Washington’s Low-Hanging Fruit: Diagnostic Imaging

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In the world of Washington politics, health care and health care policy are high stakes and high profile. With today’s skyrocketing federal budget, and burgeoning deficit, the President and Congress are looking for savings.

Health care spending is considered a target-rich environment inside the Beltway. As Congress looks for places to slash Medicare spending, eyes are drawn to the lines on the spreadsheet with big dollars: they’re also looking at categories with high growth.

Diagnostic imaging is both a big number and rapid growth area making it an easy target. Needless to say, Congress noticed. It also recognized something else about diagnostic imaging; compared to physicians in general, hospitals, and the pharmaceutical industry, all of which are well entrenched on Capitol Hill, there are fewer perceived political consequences for taking on imaging.

All of these converging issues place diagnostic imaging in the crosshairs for cuts—big cuts—and, unfortunately, a likely perennial target. Proof of the situation facing imaging is the fact that several bills now in Congress hack imaging, even in light of the massive cuts that took effect January 1, 2007 with the Deficit Reduction Act of 2005 (DRA), legislation that reduced Medicare reimbursement for imaging by $8 billion dollars.

The latest cuts proposed in Congress include a $1.2 billion reduction for imaging in the House passed Children’s Health And Medicare Protection Act (CHAMP), a bill that failed to pass the Senate. Senate and House members were due to begin negotiations on Medicare during the week of December 10, 2007. The Association for Quality Imaging, formerly NCQDIS, and its members are working with the Senate Finance and House Ways and Means Committees to ensure that they take into account the devastating cuts made in the DRA earlier in the year and the potentially catastrophic impact of further reductions. It is the mission of AQI to help educate lawmakers on other methods to achieve savings, while also improving safety, quality, and appropriateness in medical imaging.

These kinds of attacks on diagnostic imaging come from a basic lack of understanding and appreciation for the true causes of growth for our services. The unfortunate result is legislation attempting to reduce spending and growth across-the-board, without considering the root causes of the growth to begin with. AQI is working to change this reality and is having some success in doing so. Just this year, AQI had more than 135 meetings with targeted congressional offices to discuss these issues. AQI also had two substantive meetings in 2007 with both the Medicare Payment Advisory Commission (MedPAC) and the Centers for Medicare and Medicaid Services (CMS).

It is no secret that diagnostic imaging has dramatically improved health care. Less understood are the reasons behind the increase in demand for imaging services, as well as the true cost drivers behind the exploding numbers observed by Congress and other health care policymakers. AQI represents more than 2,400 independent diagnostic imaging facilities and vendors across the United States. Our mission is to advocate for diagnostic imaging, educate policy and lawmakers on the value and importance of our members, and to lobby for our safe, quality, appropriate utilization agenda.

While AQI does not have the resources or the deep political pockets of the American Medical Association (AMA) or the American Hospital Association (AHA), it is earning a reputation as a tough health care trade organization with sound, sensible public policy positions. Given the fact that we are up against strong organizations in a political environment where everyone is competing for the same health care dollar, AQI understands that it cannot win with political muscle—ours is a more targeted, policy-centric approach.

The challenges facing imaging in 2007 are likely just a snapshot of the future. AQI enjoyed some important political victories over the past few months, but appreciates that winning battles does not equate to winning the war.

To realize long-term success, AQI must do more than win the policy debate; we must steal pages from larger health care lobbying organizations by bringing to bear the forces of a grassroots organization capable to ensuring that a particular member of Congress hears from constituents back home when considering legislation targeting imaging. AQI is growing and developing its grassroots network, a requirement in today’s