Washington Update: Physicians, 1, Imaging Centers, 0

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Physicians received yet another reprieve when the Senate's final act before adjourning was to pass a broad tax and trade bill, 79-to-9, that contained the hope-for fix of the scheduled 5.1 percent cut in physician reimbursement. However, the Access for Medical Imaging Coalition failed to obtain a moratorium on the cuts to imaging contained in the Deficit Reduction Act of 2005, and many of the stringent new supervision and performance standards for imaging centers contained in the Medicare Physician Fee Schedule stand as originally proposed despite the efforts of lobbyists for the National Coalition for Quality Diagnostic Imaging Services (NCQDIS). The bill that swept through the Senate at 2 AM Saturday morning was a combination of two bills passed the night before by the House: HR 6404, which contained some controversial trade measures, and HR 6111, which continued $38 billion in popular tax credits and forestalled, once again, the scheduled cut in physician reimbursement. The legislation maintains the current level of Medicare physician reimbursement and provides a 1.5 percent increase in reimbursements to physicians who agree to report data on quality-of-care measures recently specified by the American Medical Association (AMA). In order to fund the physician fee fix, $6.5 billion will be withdrawn from a stabilization fund that was established under the 2003 Medicare law to encourage health insurers to offer Medicare prescription drug plans in underserved areas. The bill also would reduce from 6 percent to 5.5 percent the maximum allowable rate at which states can tax Medicaid providers, which would decrease federal matching funds to states and help cover the cost of the physician fee fix. But even before the House passed its final legislation on Friday, the American College of Radiology conceded the fight to establish a moratorium on the imaging cuts contained in the Deficit Reduction Act (DRA) in a letter from Arl Van Moore, MD, chairman of the American College of Radiology board of chancellors, posted on its web site on Thursday, December 8. "Despite the best efforts and long hours of work by the ACR membership, leadership, and staff, and our Access to Medical Imaging Coalition (AMIC) colleagues, legislation to delay the implementation of the imaging cuts contained in the Deficit Reduction Act of 2005 (DRA) will not be passed by Congress prior to its adjournment." —Arl Van Moore, MD "Therefore," he wrote, "the cuts will become effective on January 1, 2007. "I am deeply disappointed that Congress was unable to delay this DRA policy that many Capitol Hill lawmakers readily admitted was enacted through a closed-door process without any thought to how this policy will affect patients' timely access to medical imaging services." He vowed that the ACR would continue the effort when Congress adjourns in 2007. New IDTF Supervision and Performance Standards Meanwhile, CMS also turned a deaf ear to the protestations of the NCQDIS, which lobbied on behalf of freestanding imaging center owners to modify what it considered the onerous oversight and performance standards (see list below) contained in the proposed fee schedule. In addressing NCQDIS members at its year-end meeting in Chicago late last month, NCQDIS lobbyist Benjamin Peletier, JD, Washington, DC-based law firm Arent Fox, explained that there are some marked differences in the agenda of NCQDIS and AMIC's so-called Big Tent alliance. "What is not in the Big Tent proposal is very interesting to take note of," Peletier said. "Specific proposals on imaging physician self referral, the MedPAC recommendations, most of which revolved around self-referral, IDTF standards requirements for all providers are all things that are not in the current working draft from the Big Tent because frankly you could not get a critical mass in support of any of these proposals." Peletier also emphasized that the imaging center sector and radiology in general has a continued fight on its hands. "Aside from the DRA discussions we are having, whether we solve it next week, whether we solve it next month or whether we don't solve it at all, the imaging center industry has a big target on its back and particularly IDTFs are singled out within the community," he said. "It is where the money is and whenever Congress is trying to save dollars they are going after people who have the money. There is still the prevailing view on the Hill that there is a real problem with utilization, over usage of imaging, so these are all leading to the fact that we are not done. No matter how the DRA works out, we've got a lot more to do and we've got to continue to work on the issues." NCQDIS provided its members with a summary of the standards contained in the final CMS rule, outlined below: 1. Supervising Physician. Physicians are limited to providing supervision to no more than three independent diagnostic testing facilities (IDTFs). Supervising physicians will be held responsible for the overall IDTF operations and administration, including the hiring of competent personnel and compliance with applicable regulations. NCQDIS notes: "This regulation constitutes a significant change because it expands a supervising physician's responsibilities to include oversight of the IDTF's business and administrative functions. This regulation essentially makes a supervising physician…the CEO of an IDTF." 2. Update Enrollment Information. Any change in IDTF operations as stated in its enrollment application must be reported within 30—previously 90—days. 3. Non-solicitation. An IDTF may not directly solicit patients, which includes a prohibition on telephone, computer, or in-person contacts. NCQDIS did ask for and received clarification that the standard did not imply a prohibition on advertising by IDTFs. "CMS did clarify that it is not attempting to prohibit public advertising such as television, radio, and direct mailing of its services to beneficiaries, physicians and other suppliers," Cherrill Farnsworth, NCQDIS president and CEO of HealthHelp, Houston, told members at the year-end meeting. 4. Liability Insurance. IDTFs are now required to carry comprehensive liability insurance policy of at least $300,000 that covers the place of business and all customers and employees. 5. Medical Record Storage. An IDTF must have "proper medical record storage" and be able to retrieve a record on request from CMS within two business days. CMS defined medical record to include the services provided by the IDTF to current and prior patients, but did not specify the length of time that the record must be kept on hand. 6. Unannounced Inspections. IDTFs must permit access to representatives of CMS on demand to conduct unannounced inspections to confirm compliance with standards. CMS advised IDTFs to devise standard operating procedures in the event of an inspection so as not to disrupt patent care. 7. Calibration of Testing Equipment. The new standard requires IDTFs to calibrate and maintain its testing equipment as per manufacturer suggested standards. NCQDIS also noted that although it supported the CMS proposal to implement changes to the reassignment rule and apply its anti-markup provision to all purchased services, CMS elected to not implement these changes at this time.