Should a bill concerning Medicare come along before the end of the legislative session, all of these interests may try to have their provisions attached to the larger bill.

“In Washington, we call it ‘Christmas-treeing,’” Cooper explained, and added that because this is an extremely tight budget year, the Congressional leadership will be very opposed to the practice because tacking on provisions can quickly inflate the cost of legislation.

“The folks in charge of a Medicare bill are going to make it very clear to both sides of the aisle that there will be very few, if any extraneous provisions allowed,” he said.

Right now, the most likely vehicle to attach imaging’s provisions to is either some type of financial bill or a bill to fix the physician fee cut mandated by Medicare’s sustainable growth rate (SGR) provision. In past years, Congress has consistently passed such legislation because of concerns that Medicare patients’ access to physicians, which is already somewhat limited, will grow even worse if the SGR reduces physicians fees.

Legislators originally created the SGR provision to control the growth of Medicare, so when Congress has passed legislation preventing the SGR cut from going into effect, it has also had to reduce Medicare spending in other areas to prevent the Medicare program from becoming too expensive. Last year, the cut fell most heavily on diagnostic imaging, and this, Cooper said, gives strength to the argument that including a DRA moratorium with the SGR correction is not the same as including an extraneous provision. The two are, in fact, directly connected.

“It is very much an issue that should be included since, basically, our cuts were due to the fact that they needed money for the SGR fix,” Cooper said.

Helpful and Hurtful Competition

On July 24, Representative Michael Burgess (R-Tex) and three original co-sponsors introduced a bill (HR 5866) to, among other things, reform physician payment under the Medicare Program. It includes a provision to eliminate the SGR formula and tie physician payments to the Medicare economic index (MEI), a measure of the cost of providing physician services. However, at a July 25 hearing before members of the House Energy and Commerce Subcommittee on Health, Donald B. Marron, acting director of the Congressional Budget Office, warned that repealing the SGR system altogether and tying payment rates to medical inflation using the MEI (which forecast increases of 2% to 3%), would increase projected federal outlays by $218 billion over the next 10 years.

Even a